Reasons for Infant Mortality Racial Gap Remain Unclear

Linda Roach

December 26, 2013

Rates of infant mortality remained higher for blacks than for whites in the United States during a recent 20-year period, apparently for reasons other than the well-characterized demographic and prenatal risk factors that have long been blamed for this racial gap, report Todd Elder, PhD, from the Department of Economics, Michigan State University, East Lansing, and colleagues.

Their findings were published online December 19 in the American Journal of Public Health.

"What's surprising about our findings is that when we take out all the factors we can observe — including mother's age, education level, marital status and state of residence — the difference in the rate in which black and white infants die remained absolutely stable for two decades. We made no progress in shrinking that part of the gap," noted coauthor Steven Haider, PhD, professor of economics, Department of Economics, Michigan State University, in a university press release.

Dr. Elder and colleagues analyzed 1983-2004 data from the National Center for Health Statistics' Linked Birth/Infant Death Cohort Files for their study.

The researchers found that in absolute numbers, these records on more than 50 million births showed that the overall infant mortality rate gap between the races declined by 2.6 deaths per 100,000 live births during the 20-year period.

Deaths within the first year of life numbered 18.62 per 100,000 live births among blacks in 1983 compared with 12.26 per 100,000 in 2004. The rate of white infant deaths dropped from 9.00 per 100,000 to 5.29 per 100,000 in the same period.

However, by using inverse probability weighting methods (with bootstrapped standard errors to compute 2-tailed t tests), the authors determined that about 74% of the black–white infant mortality gap was unaccounted for by differences in known risk factors. The influence of the unknown factors was most pronounced for infants weighing less than 1000 g at birth, the authors conclude.

They did not attempt to identify the unknown risk factors, but had this recommendation for future research: "[L]ook to risk factors that are distinct from those commonly derived from birth certificate data and that influence the share of births below 1000g."

Am J Public Health. Published online December 19, 2013. Abstract

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