Differences in infant mortality by race, nativity status, and other maternal characteristics
J. C. Kleinman, L. A. Fingerhut and K. Prager
Division of Analysis, National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md 20782.
The objective of this study was to examine the effects of nativity status
(native vs foreign born) and other maternal characteristics (age, parity,
education, and marital status) on infant, neonatal, and postneonatal
mortality among white and black mothers. The design of this nonrandomized
cohort study was based on birth and death certificates. The setting
involved live births among US residents (excluding California, Texas, and
Washington) in 1983 and 1984. The participants included white mothers with
4.4 million births and black mothers with 926,000 births in single
deliveries. There were no interventions. With regard to measurements (the
main results), after adjusting for other risk factors, neonatal mortality
risk was 22% lower among the black foreign-born mothers than among the
black native-born mothers, while among white infants, there was no risk
difference by nativity. Relative risks were more similar for postneonatal
mortality, ie, 24% lower among black foreign-born mothers and 20% lower
among white foreign-born mothers. Combining the several categories of risk
factors into three broad maternal risk groups, there was a near-doubling of
black and near-tripling of white infant mortality rates between the low and
high levels of maternal risk. We concluded that if the infant mortality
rate in the low-risk groups could be achieved by the moderate- and
high-risk groups, there would be a 30% reduction in infant deaths within
each race. Since the black infant mortality rate is twice the white infant
mortality rate and black foreign-born mothers have much lower rates than
black native-born mothers, it is likely that further improvement is
possible among black infants.
