Relationship of education to the racial gap in neonatal and postneonatal mortality
R. Din-Dzietham and I. Hertz-Picciotto
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, USA.
OBJECTIVE: To examine the impact of education on race differences in
neonatal and postneonatal mortality. METHODS: Data were from North
Carolina's Linked Birth and Infant Death File for 1988 through 1993. The
study population included 169,601 African American births and 400,359
European American births, with 2606 and 3060 deaths, respectively. Multiple
logistic regression was used to assess the effects of race and education on
neonatal and postneonatal mortality, adjusting for sociodemographic,
lifestyle, and medical risk factors. RESULTS: Risks of death were higher
for African Americans than for European Americans, more so in the neonatal
than in the postneonatal period. Odds ratios (with 95% confidence intervals
in parentheses) comparing African Americans to European Americans were as
follows: neonatal deaths, 2.2 (1.9-2.5), 2.3 (2.1-2.6), and 2.8 (2.5-3.2)
for less than 12, 12, and more than 12 years of education; and postneonatal
deaths, 1.3 (1.1-1.6), 1.5 (1.3-1.7), and 2.1 (1.7-2.6), respectively. The
biggest gap was for deaths in the first day of life, with odds ratios
ranging from 2.8 to 3.6. Education had no impact on neonatal mortality in
either race. Medical factors were more influential in the neonatal than in
the postneonatal period, whereas environmental and social factors appeared
to play a greater role in the postneonatal period. CONCLUSIONS: Racial
differences in neonatal death are increasing and may be related to
inequities in the provision of health care. The racial gap in the
postneonatal period, although declining, has not disappeared and may be
more related to environmental, social, and economic factors.
