Social determinants of infant mortality amongst births to non-Hispanic Black women

Abstract

The infant mortality rate (IMR) among Non-Hispanic Black infants in the United States is almost double the national average. This study aims to identify differences in maternal social determinants between those who experienced infant mortality compared to those who lived beyond 12 months. Population-based case-control study using publicly available US birth-death records (2014—2017). Factors potentially associated with infant mortality and considered indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women with and without infant death, ≤ 12 months. Multivariate logistic regression, reported as odds ratios (95% confidence interval, CI), quantified the association between infant mortality and social determinants such as maternal age, education level, and amount of prenatal care. Of 2,219,025 live births to Non-Hispanic Black women in the US from 2014 - 2017, 22,696 experienced infant mortality (1.0%). Factors most strongly associated with infant mortality (P< 0.001), presented as odds ratio (95% CI), were no prenatal care 3.83 (3.66 – 4.01), smoking during pregnancy 1.68 (1.61 – 1.76), father of baby information not provided on birth certificate 1.66 (1.61 – 1.70), unmarried 1.35 (1.31- 1.40), Black paternal race 1.21 (1.14 – 1.29), maternal age < 18 years 1.20 (1.11 – 1.30), and did not complete high school 1.26 (1.21 – 1.30). Factors protective for infant mortality were higher education - bachelor’s degree or greater 0.65 (0.64-0.71), WIC use 0.69 (0.67 - 0.71), and maternal age 18 – 34 years 0.94 (0.91 – 0.97). Social determinants that could increase the risk for infant mortality amongst Non-Hispanic Black infants are no prenatal care, smoking, lack of father listed on the birth certificate, unmarried, maternal age under 18, Black paternal race and no high school diploma. Addressing these indicators of social determinants of health that contribute to infant mortality can impact the disparity in IMR among Non-Hispanic Black infants.View Large Image Figure ViewerDownload Hi-res image Download (PPT)