Community-level characteristics of high infant mortality: A tool to identify at-risk communities

Background: Infant mortality rate (IMR) is a key indicator of population health and has been gradually improving in the United States. However, it is still a public health problem among minority and low-income communities. Maternal factors explain some of the variation, but community-level factors may also be a contributor. This study examines measures to identify a set of indicators that explain variations in IMR at the community-level.

Methods: Data for 77 communities in a city were obtained from local health databases. We used multiple multivariable linear regression models to examine the strength of the association between IMRs and maternal, population, community wealth, and social capital characteristics.

Results: Community-level IMRs ranged from 2.1 – 25.6 deaths per 1,000 live births in 2000-2002. The final model explained 75% of the variation in IMR at the community-level (R²=0.75). The model included a high percentage of low birth weight babies, a decline in mothers who began prenatal care in the second trimester, an increase in the percentage of Hispanics, increased unemployment rates, an increase in the percentage of veterans, an increased rate of foreign-born residents, and smaller average family sizes. Social capital variables, homicide rate and vacant housing, were also significant in the final model.

Conclusion: Identifying communities at risk for high IMRs is imperative to improve maternal and child health outcomes because of shortages in public health resources. The development of a parsimonious set of community-level indicators can assist public health practitioners in targeting their resources to prevent infant mortality in high-risk communities.