Changing Race/Ethnic Disparities in Infant Mortality

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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.