Changing Race/Ethnic Disparities in Infant Mortality

描述（由申请人提供）：在过去的二十年中，美国婴儿死亡率模式的结构发生了巨大变化，因为在社会不平等的持续背景下，围产期护理取得了重大进展。尽管所有种族/族裔群体的总体婴儿死亡率（IMR）都出现了大幅绝对下降，但由于非西班牙裔白色多数群体和种族/族裔少数群体（特别是黑人）之间婴儿死亡风险的相对差异持续存在，而且在许多情况下不断上升，因此人们越来越关注这一问题。尽管解释婴儿死亡率中不断上升的黑人-白人相对差距确实是一个关键问题，并且在拟议的研究中详细讨论了这一问题，但我们认为面临的挑战更为广泛。比如我们 初步研究表明，在高危婴儿中， 实际上黑人比白人要少此外，无论是增加、减少还是相对减少， 停滞是婴儿死亡率变化的特征，这种变化预计会因具体的死亡原因和种族/族裔而异。需要进行分析，以模拟各种种族/族裔群体中按具体原因分列的婴儿死亡率的差异（相对和绝对差异）及其随时间的变化，同时考虑到产妇出生情况，并区分出生体重低的婴儿和出生体重正常的婴儿。这些模型需要在数据允许的范围内包括尽可能广泛的风险因素。这类分析构成了我们的总体目标，并以五个具体目标加以阐述。这项拟议中的研究包括所有主要的种族/少数民族，并侧重于美国婴儿死亡的五个主要原因。数据来自国家卫生统计中心的出生/婴儿死亡队列文件，这些文件目前可用于20世纪80年代初至2000年的大多数年份。这些数据所涵盖的时间间隔涵盖了上文提到的婴儿死亡率结构的许多重大变化，因此可以对婴儿死亡率结构发生重大变化的整个时期内按具体原因分列的多数/多数死亡率差异进行建模。

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.