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Differences in Infant Mortality Between Blacks and Whites -- United States, 1980-1991

National health objectives for the year 2000 include reducing the overall infant mortality rate (i.e., deaths at age less than 1 year per 1000 live births) to no more than 7.0 per 1000 live births (objective 14.1) and the infant mortality rate for blacks to no more than 11.0 (objective 14.1a) (1). Achieving this goal will require reducing the race-specific differences in infant mortality. During 1979-1981, infant mortality was the second leading cause of excess deaths among blacks aged less than 45 years, accounting for approximately 6000 more deaths among black infants than among white infants (2). Since 1960, rates for infant mortality and low birthweight (LBW) (less than 2500 g {less than 5 lbs, 8 oz}) for blacks were twice those for whites; these ratios remained stable through the early 1980s. To characterize current trends in the ratios of race-specific infant mortality, LBW, and very low birthweight (VLBW) (less than 1500 g {less than 3 lbs, 4 oz}) rates among blacks and whites, data were analyzed from published reports of final birth and mortality statistics from 1980 through 1991* (3,4). This report summarizes the results of that analysis.

From 1980 to 1991, the overall infant mortality rate in the United States declined 29.4% (from 12.6 to 8.9). Infant mortality among whites declined 33% (from 10.9 to 7.3), while infant mortality among blacks declined 20.7% (from 22.2 to 17.6). The ratio of infant mortality rates for blacks compared with whites increased 20% (from 2.0 to 2.4), while the ratio of LBW infants among black infants compared with that among white infants increased 4.0% (from 2.2 to 2.3), and the ratio of VLBW infants increased 11.2% (from 2.8 to 3.1) (Figure_1). Reported by: Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that, despite overall declines in infant mortality during the 1980s, the differences in race-specific rates for infant mortality, LBW, and VLBW between blacks and whites have steadily increased. Based on current trends, the differences are expected to be threefold by the year 2000.

A substantial portion of the race-specific difference reflects the high rate of VLBW among black infants (5). However, known risk factors for LBW and infant mortality (i.e., medical complications during pregnancy {6} and lack of prenatal care {7}) account for only a small proportion of this difference. For example, the difference persists when race-specific rates are controlled for educational level of mother (8).

Efforts to narrow the race-specific difference in infant mortality should be aimed at reducing known risk factors; however, reducing the unexplained differences will require the identification of protective and risk factors not yet clearly elucidated and the subsequent development and evaluation of prevention strategies. Efforts to identify new potential risk factors include assessment of psychosocial factors (i.e., stress, social support, and coping mechanisms), environmental factors (i.e., housing, lead exposure, and violence), and access to health care (9 ).

References

  1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

  2. US Department of Health and Human Services. Report of the Secretary's task force on black and minority health. Washington, DC: US Department of Health and Human Services, 1985.

  3. NCHS. Health, United States, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993; DHHS publication no. (PHS)93-1232.

  4. CDC. Infant mortality -- United States, 1991. MMWR 1993;42:926-30.

  5. Iyasu S, Becerra JE, Rowley DL, Hogue CJR. The impact of very low birthweight on the black-white infant mortality gap. Am J Prev Med 1992;8:271-6.

  6. Kempe A, Wise PH, Barkan SE, et al. Clinical determinants of the racial disparity in very low birth weight. N Engl J Med 1992;327:969-73.

  7. Hogue CJR, Yip R. Preterm delivery: can we lower the black infant's first hurdle? JAMA 1989;262:548-50.

  8. Schoendorf KC, Hogue CJR, Kleinman JC, Rowley D. Mortality among infants of black as compared with white college-educated parents. N Engl J Med 1992;326:1522-6.

  9. Rowley DL, Hogue CJR, Blackmore CA, et al. Preterm delivery among African American women: a research strategy. Am J Prev Med 1994;9(suppl):1-6.

* Most recent year for which published data were available.
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