Black and white rates of low birth weight, preterm birth, and infant mortality by state and county: A mid-decade evaluation of progress toward Healthy People 2010 objectives and the goal of disparity elimination

Background: Characterizing states/counties meeting Healthy People (HP) 2010 targets for perinatal outcomes by mid-decade helps to assess feasibility and identify best practices for optimizing outcomes.

Methods: Using 2004-2006 national linked birth/infant death files and Bayesian models that smooth unstable estimates, we evaluated state/county performance relative to HP 2010 targets for low birth weight (LBW, <2500 grams, target 5%), preterm birth (PTB, <37 weeks, target 7.6%), and infant mortality (IM, target 4.5/1000 births) for non-Hispanic Black and White births and assessed progress towards eliminating disparities.

Results: For IM among Whites only, Massachusetts significantly surpassed the HP target and 11 other mostly Northeastern and Western states had rates similar to the target. No other targets were achieved by states. Of 2,623 counties with Black births, none met LBW or PTB targets but one (Dane County, WI) had an IM rate that was similar to the target. Of 3,140 counties with White births, ~30 predominantly rural and Western counties had LBW or PTB rates similar to the targets. For IM, 28 counties (mostly Northeast metropolitans) did significantly better and 930 had rates similar to the HP target. In general, the few observations of low disparities (RR<1.25) were due to high white rates.

Conclusions: States and counties were more successful in meeting the IM target than for LBW and PTB, and only for Whites. Even where Black IM was lowest, it was 50% higher than for Whites. We plan to further explore these data including an evaluation of PTB subgroups (very and moderate PTB).