236646 Traditional risk factors underlie the racial disparity in infant mortality rates (365d, IMR) among term (37-42 wks) births: A population-based study

Wednesday, November 2, 2011: 9:05 AM

Gayle Soskolne, MD , Pediatric Critical Care, University of California San Francisco, San Francisco, CA
Amanda Bennett, MPH , Division of Epidemiology & Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL
Kristin M. Rankin, PhD , School of Public Health, University of Illinois at Chicago, Chicago, IL
James W. Collins, MD, MPH , Northwestern University, Children's Memorial Hospital, Chicago, IL
Background: The breadth of the racial disparity in IMR among term infants is incompletely understood. Objective: To determine whether known risk factors explain the racial disparity in IMR (including its neonatal and post-neonatal components) among term infants. Methods: Stratified and multivariable binomial regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files. Only term African-American and non-Latino White infants with U.S.-born mothers were studied. Maternal variables examined included age, education, marital status, parity, prenatal care utilization, and region of birth. Results: The IMR of term African-American infants (N=782,452) exceeded that of term White infants (N=3,684,569): 4.1/1,000 vs. 2.4/1,000 respectively; RR=1.7 (1.7-1.8). In both races, congenital anomalies were the leading cause of infant death. African-American infants had a greater percentage of mothers with high-risk characteristics than White infants (p<0.01). However, the racial disparity in IMR abated among infants (N=271,350) born to married, college-graduated mothers who received adequate prenatal care. In multivariable binomial regression models, the adjusted RR of infant, neonatal (< 28d), and post-neonatal mortality (28-365d) for term African-American (compared to White) infants were 1.1 (1.1-1.2), 1.0 (1.0-1.1), and 1.1 (1.0-1.2), respectively. Conclusions: In the US, term African-American infants have a first year survival disadvantage compared to term non-Latino White infants. Most striking, well known maternal risk factors are the major determinant of this phenomenon. These findings highlight a component of the racial disparity in overall IMR directly amenable to basic public health intervention strategies.

Learning Areas:
Public health or related research

Learning Objectives:
Discuss the relationship between traditional risk factors and the racial disparity in first year mortality rates among term infants Describe the breadth of the racial disparity in first year mortality rates among term infants

Keywords: Infant Mortality, African American

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I participated in the design of the study and assisted with the interpretation of the results
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.