Black-White Infant Mortality Gap Research Articles

Water purification efforts and the black‐white infant mortality gap, 1906–1938

According to Troesken (2004), efforts to purify municipal water supplies at the turn of the 20th century dramatically improved the relative health of Blacks. There is, however, little empirical evidence to support the Troesken hypothesis. Using city-level data published by the U.S. Bureau of the Census for the period 1906–1938, we explore the relationship between water purification efforts and the Black-White infant mortality gap. Our results suggest that, while water filtration was effective across the board, adding chlorine to the water supply reduced mortality only among Black infants. Specifically, chlorination is associated with a 9 percent reduction in Black infant mortality and a 10 percent reduction in the Black-White infant mortality gap. We also find that chlorination led to a substantial reduction in the Black-White diarrhea mortality gap among children under the age of two, although this estimate is measured with less precision.

The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap

In 1966, Southern hospitals were barred from participating in Medicare unless they discontinued their long-standing practice of racial segregation. Using data from five Deep South states and exploiting county-level variation in Medicare certification dates, we find that gaining access to an ostensibly integrated hospital had no effect on the Black-White infant mortality gap, although it may have discouraged small numbers of Black mothers from giving birth at home attended by a midwife. These results are consistent with descriptions of the federal hospital desegregation campaign as producing only cosmetic changes and illustrate the limits of anti-discrimination policies imposed upon reluctant actors.

The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap

In 1966, Southern hospitals were barred from participating in Medicare unless they discontinued their long-standing practice of racial segregation. Using data from five Deep South states and exploiting county-level variation in Medicare certification dates, we find that gaining access to an ostensibly integrated hospital had no effect on the Black-White infant mortality gap. Similarly, there is little evidence that the federal hospital desegregation campaign contributed to the trend towards in-hospital births among Southern Black mothers. These results are consistent with descriptions of the campaign as producing only cosmetic changes and illustrate the limits of anti-discrimination policies imposed upon reluctant actors.

Water Purification Efforts and the Black-White Infant Mortality Gap, 1906-1938

According to Troesken (2004), efforts to purify municipal water supplies at the turn of the 20th century dramatically improved the relative health of blacks. There is, however, little empirical evidence to support the Troesken hypothesis. Using city-level data published by the U.S. Bureau of the Census for the period 1906-1938, we explore the relationship between water purification efforts and the black-white infant mortality gap. Our results suggest that, while water filtration was effective across the board, adding chlorine to the water supply reduced mortality only among black infants. Specifically, chlorination is associated with an 11 percent reduction in black infant mortality and a 13 percent reduction in the black-white infant mortality gap. We also find that chlorination led to a substantial reduction in the black-white diarrhea mortality gap among children under the age of 2, although this estimate is measured with less precision.

The changing character of the Black-White infant mortality gap, 1983-2004.

We examined how changes in demographic, geographic, and childbearing risk factors were related to changes in the Black-White infant mortality rate (IMR) gap over 2 decades. Using 1983-2004 Vital Statistics, we applied inverse probability weighting methods to examine the relationship between risk factors and 3 outcomes: the overall IMR gap, its birth weight component, and its conditional (on birth weight) IMR component. The unexplained IMR gap (the part not related to observed risk factors) was stable, changing from 5.0 to 5.3 deaths per 1000 live births. By contrast, the explained gap declined from 4.6 to 1.9. The decline in the explained gap was driven by the changing relationship between risk factors and IMR. Further analysis revealed that most of the unexplained gap occurred among infants weighing less than 1000 grams at birth, whereas most of the explained gap occurred among infants weighing more than 1000 grams. The unexplained gap was stable over the last 2 decades, but the explained gap declined markedly. If the stability of the unexplained gap continues, even complete convergence of risk factors would reduce the Black-White IMR gap by only one quarter.

Racial Disparities in US Infant Birth Outcomes: A Protective Effect of Military Affiliation?

Research has been unable to determine why African Americans have higher infant mortality and preterm birth prevalence than whites, even taking into account measurable social and economic differences. This is, in part, due to the difficulty of adequately measuring the impacts of racial inequality and residential segregation. As an alternative approach, this paper comparatively examines infant outcomes among military-affiliated and civilian black and white women. The military setting provides higher-than-average economic equality and universal healthcare access. Although military-affiliated populations are usually left out of most major datasets, we construct a new variable that allows us to identify military affiliation using the CDC’s PRAMS survey data. Multinomial logistic regression analyses show that there is a negative association between adverse birth outcomes and military affiliation for both white and black women. Thus, the black-white infant mortality gap persists in the military even though black affiliates experience significant improvement in outcomes relative to their same-race civilian counterparts. Nevertheless, the black-white disparity among military-affiliated women is somewhat lessened compared to the black-white civilian disparity.

A Deadly Disparity: A Unified Assessment of the Black-White Infant Mortality Gap

Abstract We provide a unified assessment of a striking disparity in the United States: the differential rate at which white and black infants die. We separate the overall mortality gap into three temporal components—fitness at birth, conditional neonatal mortality, and conditional post-neonatal mortality—and quantify the extent to which each of the components can be predicted using a flexible reweighting method. Almost 90 percent of the overall mortality gap is due to differential fitness at birth, little of which can be predicted by racial differences in background characteristics. The remaining mortality gap stems from conditional post-neonatal mortality differences, nearly all of which can be predicted by background characteristics. The predictability of the mortality gap has declined substantially over the past two decades, largely because the mortality gap among extremely low-fitness infants is increasingly unrelated to background characteristics.

Community-Academic Partnerships to Reduce Black-White Disparities in Infant Mortality in Florida

In Florida, data reveal a widening black-white disparity in infant mortality to the disadvantage of black families. Eight Florida counties have a significantly pronounced black-white infant mortality gap: Broward, Duval, Gadsden, Hillsborough, Miami-Dade, Orange, Palm Beach, and Putnam. The black Infant Health Community Collaborative (BIHCC) was established to address the rising racial/ethnic disparities in infant mortality. The program used a community-based participatory research (CBPR) approach to enable communities to develop sustainable initiatives to improve community health and reduce infant mortality. Grounded in CBPR principles, a community-academic-state partnership was created to address the upsurge in black-white disparity in infant mortality. Community teams from each participating county underwent a 2-year period of capacity building. The culmination of this process was community-driven action plans to alleviate infant health disparities. The BIHCC provides a replicable model for the development of community-academic-state partnerships to enhance capacity for improving infant health outcomes.

A Deadly Disparity: A Comprehensive Assessment of the Black-White Infant Mortality Gap

We provide a comprehensive assessment of a striking disparity in the United States: The differential rate at which white and black infants die. We separate the overall mortality gap into three temporal components - fitness at birth, neonatal mortality, and post-neonatal mortality - and quantify the extent to which each of the components can be explained using a flexible reweighting method. Roughly 90 percent of the overall mortality gap is due to differential fitness at birth, little of which can be explained by racial differences in background characteristics. The remaining mortality gap stems from post-neonatal mortality differences, nearly all of which can be explained by background characteristics. The amount of the mortality gap that can be explained by background characteristics has declined sharply over the past two decades, largely due to background characteristics explaining less of the racial disparity in extremely low-fitness births.

The contribution of preterm birth to the Black-White infant mortality gap, 1990 and 2000.

We evaluated whether the decline of the racial disparity in preterm birth during the last decade was commensurate with a decline in the contribution of preterm birth to the infant mortality gap. We used linked files of 1990 and 2000 data on US infant births and deaths to partition the gap between Black and White infant mortality rates into differences in the (1) distribution of gestational age and (2) gestational age-specific mortality rates. Between 1990 and 2000, the Black-White infant mortality rate ratio did not change significantly (2.3 vs 2.4). Excess deaths among preterm Black infants accounted for nearly 80% of the Black-White infant mortality gap in both 1990 and 2000. The narrowing racial disparity in the preterm birth rate was counterbalanced by greater mortality reductions in White than in Black preterm infants. Extremely preterm birth (<28 weeks) was 4 times higher in Black infants and accounted for more than half of the infant mortality gap. Substantial reductions in the Black-White infant mortality gap will require improved prevention of extremely preterm birth among Black infants.

Changes in the black-white infant mortality gap from 1983 to 1991 in the United States

Background: The long-standing difference in infant mortality in the United States between black and white infants has increased in recent years. To help identify the cause, we evaluated changes in birthweight distributions (BDs) and birthweight-specific mortality rates (BSMRs) among black and white infants born in the United States between 1983 and 1991. Methods: Using national linked birth and death certificate data, we limited analyses to singleton births that occurred in the United States to resident, non-Hispanic black and white women. Birthweight data were analyzed in 500 g increments. The black-white gap was partitioned into deaths due to differences in BDs and BSMRs. Results: The black-white infant mortality rate ratio increased from 2.1 in 1983 to 2.4 in 1991. Decreases in BSMRs among infants weighing from 500 to 2499 g occurred in both groups but were smaller among black than white infants; consequently, the percentage of excess deaths to black infants due to differences in BSMRs almost doubled during the study period, from 6.5% to 11.9%. Rates of very low birthweight (VLBW, <1,500 g) increased for black infants, but the BD for white infants changed little. Although about 90% of the excess deaths to black infants resulted from differences in BDs, the changes in BDs had a minimal effect on the widening infant mortality gap. Conclusions: A significant reduction in the black-white infant mortality gap will require a reduction in VLBW and low birthweight (LBW, <2,500 g). To keep the gap from growing, we must also investigate why decreases in BSMRs were smaller among black than white infants between 1983 and 1991.

Impact of Very Low Birthweight on the Black-White Infant Mortality Gap

In recent years, the rate of decline for the black infant mortality risk (IMR) has been slower than that for whites. The resultant widening in the black-white infant mortality gap has been accompanied by an increased percentage of very low birthweight (VLBW) infants (227 g-1,499 g) among black live births. Restricting our analysis to non-Hispanic black and white single live births, we used the 1983 national linked birth-death file to assess the relative contribution of VLBW infants to the black-white gap in IMR. VLBW occurred among 2.3% of all black live births and among 0.8% of all white live births. Deaths among VLBW infants accounted for 62.5% of the black-white gap in IMR. Although VLBW newborns represent a fraction of all live births in the United States, they account for almost two-thirds of the black-white gap in IMR. Since preterm delivery is associated with most VLBW infant deaths, our findings indicate the crucial need to identify strategies that reduce preterm births, among blacks in particular, to reduce significantly the infant mortality gap in the United States.