Associations between Medical Risk Factors and 2007-2009 Infant Mortality among White and Black Singletons in the United States

Introduction: The agenda to reduce disparities has primarily been set on national and state levels and is based on national and state level data.These levels may be different from the individual level where health outcomes are realized or the community level where interventions are implemented; this disconnect may be a contributing factor in the slow progress made in reducing disparities. The federal Healthy People initiative lists infant mortality disparities reduction as a priority area.

Methods: Birth outcomes and information on infant, maternal, and medical risk factors by county is extracted from 2007-2009 period linked birth/infant death CDC datasets and merged with the 2008 American Community Survey data by County. Multilevel logistic regression is used to quantify county-level variations in infant mortality. Fixed-effects logistic regression and survival analysis further examine contributing factors to racial disparities in infant mortality.

Results: Preliminary analysis showed racial disparities in some risk factors; non-Hispanic Black singletons born at advanced maternal age were associated with lower risk of infant mortality while the results weren't significant for non-Hispanic White singletons. Among 199 counties (population≥ 250,000) used in the analysis, Baltimore County, MD had the highest 3-year infant mortality rate (1.006%). Pairwise correlation analysis showed that county-level infant mortality rates were significantly associated with White/Black population ratio (¦Ñ=-0.588).

Discussion: It's necessary to understand the contribution of risk factors. Identifying counties with the greatest difference in infant mortality rates allows for targeted interventions to the areas in most need.