Disparities In Infant Mortality Research Articles

Systemic racism and Non-Hispanic Black to Non-Hispanic White disparities in infant mortality at the county level.

To use a novel measure of systemic racism to examine its relationship with Non-Hispanic Black (NHB) to Non-Hispanic White (NHW) racial disparities in infant mortality across U.S. counties. In this cross-sectional study, a composite, multi-dimensional measure of systemic racism at the county level was developed using confirmatory factor analysis based on indicators across five dimensions of systemic racism. Using linear regression analysis, we examined the relationship between the systemic racism factor scores and the NHB to NHW racial disparities in county-level infant mortality rates. Additionally, we performed a multi-level analysis of infant mortality, with births nested within counties by running a random intercept model that controlled for factors at both the individual and county levels to take into account the clustered nature of the data. There were 325 counties that met inclusion criteria for the county level analysis and 1181 counties for the individual level analysis. Each one standard deviation increase in the Systemic Racism Index was associated with an increase of 10.4% in the Non-Hispanic Black to Non-Hispanic White infant mortality rate ratio at the county level (aOR 1.104, 95% CI [1.061-1.148]). After controlling for individual level clinical factors and county level factors, each one standard deviation increase in the systemic racism index score was associated with a decrease of 3.5% in the NHW infant mortality rate (aOR 0.965, 95% CI [0.943-0.988]). Systemic racism is significantly associated with differences between counties in the magnitude of their Non-Hispanic Black to Non-Hispanic White racial disparities in infant mortality rates.

Mass Incarceration, Maternal Vulnerability, and Birth Outcomes Across U.S. Counties.

To examine the associations among mass incarceration, maternal vulnerability, and disparities in birth outcomes across U.S. counties, utilizing an ecological model and reproductive justice perspective was used. This study tests whether mass incarceration is associated with infant mortality and low birthweight across U.S. counties, and whether maternal vulnerability explains the relationship between mass incarceration and birth disparities. Data were derived from a variety of public sources and were merged using federal FIPS codes. Outcomes from the CDC Vitality Statistics include percent low birth weight births (births below 2499g divided by singleton births to women aged 20 to 39) and infant mortality (infant deaths per 1000 live births). Black-White rate ratios were calculated for the birth outcomes to specifically examine the large Black-White disparity in birth outcomes. The analysis controlled for urbanicity, income inequality, median household income, residential segregation, and southern region, as well as a fixed effect for state level differences. Findings show that counties with higher rates of incarceration have higher prevalence of infant mortality and low birthweight, as well as greater Black-White disparity in infant mortality. Mass incarceration is associated with increases in adverse birth outcomes and maternal vulnerability partially mediates this relationship. Findings provide evidence that heightened levels of incarceration affect birth outcomes for all residents at the county-level. It is imperative to address the overuse of mass incarceration in order to support adequate reproductive healthcare of vulnerable populations in the United States.

Decomposition analysis of disparities in infant mortality rates across 27 US states

Decomposition analysis of disparities in infant mortality rates across 27 US states

The influence of socioeconomic and demographic factors on rural-urban disparities in infant mortality in Kakamega Central Sub-County, Kakamega County, Kenya

Background: Infant mortality, measured as the summation of neonatal and post-neonatal mortalities, remain unacceptably high in Kakamega Central Sub-County, Kakamega County, Kenya. Reducing infant mortality is paramount not only in assessing the progress made towards the third sustainable development goal but also in creating a conducive environment for fertility reduction and in giving a chance to new-born babies to live out their social and economic potential in their families and societies at large. Objective: This study sought to establish the influence of socioeconomic and demographic factors on rural – urban disparities in infant mortality in Kakamega Central Sub - County, Kakamega County, Kenya. Methods: A cross-sectional research design was used. Systematic random sampling was employed to obtain a sample of 422 mothers within the reproductive age range of 15 to 49 years. Purposive sampling was used to arrive at key informants that were engaged in the study. Primary data were collected from December 2022 to January 2023 by administering pretested and validated questionnaires and interviewing key informants. Descriptive statistics and multinomial logistic regression analyses were conducted on the Statistical Package for Social Sciences computer software to estimate the prevalence of infant mortality and the odds ratio used as a measure of association at ρ<0.05. Results: Results of multivariate analysis indicated that there were higher likelihoods of rural neonatal (aOR = 1.913) and urban post-neonatal (aOR = 3.823) mortalities amongst mothers with no education qualifications. There were reduced likelihoods of rural post-neonatal (aOR = 0.105) and urban neonatal (aOR = 0.108) mortalities amongst mothers working in the professional, technical, managerial and clerical sectors. Both young (aOR = 1.579 for neonatal mortality) and old (aOR = 2.742 for infant mortality) ages at motherhood, and first births (aOR = 3.492 for infant mortality) and births of high orders (1.881 for neonatal mortality) were associated with increased likelihoods of mortalities in urban and rural areas, respectively. Urban mothers who observed a ≤ 24 months wait period prior to an index birth were more likely to report both post-neonatal (aOR = 3.294) and infant (aOR = 3.616) mortalities. Conclusions: The major contributors to the rural - urban disparities in infant mortality in Kakamega Central Sub-County were order of the index birth, which was significant only in rural areas, and wait period prior to the index birth, which was significant only in urban areas, after controlling for the confounding variables. It is important to advocate for childbearing during the middle reproductive ages and widen the wait period between successive births so as to improve the maturity of the mother and reduce parity, both of which correlate with low infant mortality. Future studies should be done on the relationship between marital status of the mother and infant mortality.

Measuring variation in infant mortality and deaths of despair by US congressional district in Pennsylvania: a methodological case study.

Many ecological studies examine health outcomes and disparities using administrative boundaries such as census tracts, counties, or states. These boundaries help us to understand the patterning of health by place, along with impacts of policies implemented at these levels. However, additional geopolitical units (units with both geographic and political meaning), such as congressional districts (CDs), present further opportunities to connect research with public policy. Here we provide a step-by-step guide on how to conduct disparities-focused analysis at the CD level. As an applied case study, we use geocoded vital statistics data from 2010-2015 to examine levels of and disparities in infant mortality and deaths of despair in the 19US CDs of Pennsylvania for the 111th-112th (2009-2012) Congresses and 18 CDs for the 113th-114th (2013-2016) Congresses. We also provide recommendations for extending CD-level analysis to other outcomes, states, and geopolitical boundaries, such as state legislative districts. Increased surveillance of health outcomes at the CD level can help prompt policy action and advocacy and, hopefully, reduce rates of and disparities in adverse health outcomes.

Medical Misadventures as Errors and Mistakes and Motor Vehicular Accidents in the Disproportionate Burden of Childhood Mortality among Blacks/African Americans in the United States: CDC Dataset, 1968-2015.

Racial disparities in infant mortality in the United States persist after adjustment for known confounders of race and mortality association, as well as heterogeneity assessment. Epidemiologic and clinical data continue to show the survival disadvantages of Black/AA children: when Black/AAs are compared to whites, they are three times as likely to die from all-cause mortality. The persistent inability to remove the variance in race-mortality association is partly due to unobserved, unmeasured, and residual confounding, as well as implicit biases in public health and clinical medicine in health equity transformation. This current epidemiologic-perspective explanatory model study aimed to examine the possible explanation of racial differences in U.S. infant mortality using medical misadventures as errors and mistakes, and infants' involvement in motor vehicular traffic accidents. Using CDC WONDER ecologic data from 1968 to 2015, we assessed the infant mortality-rate ratio and percent change associated with medical misadventures as well as motor vehicular accidents or trauma. The rate ratio and percent change were estimated using stratification analysis and trend homogeneity, respectively. There was a Black-white racial difference in medical misadventures during the study period. Relative to the years 1968-1978 (rate ratio [RR], 1.43), there was a steady increase in the mortality-rate ratio in 1979-1998 (52%, RR = 1.52), and mortality was more than two times as likely in 1999-2015 (RR = 2.37). However, with respect to motor vehicular accident/trauma mortality, the mortality ratio, although lower among Blacks in 1968-1978 (RR, 0.92), increased in 1979-1998 by 27% (RR = 1.27) but decreased in 1999-2015 (RR, 1.17), though there was still an excess of 17% mortality among Black/AAs. The percent change for medical misadventures indicated an increasing trend from 9.3% in 1998 to 52% in 2015. However, motor vehicular-related mortality indicated a positive trend in 1998 (38.5%) but a negative trend in 2015 (-8.4%). There were substantial race differentials or variances in infant mortality associated with medical misadventures compared to traffic accidents, and Black/AA children relative to whites experienced a survival disadvantage. These comparative findings are suggestive of medical misadventures and motor vehicular trauma as potential explanations for some of the persistent Black-white disparities in overall infant mortality in the U.S. From these findings, we recommend a national effort to address these issues, thus narrowing the observed disparities in the U.S. infant mortality burden among Black/AAs.

610 Environmental exposures and disparities in infant mortality: a positive deviance analysis

610 Environmental exposures and disparities in infant mortality: a positive deviance analysis

The Effects of Race, Ethnicity, and Maternal Education on Infant Mortality.

The state of New Jersey has a large Black/African American (AA) versus White racial disparity in infant mortality and educational level at childbirth. This disparity, measured by rate ratio, increases with greater maternal education among varied racial-ethnic groups. The nature of this disparity measured by rate differences has not been explored. Infant birth and mortality data were used to examine whether racial or ethnic disparities in infant mortality increased with greater maternal education, comparing rate differences and rate ratios. Racial and ethnic variations in the association between maternal education and infant mortality were examined. Data were from the New Jersey State Health Assessment Data for all New Jersey births between 2014 and 2018 stratified by race and ethnicity, maternal education, and infant mortality ( n = 481,333). R software was used to create a data set and estimate additive and multiplicative interactions, rate differences, and rate ratios for infant mortality by maternal race/ethnicity and educational levels among four racial-ethnic groups. Infant mortality was significantly greater for Black/AA and Hispanic mothers than for White mothers. At all educational levels, Black/AA mothers had the highest prevalence of infant mortality compared to other racial or ethnic groups. Rate differences in infant mortality showed a decrease in Black/AA-White differences for mothers with a high school education or less compared to mothers with a college degree. However, rate ratios showed an increase in Black/AA-White ratio with increasing education levels for mothers with high school education or less than mothers with a college degree. Risk ratios comparing infant mortality for Black/AA versus Hispanic or Asian mothers showed more than a twofold greater risk at all education levels for Black/AA infants. Finally, college-educated Black/AA mothers had significantly higher rates of infant mortality than White or Hispanic mothers with a high school education or less. Black/AA mothers with a college degree had a higher infant mortality rate than White, Hispanic, or Asian mothers with a high school education or less. Future research should address contextual/systemic contributors to this disparity.

Identifying regional disparities of infant mortality rates in Bangladesh: insights from nationwide cross-sectional studies and a statistical modelling approach using linear mixed effects model with temporal variability

ObjectiveThe major objective of this project is to find the best suitable model for district-wise infant mortality rate (IMR) data of Bangladesh over the period 2014–2020 that captures the regional...

Geographic heterogeneity in Black-white infant mortality disparities.

Despite recent decreases in Black infant mortality, racial disparities persist, motivating continued research into factors related to these inequalities. While the inverse association between education and infant mortality has been documented across races, less is known about its geographic heterogeneity. Using vital statistics from the National Center for Health Statistics, this study considers Black-white disparities in infant mortality for births occurring between 2011 and 2015 across regions and metropolitan status of maternal residence. With logistic regressions, we investigate heterogeneity in maternal educational gradients of infant mortality by geographic residence both within and between races. Beyond confirming the well-known relationship between education and infant mortality, our findings document a slight metropolitan advantage for infants born to white mothers as well as lower returns to education for infants born to Black mothers residing in nonmetropolitan counties. We observe a metropolitan advantage for infants born to Black mothers with at least a bachelor's degree, but a metropolitan disadvantage for infants born to Black mothers with less than a high school degree. The South is driving this divergence, pointing to particular mechanisms limiting returns to education for Southern Black mothers in nonmetropolitan areas. This paper's geographic perspective emphasizes that racial infant health disparities are not uniform across the country and cannot be fully understood through individual and household characteristics.

Disparities in infant mortality by maternal race and Hispanic origin, 2017-2018

Disparities in infant mortality by race and Hispanic origin groups continue to persist in the United States. Maternal and infant characteristics known to be associated with infant mortality vary by race and ethnicity. This report describes racial and ethnic disparities in infant mortality in the United States using the 2017-2018 cohort linked birth/infant death files from the National Vital Statistics System. Distributions of births and infant mortality rates are described by selected maternal and infant characteristics. Adjusted rates and rate ratios from logistic regression models, compared to unadjusted rates and ratios, show the extent to which race and Hispanic origin disparities would be attenuated if all groups had the same distributions of select maternal and infant factors. Results support the premise that the different distributions of several variables across racial/ethnic groups, most notably gestational age, account for a significant portion of the disparities in infant mortality between racial/ethnic groups.

Transitory inequalities: how individual-level cause-specific death data can unravel socioeconomic inequalities in infant mortality in Maastricht, the Netherlands, 1864–1955

ABSTRACT The decline in infant mortality played a crucial role in the health transition in the Western World. This decline among the vulnerable new-borns was however not an evenly dispersed process. Inequalities as a result of regional differences, cultural influences or socioeconomic status shaped the paths towards low mortality rates. The role of socioeconomic status in levels of infant mortality and its decline remain highly debated. In this article, we study the development of socioeconomic disparities in infant mortality in the Dutch town of Maastricht in the period 1864–1955. This study uses unique individual-level cause of death data in order to see when changes in disease patterns took place for different socioeconomic groups. The aim is to identify socioeconomic inequalities by mapping changing epidemiological patterns over time, according to age within the first year of life. By deploying a multinomial logistic regression analysis we can trace the different timing of changes in the epidemiological regime. The results reveal that for most infants the change in mortality patterns from water- and foodborne infectious diseases towards a predominance of airborne infectious diseases occurred simultaneously with the massive decline in infant mortality from the start of the First World War onwards. Infants from the upper classes, however, appeared to have gained an earlier advantage, followed by infants from unskilled workers. Finally, from qualitative data it becomes clear that the awareness of the problematic nature of infant mortality, knowledge on infant care, hygienic practices, breastfeeding practices and the economic situation of World War I were factors aiding to the uneven decline in infant mortality.

Geographical disparities in infant mortality in the rural areas of China: a descriptive study, 2010–2018

BackgroundThe infant mortality rate (IMR) is considered a basic measure of public health for countries around the world. The specific aim of our study was to provide an updated description of infant mortality rate among different regions in rural China, and assess the trends and causes of the IMR geographical disparities.MethodsData were collected from China’s Under-5 Child Mortality Surveillance System(U5CMSS). The annual number of deaths and causes of death were adjusted using a 3-year moving average underreporting rate based on annual national data quality control results. The average annual decline rate (AADR) and the relative risk (RR) of the IMR and cause-specific infant mortality were calculated by Poisson regression and the Cochran–Mantel–Haenszel method. Data analysis was completed by SAS software.ResultsThere was an apparent decrease in infant mortality in rural China from 2010 to 2018, at the AADR of 11.0% (95%CI 9.6–12.4), 11.2% (95%CI 10.3–12.1) and 6.6% (95%CI 6.0–7.3) in the eastern, central and western rural areas, respectively. The IMR was highest in the western rural area, followed by the central and eastern rural areas. Compared with the eastern rural area, the RR of infant mortality in the central rural area remained at 1.4–1.6 and increased from 2.4 (95%CI 2.3–2.6) in 2010–2012 to 3.1 (95% CI 2.9–3.4) in 2016–2018 in the western rural area. Pneumonia, preterm birth /LBW and birth asphyxia were the leading causes of infant deaths in the western rural area. Mortality rates of these three causes fell significantly in 2010–2018 but contributed to a higher proportion of deaths in the western rural area than in the central and western rural ares.ConclusionsOur study indicated that the infant mortality rate dropped significantly from 2010 to 2018, however, geographical disparities of IMR in rural China are still persist. Therefore, there is an urgent need for public health programmes and policy interventions for infants in western rural China.

Reconceptualizing Measures of Black–White Disparity in Infant Mortality in U.S. Counties

Reconceptualizing Measures of Black–White Disparity in Infant Mortality in U.S. Counties

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality.

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.

Abstract P141: Infant Mortality Risk In Hypertensive Disorders Of Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) increase the risk of infant and maternal morbidity and mortality, disproportionately affecting racial and ethnic minority groups. Less is known about disparities in infant mortality by mother’s HDP status. We assessed the relationships between HDP and pre-pregnancy hypertension and other pregnancy and delivery characteristics with infant mortality. Methods: This retrospective cohort study included 667,359 live, singleton deliveries (mother’s race/ethnicity: non-Hispanic White [NHW; 56.5%], non-Hispanic Black [NHB; 32.2%)], Hispanic [9.0%], other race/ethnicity [2.2%]) in South Carolina (2004-2016) to women aged 12-49 years. HDP (pre-eclampsia, eclampsia, gestational hypertension) and pre-pregnancy hypertension were defined by hospitalization/emergency department (ED) visit data or birth certificates. Infant mortality within one year (n=2,431) was defined by death certificates. Logistic regression models controlled for covariates. Results: Deliveries to women with pre-pregnancy hypertension with superimposed HDP (2.1%), HDP (16.9%), pre-pregnancy hypertension without superimposed HDP (0.3%), and neither condition (80.6%) were described. Infant mortality was increased for women with HDP with and without pre-pregnancy hypertension. Also associated with higher odds of infant mortality were NHB mothers, with high school education or less, Medicaid, higher pre-pregnancy BMI, no prenatal care, increasing number of prior pregnancies, prior Cesarean section, prior preterm birth, and women smoking during pregnancy; with the odds lower for increasing maternal age, Hispanic mothers, and female sex of baby. Discussion: The odds of infant mortality were increased 48% in women with HDP and 83% in women with both HDP and pre-pregnancy hypertension than women with neither condition after adjusting for pregnancy and delivery characteristics. Future studies are needed to identify social or other factors contributing to differences.

A Review of Racial Disparities in Infant Mortality in the US.

Racial disparities in infant mortality have persisted, despite the overall decline in the United States’ overall infant mortality rate (IMR). The overall IMR of the entire United States (5.58 per 1000 live births) population masks significant disparities by race and ethnicity: the non-Hispanic Black population experienced an IMR of 10.8 followed by people from Native Hawaiian or Other Pacific Islander populations at 9.4 and American Indians at 8.2. The non-Hispanic White and Asian populations in the United States have the lowest IMR at 4.6 and 3.6, respectively, as of 2018. A variety of factors that characterize minority populations, including experiences of racial discrimination, low income and education levels, poor residential environments, lack of medical insurance, and treatment at low-quality hospitals, demonstrate strong correlations with high infant mortality rates. Identifying, acknowledging, and addressing these disparities must be performed before engaging in strategies to mitigate them. Social determinants of health play a major role in health disparities, including in infant mortality. The study and implementation of programs to address neighborhood factors, education, healthcare access and quality, economic stability, and other personal and societal contexts will help us work towards a common goal of achieving health equity, regardless of racial/ethnic background.

Tackling Persistent and Large Disparities in Birth Outcomes in Allegheny County, Pennsylvania.

Based in Allegheny County, a coalition of local stakeholders took note of the region's infant mortality rates, particularly the stark disparities observed by race, and established a vision to reduce infant mortality in the region. The group undertook a multi-faceted effort to (1) develop predictive models of infant mortality risk; (2) evaluate the effectiveness of available interventions; and (3) combine these tools in order to tailor intervention referrals based on maternal risk profiles. With this effort, the coalition sought to address the apparent disconnect between the region's robust maternal and child health care system and relatively poor birth and infant outcomes and racial disparities. The effort started with the integration of data from a variety of sources into an integrated database built specifically for this research effort covering the period 2003 to 2013. With the database, researchers linked each individual's data across multiple data sources, including the Allegheny County Health Department, the University of Pittsburgh Medical Center, the Allegheny County Department of Human Services Data Warehouse, and individual programs. With these data, we used a standard method for comparing outcomes and measuring the racial disparity between Black and white infants that involved calculating a ratio by dividing the rate or percentage for Black infants by the rate or percentage for white infants. Overall, the results showed that between 2003 and 2013 in Allegheny County disparities were more pronounced for infant mortality (3.25) than low birthweight (1.88) or preterm birth (1.49). Among the different potential causes of infant mortality, the most pronounced disparity was for SIDS (1.78). Among maternal health factors, pre-pregnancy obesity and gestational diabetes had the highest infant mortality disparity. The low birthweight disparity was similar and lower than the infant mortality disparity across all of the maternal health factors, while the preterm birth disparity was even lower. For the maternal behavioral and contextual factors, the infant mortality disparity ranged from 1.5 to 2.3. The 11-year span of data reported in the IMPreSIv database and the breadth of intervention data included allowed us to report granular information on birth outcomes within Allegheny County over this time period. The database also allowed us to summarize the various factors associated with the range of birth outcomes and describe the participation rates in the medical and community setting interventions. Against this backdrop of pronounced disparities in birth outcomes across a range of factors, we examined the effectiveness of interventions for women with different risk factors (e.g. substance use disorders) in order to develop a tool to facilitate individualized referrals to the interventions that will help the most for a specific risk profile.

Co-establishing an infrastructure for routine data collection to address disparities in infant mortality: planning and implementation

BackgroundEfforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations.MethodsTaking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings.ResultsBy standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis.ConclusionWhile a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone.

Addressing Black Infant Mortality Through Harnessing the Power of Community.

In Hamilton County, Ohio, the infant mortality rate is above the national average and the Black infant mortality rate is more than 3 times the white infant mortality rate. These racial disparities in infant mortality cannot be explained through other socio-economic characteristics like education, income, housing, or medical insurance. Research has shown that racism, not race itself, is the driving force behind the high disparity in infant mortality rates in Hamilton County and the nation as well. The World Health Organization (WHO) and the Institute of Medicine have long cited institutional/structural racism and cultural racism as a key factor in health disparity. A paradigm shift needed to occur to address the consequences of racism within the lives of Black women, namely disempowerment and agency. The Commission on Social Determinants of Health (CSDH) model was which engaged Black women and positioned them as an asset, to share in the process of strategizing, creating, and implementing a plan. Queens Village was founded to implement the CSDH model and address the upstream determinants of infant mortality through cultivating a sense of community.