Infant Mortality: Explaining Black/White Disparities in Wisconsin
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objectives: Understanding the factors contributing to black/white disparities in infant mortality rates in Wisconsin is a prerequisite to decreasing these disparities and improving birth outcomes. We examined multiple determinants of infant mortality to understand the impact of specific risk factors on the infant mortality rates of blacks and whites in Wisconsin.
Methods: We used the Wisconsin Interactive Statistics on Health database to examine infant mortality data for the 5-year time period, 1998–2002 (N=32,166 black infant births; 272,559 white infant births). We conducted a bivariate analysis of relative risks (RR) of infant mortality (black vs. white) using specific variables available in the database. We then examined the relationship between infant mortality rate and selected risk factors using regression analyses.
Results: Unadjusted, black infants were 3.0 times more likely to die during their first year of life, compared with white infants. Adjusting for gestational age black infants were only 1.9 times more likely to die. The risk was further reduced, after adjusting for birth weight, to 1.3. However, stratifying and adjusting for 8 other multiple variables accounted for some, but not all of the disparity. Black infants who had the same risk profile as white infants still had a 2-fold excess risk of death. In addition, simultaneously controlling for 4 of the 8 risk factors (maternal age, maternal education, adequacy of prenatal care received, and region of the state) also reduced, but did not eliminate, this excess risk (RR was still 2.2 for black infants). Independent of maternal age and region of the state, adequate prenatal care and higher levels of education are significant indicators of the racial disparity between whites and blacks.
Conclusions: These results suggest that, within a given racial group, increasing access to prenatal care and increasing maternal educational attainment will improve infant mortality rates but will not eliminate the black/white disparity in infant mortality. In fact, these interventions may actually widen the disparity in infant mortality rate between blacks and whites, especially if funds and programs are applied equally throughout the population, rather than targeted to high-risk individuals, who lag significantly behind the majority population. The Wisconsin white population, which has already attained an infant mortality rate of 4.5 per 1,000 live births, will continue to have greatest benefit from these programs compared to blacks who have a rate of 19.2 in 2004; thus, the disparity is not eliminated and the gap widens probably due to differential uptake of health messages secondary to health literacy issues. Further research is needed to fully understand the additional, more difficult to measure factors that contribute significantly to infant mortality, especially among black women.
- Hoyert DL, Mathews TJ, Menacker F, Strobino DM, Guyer B. Annual summary of vital statistics: 2004. Pediatrics 2006;117:168–83. CrossRef
- Kvale KM, Mascola MA, Glysch R, Kirby RS, Katcher ML. Trends in maternal and child health outcomes: Where does Wisconsin rank in the national context? Wis Med J 2004;103(5):42–7.
- Katcher ML, Pritzl JJ, Bartholomew MT, Kvale KM, Harvieux A, Kruse T. Healthy babies in Wisconsin: a call to action. Wis Med J 2003;102(5):48–50.
- Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: A life-course perspective. Matern Child Health J 2003;7:13–30. CrossRef
- Institute of Medicine. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press; 2002.
- Collins JW, David RJ, Symons R, Handler A, Wall S, Dwyer L. Low-income African American mothers’ perception of exposure to racial discrimination and infant birthweight. Epidemiology 2000;11:337–9. CrossRef
- Collins JW, David RJ, Handler A, Wall S, Andes S. Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination. Am J Public Health 2004; 94:2132–38.
- Buka SL, Brennan RT, Rich-Edwards JW, Raudenbush SW, Earls F. Neighborhood support and the birth weight of urban infants. Am J Epidemiol 2003;157:1–8. CrossRef
- Pearl M, Braveman P, Abrams B. The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. Am J Public Health 2001;91:1808–14.
- Laraia BA, Messer L, Kaufman JS, Dole N, Caughy M, O’Campo P, Savitz DA. Direct observation of neighborhood attributes in an urban area of the US south: characterizing the social context of pregnancy. Int J Health Geogr 2006;5:11–21. CrossRef
- Collins JW, Hawkes EK. Racial differences in post-neonatal mortality in Chicago: what risk factors explain the black infant's disadvantage? EthnHealth 1997;2:117–25.
- Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994;84:1414–20.
- Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. Nat Vital Stat Rep 2001;49(2):3–27.
- Hoyert DL, Arias E, Smith BL, Murphy SL, Kochanek KD. Deaths: final data for 1999 (technical notes and references). Natl Vital Stat Rep 2001;49(8):93–104.
- Hessol NA, Fuentes-Afflick E. Ethnic differences in neonatal and postneonatal mortality. Pediatrics 2005;115:44–51.
- US Dept of Health and Human Services. Healthy People 2010. 2nd ed. Understanding and improving health and objectives for improving health. 2 vols. Washington, DC: US Government Printing Office, November 2000.
- Dever A. Community health analysis: global awareness at the local level. Maryland: Aspen Publishers; 1991.
- Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995;332:1113–7. CrossRef
- Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002;109:399–403. CrossRef
- City of Milwaukee Health Department. City of Milwaukee 2003 infant mortality and disparities fact sheet. Milwaukee: City of Milwaukee Health Department; 2005.
- Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs 2006;35:3–12. CrossRef
- DiGiuseppe, DL, Aron DX, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. MaternChild Health J 2002;6:169–79. CrossRef
- Muhuri PK, MacDorman MF, Ezzati-Rice TM. Racial differences in leading causes of infant death in the United States. Paediatr Perinat Epidemiol 2004;18:51–60. CrossRef
- Collins JW Jr., David RJ. Differences in neonatal mortality by race, income, and prenatal care. Ethn Dis 1992;1:18–26.
- Rowley DL. Closing the gap, opening the process: why study social contributors to preterm delivery among black women. Matern Child Health J 2001;5:71–4. CrossRef
- LaVeist TA. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q 1993;71:41–64. CrossRef
- Lobel M, Dunkel-Schetter C, Scrimshaw SCM. Prenatal maternal stress and prematurity: a prospective study of socio-disadvantaged women. Health Psychol 1992;11:32–40. CrossRef
- Brett K, Schoendorf K, Kiely J. Differences between black and white women in the use of prenatal care technologies. Am J Obstet Gynecol 1994;170:41–6.
- David RJ. The quality and completeness of birthweight and gestational age data in computerized birth files. Am J Public Health 1980;70:964–73. CrossRef
- Mustafa G, David RJ. Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Rep 2001;116:15–20. CrossRef
- Wisconsin Department of Health and Family Services, Division of Public Health, Minority Health Program. The health of racial and ethnic populations in Wisconsin, 1996–2000. Madison: Wisconsin Department of Health and Family Services; 2004.
- Institute of Medicine. Committee on Health Literacy. Health Literacy: A prescription to end confusion. Washington, DC: National Academy Press; 2004.
- Infant Mortality: Explaining Black/White Disparities in Wisconsin
Maternal and Child Health Journal
Volume 11, Issue 4 , pp 319-326
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- Infant mortality
- Racial disparities
- Risk factor model
- Birth outcomes
- Industry Sectors
- Author Affiliations
- 1. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- 2. University of Wisconsin Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- 4. DeAnnah R Byrd, MS, City of Milwaukee Health Department, 841 N. Broadway, 3rd Floor, Milwaukee, WI, 53202, USA
- 3. Division of Public Health, Wisconsin Department of Health and Family Services, Madison, Wisconsin, USA