Maternal and Child Health Journal

, Volume 11, Issue 4, pp 319–326 | Cite as

Infant Mortality: Explaining Black/White Disparities in Wisconsin

  • DeAnnah R. Byrd
  • Murray L. Katcher
  • Paul Peppard
  • Maureen Durkin
  • Patrick L. Remington
Original Paper


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.


Infant mortality Racial disparities Risk factor model Birth outcomes Wisconsin 


  1. 1.
    Hoyert DL, Mathews TJ, Menacker F, Strobino DM, Guyer B. Annual summary of vital statistics: 2004. Pediatrics 2006;117:168–83.CrossRefPubMedGoogle Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: A life-course perspective. Matern Child Health J 2003;7:13–30.CrossRefPubMedGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.PubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    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.Google Scholar
  15. 15.
    Hessol NA, Fuentes-Afflick E. Ethnic differences in neonatal and postneonatal mortality. Pediatrics 2005;115:44–51.Google Scholar
  16. 16.
    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.Google Scholar
  17. 17.
    Dever A. Community health analysis: global awareness at the local level. Maryland: Aspen Publishers; 1991.Google Scholar
  18. 18.
    Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995;332:1113–7.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    City of Milwaukee Health Department. City of Milwaukee 2003 infant mortality and disparities fact sheet. Milwaukee: City of Milwaukee Health Department; 2005.Google Scholar
  21. 21.
    Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs 2006;35:3–12.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Collins JW Jr., David RJ. Differences in neonatal mortality by race, income, and prenatal care. Ethn Dis 1992;1:18–26.Google Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    LaVeist TA. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q 1993;71:41–64.CrossRefPubMedGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    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.Google Scholar
  29. 29.
    David RJ. The quality and completeness of birthweight and gestational age data in computerized birth files. Am J Public Health 1980;70:964–73.PubMedCrossRefGoogle Scholar
  30. 30.
    Mustafa G, David RJ. Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Rep 2001;116:15–20.CrossRefPubMedGoogle Scholar
  31. 31.
    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.Google Scholar
  32. 32.
    Institute of Medicine. Committee on Health Literacy. Health Literacy: A prescription to end confusion. Washington, DC: National Academy Press; 2004.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • DeAnnah R. Byrd
    • 1
    • 2
    • 4
  • Murray L. Katcher
    • 1
    • 3
  • Paul Peppard
    • 1
    • 2
  • Maureen Durkin
    • 1
  • Patrick L. Remington
    • 1
    • 2
  1. 1.Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.University of Wisconsin Population Health InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Division of Public HealthWisconsin Department of Health and Family ServicesMadisonUSA
  4. 4.DeAnnah R Byrd, MS, City of Milwaukee Health DepartmentMilwaukeeUSA

Personalised recommendations