, Volume 41, Issue 4, pp 773–800

The increasing racial disparity in infant mortality: Respiratory distress syndrome and other causes

  • W. Parker Frisbie
  • Seung-eun Song
  • Daniel A. Powers
  • Julie A. Street


Although substantial declines in infant mortality rates have occurred across racial/ethnic groups, there has been a marked increase in relative black-white disparity in the risk of infant death over the past two decades. The objective of our analysis was to gain insight into the reasons for this growing inequality on the basis of data from linked cohort files for 1989–1990 and 1995–1998. We found a nationwide reversal from a survival advantage to a survival disadvantage for blacks with respect to respiratory distress syndrome over this period. The results are consistent with the view that the potential for a widening of the relative racial gap in infant mortality is high when innovations in health care occur in a continuing context of social inequality. As expected, the results for other causes of infant mortality, although similar, are less striking. Models of absolute change demonstrate that among low-weight births, absolute declines in mortality were greater for white infants than for black infants.


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  1. Alexander, G.R. and M. Kotelchuck. 2001. “Assessing the Role and Effectiveness of Prenatal Care: History, Challenges, and Directions for Future Research.” Public Health Reports 116:306–16.Google Scholar
  2. Alexander, G.R., M.E. Tompkins, M.C. Allen, and T.C. Hulsey. 1999. “Trends and Racial Differences in Birth Weight and Related Survival.” Maternal and Child Health Journal 3:71–79.CrossRefGoogle Scholar
  3. Almond, D., K.Y. Chay, and D.S. Lee. 2003. “Does Low Birth Weight Matter? Evidence From the U.S. Population of Twin Births.” Working Paper No. 53. Center for Labor Economics, University of California, Berkeley.Google Scholar
  4. American Academy of Pediatrics. 1999. “Surfactant Replacement for Respiratory Distress Syndrome.” Pediatrics 103:684–85.CrossRefGoogle Scholar
  5. Blalock, H.M., Jr. 1979. Social Statistics. Rev. 2nd ed. New York: McGraw-Hill.Google Scholar
  6. Blondel, B., M.D. Kogan, G.R. Alexander, N. Dattani, M.S. Kramer, A. Macfarlane, and S.W. Wen. 2002. “The Impact of the Increasing Number of Multiple Births on the Rates of Preterm Birth and Low Birthweight: An International Study.” American Journal of Public Health 92:1323–30.CrossRefGoogle Scholar
  7. British Columbia Reproductive Care Program. 1993. “Surfactant Replacement Therapy.” Newborn Guideline 6:1–4.Google Scholar
  8. Cabral, H., L.E. Fried, S. Levenson, H. Amaro, and B. Zuckerman. 1990. “Foreign-Born and U.S. Born Black Women: Differences in Health Behaviors and Birth Outcomes.” American Journal of Public Health 80:70–72.Google Scholar
  9. Chomitz, V.R., L.W.Y. Cheung, and E. Lieberman. 1995. “The Role of Lifestyle in Preventing Low Birth Weight.” The Future of Children 5:121–38.CrossRefGoogle Scholar
  10. Cobas, J.A., H. Balcazar, M. Benin, V.M. Keith, and Y. Chong. 1996. “Acculturation and Low- Birthweight Infants Among Latino Women: A Reanalysis of HHANES Data With Structural Equation Models.” American Journal of Public Health 86:394–96.CrossRefGoogle Scholar
  11. Cramer, J.C. 1987. “Social Factors and Infant Mortality: Identifying High-Risk Groups and Proximate Causes.” Demography 24:299–322.CrossRefGoogle Scholar
  12. Demissie, K., G.G. Rhoads, C.V. Anath, G.R. Alexander, M.S. Kramer, and K.S. Joseph. 2001. “Trends in Preterm Birth and Neonatal Mortality Among Blacks and Whites in the United States from 1989 to 1997.” American Journal of Epidemiology 54:307–15.CrossRefGoogle Scholar
  13. Dorland’s Illustrated Medical Dictionary. 1988. 27th ed. Philadelphia: Saunders.Google Scholar
  14. Eberstein, I.W., C. Nam, and R.A. Hummer. 1990. “Infant Mortality by Cause of Death: Main and Interaction Effects.” Demography 27:413–30.CrossRefGoogle Scholar
  15. Frisbie, W.P. Forthcoming. “Infant Mortality.” Chap. 9 in Handbook of Population, edited by D.L. Poston, Jr., and M. Micklin. New York: Kluwer/Plenum.Google Scholar
  16. Frisbie, W.P., M. Biegler, P.B. de Turk, D. Forbes, and S.G. Pullum. 1997. “Racial and Ethnic Differences in Determinants of Intrauterine Growth Retardation and Other Compromised Birth Outcomes.” American Journal of Public Health 87:1977–83.CrossRefGoogle Scholar
  17. Frisbie, W.P., D. Forbes, and R.A. Hummer. 1998. “Hispanic Pregnancy Outcomes: Additional Evidence.” Social Science Quarterly 79:149–69.Google Scholar
  18. Frisbie, W.P. and S.E. Song. 2003. “Hispanic Pregnancy Outcomes: Differences Over Time and Current Risks.” Policy Studies Journal 31:237–52.CrossRefGoogle Scholar
  19. Geronimus, A.T. 1987. “On Teenage Childbearing and Neonatal Mortality in the United States.” Population and Development Review 13:245–79.CrossRefGoogle Scholar
  20. Geronimus, A.T. and S.D. Korenman. 1993. “Maternal Youth or Family Background?: On the Health Disadvantages of Infants With Teenage Mothers.” American Journal of Epidemiology 137:213–25.Google Scholar
  21. Gershan, W.M., N.S. Besch, and R.A. Franciosi. 2002. “A Comparison of Apparent Life-Threatening Events Before and After the Back to Sleep Program.” Wisconsin Medical Journal 101:39–45.Google Scholar
  22. Gibson, E., J.S. Greenspan, S. Rubin, and C.A. Dembofsky. 2000. “Infant Sleep Position Practices 2 Years Into the ‘Back to Sleep’ Campaign.” Clinical Pediatrics 39:285–89.CrossRefGoogle Scholar
  23. Gortmaker, S.L. and P.H. Wise. 1997. “The First Injustice: Socioeconomic Disparities, Health Services Technology, and Infant Mortality.” Annual Review of Sociology 23:147–70.CrossRefGoogle Scholar
  24. Guyer, B., M.F. MacDorman, J.A. Martin, K.D. Peters, and D.M. Strobino. 1998. “Annual Summary of Vital Statistics—1997.” Pediatrics 102:1333–49.CrossRefGoogle Scholar
  25. Hack, M. and A.A. Fanaroff. 1993. “Outcomes of Extremely Immature Infants—A Perinatal Dilemma.” New England Journal of Medicine 329(22):1649–50.CrossRefGoogle Scholar
  26. Halliday, H.L. 1997. “Surfactant Therapy: Questions and Answers.” Journal of Neonatal Nursing 3:28–36.Google Scholar
  27. Hamvas, A., P.H. Wise, R.K. Yang, N.S. Wampler, A. Noguchi, M.M. Maurer, C.A. Walentik, W.F. Schramm, and F.S. Cole. 1996. “The Influence of the Wider Use of Surfctant Therapy on Neonatal Mortality Among Blacks and Whites.” New England Journal of Medicine 334(25): 1635–40.CrossRefGoogle Scholar
  28. Horbar, J.D. and J.F. Lucey. 1995. “Evaluation of Neonatal Intensive Care Technologies.” The Future of Children 5:139–61.CrossRefGoogle Scholar
  29. Hoyert, D.L., E. Arias, B.L. Smith, S.L. Murphy, and K.D. Kochanek. 2001. “Deaths: Final Data for 1999.” National Vital Statistics Reports 49(8). Hyattsville, MD: National Center for Health Statistics.Google Scholar
  30. Hulsey, T.C., G.R. Alexander, P.Y. Robillard, D.J. Annibale, and A. Keenan. 1993. “Hyaline Membrane Disease: The Role of Ethnicity and Maternal Risk Characteristics.” American Journal of Obstetrics and Gynecology 168:572–76.Google Scholar
  31. Hummer, R.A., M. Biegler, P.B. de Turk, D. Forbes, W.P. Frisbie, Y. Hong, and S.G. Pullum. 1999. “Race/Ethnicity, Nativity, and Infant Mortality in the United States.” Social Forces 7: 1083–118.CrossRefGoogle Scholar
  32. Hummer, R.A., C.P. Schmertmann, I.W. Eberstein, and S. Kelly. 1995. “Retrospective Reports of Pregnancy Wantedness and Birth Outcomes in the United States.” Social Science Quarterly 76:402–18.Google Scholar
  33. Institute of Medicine. 1988. Reaching Mothers, Reaching Infants. Washington, DC: National Academy Press.Google Scholar
  34. Kallan, J.E. 1993. “Race, Intervening Variables, and Two Components of Low Birth Weight.” Demography 30:489–506.CrossRefGoogle Scholar
  35. Kleinman, J.C. and S.S. Kessel. 1987. “Racial Differences in Low Birth Weight: Trends and Risk Factors.” New England Journal of Medicine 317:749–53.Google Scholar
  36. Kline, J., Z. Stein, and M. Susser. 1989. Conception to Birth: Epidemiology of Prenatal Development. New York: Oxford.Google Scholar
  37. Kotelchuck, M. 1994a. “The Adequacy of the Prenatal Care Utilization Index: Its US Distribution and Association With Low Birthweight.” American Journal of Public Health 84:1486–89.CrossRefGoogle Scholar
  38. —. 1994b. “An Evaluation of the Kessner Adequacy of Prenatal Care Index and a Proposed Adequacy of Prenatal Care Utilization Index.” American Journal of Public Health 84:1414–20.CrossRefGoogle Scholar
  39. Kresch, M.J. and J.M. Clive. 1998. “Meta-Analyses of Surfactant Replacement Therapy of Infants With Birth Weights Less Than 2000 Grams.” Journal of Perinatology 18:276–83.Google Scholar
  40. Link, B.G. and J.C. Phelan. 1995. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior 35(Extra Issue):80–94.CrossRefGoogle Scholar
  41. —. 2002. “McKeown and the Idea That Social Conditions Are Fundamental Causes of Disease.” American Journal of Public Health 92:730–32.CrossRefGoogle Scholar
  42. Malloy, M.H. and D.H. Freeman. 2000. “Respiratory Distress Syndrome Mortality in the United States, 1987 to 1995.” Journal of Perinatology 20:414–20.CrossRefGoogle Scholar
  43. Mathews, M.S., F. Menacker, and M.F. MacDorman. 2002. “Infant Mortality Statistics From the 2000 Period Linked Birth/Infant Death Data Set.” National Vital Statistics Reports 50(12).Google Scholar
  44. Hyattsville, MD. National Center for Health Statistics. McCormick, M.C. 1985. “The Contribution of Low Birth Weight to Infant Mortality and Childhood Mortality.” New England Journal of Medicine 312:82–90.CrossRefGoogle Scholar
  45. Minino, A.M., E. Arias, K.D. Kochanek, S.L. Murphy, and B.L. Smith. 2002. “Deaths: Final Data for 2000.” National Vital Statistics Reports 50(15). Hyattsville, MD: National Center for Health Statistics.Google Scholar
  46. Moss, N.E., and K. Carver. 1998. “The Effect of WIC and Medicaid on Infant Mortality in the United States.” American Journal of Public Health 88:1354–61.CrossRefGoogle Scholar
  47. Muhuri, P.K., M.F. MacDorman, and T.M. Ezzati-Rice. 2004. “Racial Differences in Leading Causes of Infant Death in the United States.” Paediatric and Perinatal Epidemiology 18:51–60.CrossRefGoogle Scholar
  48. National Center for Health Statistics. 1993. Vital Statistics of the United States, 1989. Vol. II, Mortality, Part A. Washington, DC: Public Health Service.Google Scholar
  49. Palloni, A. and J.D. Morenoff. 2001. “Interpreting the Paradoxical in the Hispanic Paradox: Demographic and Epidemiologic Approaches.” Annals of the New York Academy of Sciences 954: 140–74.CrossRefGoogle Scholar
  50. Ranganathan, D., S. Wall, B. Khoshnood, J.K. Singh, and K.S. Lee. 2000. “Racial Differences in Respiratory-Related Neonatal Mortality Among Very Low Birth Weight Infants.” Journal of Pediatrics 136:454–59.CrossRefGoogle Scholar
  51. Rao, C.R. 1973. Linear Statistical Inference and Its Applications. 2nd ed. New York: Wiley.CrossRefGoogle Scholar
  52. Richardson, D.K. and J.S. Torday. 1994. “Racial Differences in Predictive Value of the Lecithin/ Sphingomyelin Ratio.” American Journal of Obstetrics and Gynecology 170:1273–78.Google Scholar
  53. Schwartz, R.M., J.H. Muri, M.D. Overpeck, J.C. Pezzullo, and M.D. Kogan. 2000. “Use of High-Technology Care Among Women With High-Risk Pregnancies in the United States.” Maternal and Child Health Journal 4:7–18.CrossRefGoogle Scholar
  54. Scribner, R. 1996. “Editorial: Paradox as Paradigm-The Health Outcomes of Mexican Americans.” American Journal of Public Health 86:303–305.CrossRefGoogle Scholar
  55. Shiono, P.H. and R.E. Behrman. 1995. “Low Weight Birth: Analysis and Recommendations.” The Future of Children 5:4–18.CrossRefGoogle Scholar
  56. Singh, G.K. and S.M. Yu. 1996. “Adverse Pregnancy Outcomes: Differences Between US- and Foreign-Born Women in Major US Racial and Ethnic Groups.” American Journal of Public Health 86:837–43.CrossRefGoogle Scholar
  57. Sowards, K.A. 1997. “Premature Birth and the Changing Composition of Newborn Infectious Disease Mortality: Reconsidering ‘Exogenous’ Mortality.” Demography 34:399–409.CrossRefGoogle Scholar
  58. U.S. Census Bureau. 2001. Statistical Abstract of the United States: 2001. Washington, DC: U.S. Census Bureau.Google Scholar
  59. U.S. Department of Health and Human Services. 1995. “Linked Birth/Infant Death Data Set: 1989 Cohort.” Public Use Data File Documentation. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  60. Walfisch, A., M. Hallak, and M. Mazor. 2001. “Multiple Courses of Antenatal Steroids: Risks and Benefits.” Obstetrics and Gynecology 98:491–97.CrossRefGoogle Scholar
  61. Wilcox, A.J. and I.T. Russell. 1986. “Birthweight and Perinatal Mortality: III. Towards a New Method of Analysis.” International Journal of Epidemiology 15:188–96.CrossRefGoogle Scholar
  62. —. 1990. “Why Small Black Infants Have a Lower Mortality Rate Than Small White Infants: The Case for Population-Specific Standards for Birth Weight.” Journal of Pediatrics 116:7–10.CrossRefGoogle Scholar
  63. Wise, P.H. 1993. “Confronting Racial Disparities in Infant Mortality: Reconciling Science and Politics.” Pp. 7-16 in Racial Differences in Preterm Delivery: Developing a New Research Paradigm, edited by D. Rowley and H. Tosteson. American Journal of Preventive Medicine, Suppl. to Vol. 9(6).Google Scholar
  64. —. 2003. “The Anatomy of a Disparity in Infant Mortality.” Annual Review of Public Health 24:341–62.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2004

Authors and Affiliations

  • W. Parker Frisbie
    • 1
  • Seung-eun Song
    • 2
  • Daniel A. Powers
    • 2
  • Julie A. Street
    • 2
  1. 1.Population Research CenterUniversity of Texas at AustinAustin
  2. 2.University of Texas at Austin

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