Changing Race/Ethnic Disparities in Infant Mortality

描述(申请人提供)：过去二十年的特点是美国婴儿死亡模式的结构发生了巨大变化，围产期护理方面的重大进展发生在社会不平等的持续背景下。尽管所有种族/族裔的婴儿总死亡率都出现了大幅度的绝对下降，但由于占多数的非西班牙裔白人与种族/族裔少数群体(特别是黑人)在婴儿死亡风险方面的相对差距持续存在，而且在许多情况下，这种差距不断扩大，人们日益感到关切。尽管解释婴儿死亡率中黑人和白人之间日益扩大的相对差异确实是一个关键问题，并在拟议的研究中详细阐述了这一问题，但我们认为，面临的挑战甚至更广泛。例如，我们的 初步研究表明，在高危婴儿中，婴儿死亡率的绝对水平下降 实际上黑人的比例要小于白人的比例。此外，无论是增加、下降还是相对 停滞是婴儿死亡率变化的特征，预计这种变化会因具体的死因和种族/族裔而有所不同。需要分析模型差异(包括相对差异和绝对差异)以及这些差异随时间的变化，分析各种种族/族裔群体的特定原因婴儿死亡率，同时考虑到母亲的出生情况，并区分低体重儿和正常体重儿。这类模型需要在数据允许的范围内包含尽可能广泛的风险因素。这类分析构成了我们的总体目标，并根据五个具体目标加以阐述。这项拟议的研究包括所有主要的种族/少数民族，重点是美国婴儿死亡的五大原因。数据来自国家卫生统计中心，目前从20世纪80年代初到2000年的大多数年份都有出生/婴儿死亡队列文件。这些数据所涵盖的时间间隔包括上文提到的婴儿死亡率结构的许多重大变化，并允许在婴儿死亡率结构发生重大变化的一段时间内对特定原因死亡率的多数/多数差异进行建模。

DESCRIPTION (provided by applicant): The past two decades have been characterized by tremendous changes in the structure of infant mortality patterns in the United States, as major advances in perinatal care have occurred in a continuing context of social inequality. Although substantial absolute declines in the overall infant mortality rate (IMR) have occurred across all racial/ethnic groups, there has been a growing concern because of continued and, in many cases, rising relative disparities in the risk of infant death between the non-Hispanic white majority and race/ethnic minorities (particularly blacks). Although accounting for the rising black-white relative disparity in infant mortality is indeed a crucial issue, and is addressed in detail in the proposed research, we would argue that the challenge faced is even more extensive. For example, our preliminary studies show that, among high-risk infants, the decline in absolute levels of infant mortality has actually been smaller for blacks than for whites. Further, whether increases, declines, or relative stasis characterizes changes in infant mortality, such changes can be expected to vary by specific cause of death and by race/ethnicity. Analyses are needed that model differentials (both relative and absolute) and changes over time in those differentials, in cause-specific infant mortality across a wide range of racial/ethnic groups, taking maternal nativity into account, and distinguishing infants born at low weights as well as those born at normal weights. Such models need to include as wide a range of risk factors as the data allow. An analysis of this sort constitutes our general objective that is elaborated in terms of five specific aims. The proposed study includes all major racial/ethnic minorities and focuses on the five leading causes of infant death in the United States. Data come from the National Center for Health Statistics linked birth/infant death cohort files currently available for most years from the early 1980s to 2000. The time interval covered by these data encompasses many of the dramatic changes in the structure of infant mortality referred to above and allows for the modeling of majority/majority differences in cause-specific mortality across a time period of substantial change in the structure of infant mortality.