9 - Social and Economic Contributors to Neonatal Outcome in the United States

Abstract

While there have been significant improvements in neonatal and infant mortality in the United States over the past 50 years, compared to other high income countries, the United States lags behind in infant mortality rates. Infant mortality and morbidity rates are commonly used as important indicators worldwide of overall population health. One major factor contributing to these poor perinatal and infant outcomes in the United States is the significant health disparities seen among women and infants related to race and ethnicity. Other disparities in health outcomes in the perinatal period in the United States are related to poverty, lack of health care access, and other overall indicators of poor socioeconomic status. In the United States, non-Hispanic black infants have the highest rates of infant mortality and prematurity compared to other races and ethnic groups. Non-Hispanic black mothers also have extremely high rates of maternal mortality and morbidity, as well as obesity, leading to other poor outcomes. Native American/Alaska Natives also suffer from a disproportionate share of infant mortality and prematurity as well as higher rates of sudden unexpected death of infancy. Hispanic mothers also suffer from adverse outcomes such as obesity, yet seem somewhat protected from other neonatal adverse outcomes. In the United States, optimal social determinants of health that are lacking in minority races and ethnicities play a major role in the poor outcomes seen in the perinatal and neonatal period suffered by these groups. Specific interventions targeting racial and ethnic disparities in neonatal mortalities and morbidities will be needed to improve current US perinatal and neonatal outcomes.