The increasing racial disparity in infant mortality rates: Composition and contributors to recent US trends
We examined trends in birthweight-gestational age distributions and related infant mortality for African American and white women and calculated the estimated excess annual number of African American infant deaths.
Live births to US-resident mothers with a maternal race of white or African American were selected from the National Center for Health Statistics' linked live birth-infant death cohort files (1985-1988 and 1995-2000).
The racial disparity in infant mortality widened despite an increasing rate of white low-birthweight infants. White preterm infants had relatively greater gains in survival and the white advantage in survival at term increased. Annually, African American women experience approximately 3300 more infant deaths than would be expected.
The increasing US racial disparity in infant mortality is largely influenced by changes in birthweight-gestational age-specific mortality, rather than the birthweight-gestational age distribution. Improvement in the survival of white preterm and low-birthweight infants, probably reflecting advances in and changing access to medical technology, contributed appreciably to this trend.
Available from: Emily Harville
- "Decades of policy and public health intervention targeting reproductive health have done little to reduce the disproportionately high rates of adverse perinatal outcomes experienced by African American women compared to women of other racial and ethnic groups in the United States (Alexander et al., 2008; Lu et al., 2010). Moving beyond individual and interpersonal-level risk factors, a growing body of research has examined social and structural determinants of reproductive health in an effort to explain the persistence of racial disparities (Kramer and Hogue, 2009). "
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ABSTRACT: Large disparities in adverse birth outcomes persist between African American and white women in the US despite decades of research, policy, and public health intervention. Allostatic load is an index of dysregulation across multiple physiologic systems that results from chronic exposure to stress in the physical and socio-cultural environment which may lead to earlier health deterioration among racially or socio-economically disadvantaged groups. The purpose of this investigation was to examine relationships between maternal biomarkers of allostatic load prior to conception and the occurrence of preterm birth and small for gestational age infants among a cohort of white and African American women participants in the Bogalusa Heart Study.
Data from women participants were linked to the birth record of their first-born infant. Principal components analysis was used to construct an index of allostatic load as a summary of the weighted contribution of nine biomarkers representing three physiologic domains: cardiovascular, metabolic, and immune systems. A series of Poisson regression models based on samples ranging from 1467 to 375 women were used to examine race, individual biomarkers of allostatic load, and quartiles of the allostatic load index as predictors of preterm birth (n = 150, 10.2%) and small for gestational age (n = 135, 9.2%).
There was no evidence of a relationship between maternal preconception allostatic load and either adverse birth outcome in this sample. Further, there was no evidence of effect modification of by race or education.
More work is needed in understanding the biological mechanisms linking social inequities to racial disparities in adverse birth outcomes.
Available from: Suzanne Holland
- "“Why” questions with a social justice bent often make great discovery questions. For example, one team investigating the causes of premature birth among women in the United States has asked, “Why is the African American and white disparity in infant mortality growing despite reduction efforts, and despite an increasing rate of white low birth weight infants?”32 These types of studies represent a shift in thinking about what constitutes good science: the criteria of significance and impact can include weighted consideration of novel, rigorous science that also addresses a stubborn and puzzling health disparity.33–35 "
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ABSTRACT: The speed and effectiveness of current approaches to research translation are widely viewed as disappointing given small gains in real population health outcomes despite huge investments in basic and translational science. We identify critical value questions-ethical, social, economic, and cultural-that arise at moments throughout the research pathway. By making these questions visible, and promoting discussion of them with diverse stakeholders, we can facilitate handoffs along the translational pathway and increase uptake of effective interventions. Who is involved with those discussions will determine which research projects, populations, and methods get prioritized. We argue that some upfront investment in community and interdisciplinary engagement, shaped by familiar questions in ethics, social justice, and cultural knowledge, can save time and resources in the long run because interventions and strategies will be aimed in the right direction, that is, toward health improvements for all. Clin Trans Sci 2012; Volume 5: 445-451.
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ABSTRACT: The U.S. infant mortality rate (IMR) improved substantially between 1985 and 2001, falling 35 percent from 10.4 to 6.8 per 1,000 live births. Despite these improvements, large racial disparities persist: in 2001, the IMR was 13.2 for blacks compared with 5.6 for whites. Although it is natural to suspect that the black-white IMR gap arises from socioeconomic differences, such an explanation seems at odds with the fact that the IMR for another socioeconomically disadvantaged group, U.S. Hispanics, was 5.4 in 2001, lower than that of whites. In this paper, we systematically examine the differences in IMRs between blacks and whites, assessing when these differences arise and their potential explanations. Specifically, we consider differences in the birthweight distribution, mortality over the first 28 days, mortality over the remaining part of the first year, the correlates of each of these underlying IMR components, and infant death reporting. The main contributions of this paper are three-fold: we provide a transparent and systematic treatment of the underlying components of infant mortality and their correlates, we pay specific attention to how these components fit together, and we present similar results for other racial/ethnic groups to place the black-white gaps in perspective.
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