Abstract
BackgroundYoung maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study.MethodsWe conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997–1999. Infant mortality rates for all singleton births to adolescent women (12–17 years, n = 10,131; 18–19 years, n = 18,954) were compared to those for older women (20–35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations.ResultsThe risk of infant (OR 1.95, CI 1.54–2.48), neonatal (1.69, 1.24–2.31) and post-neonatal mortality (2.47, 1.70–3.59) were significantly higher for younger adolescent (12–17 years) than older (20–34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14–2.64) but not neonatal mortality (1.43, 0.98–2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18–19 years) mothers.ConclusionSocioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.
Highlights
Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial
We examined linked birth-death certificate data for Missouri residents to assess the role of poverty status and other potential risk factors on infant mortality among teenage mothers
A comparison population included a random sample of singleton live births for mothers who were 20–34 years old during 1997–1999, since the infant mortality rates were relatively stable for this age group but higher for older mothers
Summary
Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. The etiology explaining the higher mortality risk for adolescent mothers has been debated for as long as the phenomenon has been observed. In a large study spanning 20 years of live births from Utah, found maternal age to be an independent predictor for poor birth outcomes, but this study did not address infant mortality or socioeconomic status directly [11]. Minority status, suboptimal prenatal care, poor education and unmarried status are more common in teenage compared to older mothers, and are known risk factors for low birth weight, preterm birth and higher infant mortality in the United States [11]. Support can be found to defend or refute all or none of these factors as independent risk factors [6,7,11,14,15,16]
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