Secular trends in black:White disparities for US neonatal mortality from 1917 to 2005

Using data from the Millenial Edition of the Historical Statistics of the United States and the public CDC Wonder site, we described black:white disparity in neonatal mortality from 1917 to 2005. By inspection, three distinct periods are evident: (a) 1917-1947 mean (plus or minus standard deviation (s.d.)) for the black:white neonatal mortality rate ratio=1.39 (0.05); (b) 1948-1972=1.59 (0.09); and (c) 1973-2005=(2.20 (0.27)). The second two periods are marked by initial increases in black:white neonatal mortality rate ratios which are then maintained. Specifically, the second period shows an increase from 1.38 in 1948 to 1.67 in 1958; then, from 1958 to 1972 the mean (plus or minus s.d.) is 1.64 (0.03). The third period shows an increase from 1.64 in 1973 to 2.49 in 1992; then, from 1993 to 2005, the mean (plus or minus s.d.) is 2.42 (0.05). The data are consistent with the hypothesis that increased black:white disparities in neonatal mortality from 1917 to 2005 were influenced, in part, by events occurring between 1948-1958 and 1973-1992. Infant and neonatal mortality during the former period are associated with improvement rather than decline in the relative socio-economic status of African Americans. Further, both 1948-1958 and 1973-1992 are associated with major improvements in the delivery of hospital based newborn care, the former through post-World War II (Hill-Burton) hospital construction (with Southern blacks being largely excluded by segregation), as well as the advent of exchange transfusion in 1946, and the latter through development of neonatal intensive care units and regionalization of neonatal care.