Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality.

The increasing racial disparity in infant mortality rates: Composition and contributors to recent US trends

Objectives 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. Study Design 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). Results 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. Conclusion 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.

Racial disparity in previable birth

We sought to assess the contribution of paternal involvement to racial disparities in infant mortality. Using vital records data from singleton births in Florida between 1998 and 2005, we generated odds ratios (OR), 95% confidence intervals (CI), and preventative fractions to assess the association between paternal involvement and infant mortality. Paternal involvement status was based on presence/absence of paternal first and/or last name on the birth certificate. Disparities in infant mortality were observed between and within racial/ethnic subpopulations. When compared to Hispanic (NH)-white women with involved fathers, NH-black women with involved fathers had a two-fold increased risk of infant mortality whereas infants born to black women with absent fathers had a seven-fold increased risk of infant mortality. Elevated risks of infant mortality were also observed for Hispanic infants with absent fathers (OR = 3.33. 95%CI = 2.66-4.17). About 65-75% of excess mortality could be prevented with increased paternal involvement. Paternal absence widens the black-white gap in infant mortality almost four-fold. Intervention programs to improve perinatal paternal involvement may decrease the burden of absent father-associated infant mortality.

Confronting Racial Disparities in Infant Mortality: Reconciling Science and Politics

To assess state-level progress on eliminating racial disparities in infant mortality. Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.

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.

The Impact of Nurse Case Management Home Visitation on Birth Outcomes in African-American Women

Evaluation of Interventions to Reduce Racial Disparities in Infant Mortality: Health Insurance Coverage of Maternal and Infant Care for Minority Women

Disparities in infant mortality by maternal race and Hispanic origin, 2017-2018

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.

To determine IMR trends and regional variations among 47 prefectures in Japan and to identify associated population-based factors. We conducted an ecological study of infant mortality rate (IMR) by analyzing publicly available data from the Ministry of Health, Labour and Welfare of Japan. Outcome measure for trend is the IMR for each of 47 prefectures from 1999 to 2007; for variation, IMRs for 2006 and 2007 in each prefecture were averaged. We considered as covariates prefecture-level variables related to public health, socio-economic status, clinical services and health care facilities. We conducted multivariate statistical analyses to determine covariates most strongly associated with both 1999-2007 IMR trends and 2006-2007 IMR. The mean IMR decreased from 3.42 deaths per 1000 live births (range 2.1 to 5.1) in 1999 to 2.54 (range 1.5 to 4.4) in 2007; reductions were greater in prefectures with higher concentrations of public health nurses (PHNs) and nurses. In 2006-2007, nine prefectures had IMRs ≤ 2.25; eight had IMRs ≥ 3.0. When low-, moderate- and high-IMR prefectures were compared, per capita PHNs, maternal education, centralized water supply and household income were identified as significant covariates. Both national and prefecture-level IMR in Japan decreased from 1999 to 2007; however, the degree of reduction varied by prefecture. Given that more nurses and PHNs per capita were associated with greater IMR reductions from 1999 to 2007 and more PHNs with lower 2006-2007 IMRs, distribution of preventive health services may play a major role in reducing regional disparities in IMR.

BackgroundHealth and health disparities vary substantially by geography, including geopolitical boundaries such as United States congressional districts. Every ten years congressional districts for the House of Representatives are redistricted, but occasionally the Courts step in and force states to redistrict gerrymandered congressional maps. Analyses of court mandated redistricting decisions often focus on the distribution of voters by political party and race, but less is known about how health and health disparities are distributed across congressional districts before and after redistricting. In this analysis, we examine how the magnitude of disparities varied between and within congressional districts in Pennsylvania, before and after the state Supreme Court of Pennsylvania’s decision ordering a redistricting in 2018 that produced less politically gerrymandered districts.MethodsUsing georeferenced vital statistics data from 2013–2015 (before the redistricting), we explore levels of and disparities in infant mortality rates (IMR) and deaths of despair (DoD) using boundaries from before (Congresses 113–115) and after (Congress 116) this redistricting.ResultsUsing consistent mortality data (2013–2015) and boundaries from before and after the 2018 redistricting, we find that after redistricting disparities in infant mortality and deaths of despair between congressional districts were slightly wider for all educational groups except for those with less than a high school degree, and slightly narrower for all racial-ethnic groups other than for Hispanic and non-Hispanic White populations, compared with before redistricting.ConclusionsUnderstanding how disparities vary between and within districts after redistricting can inform our understanding of the relationships between geopolitical boundaries, election processes, and health disparities.

Despite mounting evidence that social factors and public policies affect state infant mortality rates (IMRs), few researchers have examined variation in IMRs associated with those factors and policies. We quantified disparities in infant mortality by state social factors and public policy characteristics. We hypothesized that some social factors and public policies would be more strongly associated with infant mortality than others, and that states with similar factors and policies would form clusters with varying levels of infant mortality. We examined associations of women’s economic empowerment, health and well-being, political participation, reproductive rights, and work and family-related policies with state IMRs in 2012 and 2015, using indicators created by the Institute for Women’s Policy Research. Methods included generalized linear models, principal component analysis, and cluster analysis. Health and well-being predicted IMRs (2012, 2015, both p < .05), as did poverty and opportunity, and reproductive rights (2012, p < .10). Consistent with our hypothesis, states formed clusters, with the states in each cluster having similar social factors and public policies, and similar IMRs. Women’s health status and insurance coverage were more predictive of state IMRs than other social factors. Improving health and insurance coverage may be an effective way to reduce state IMRs.

Appalachian counties have historically had elevated infant mortality rates. Changes in infant mortality disparities over time in Appalachia are not well-understood. This study explores spatial inequalities in white infant mortality rates over time in the 13 Appalachian states, comparing counties in Appalachia with non-Appalachian counties. Data are analyzed for 1,100 counties in 13 Appalachian states that include 420 counties designated as Appalachian by the Appalachian Regional Commission. Area Resource File data for 1976-1980 and 1996-2000 provide county- and city-level infant mortality rates, poverty rates, rural-urban continuum codes, and numbers of physicians per 1,000 residents. Multiple regression analyses evaluate whether Appalachian counties are significantly associated with elevated white infant mortality in each time period, accounting for covariates. White infant mortality rates decreased substantially in all sub-regions over the last 2 decades; however, disparities in infant mortality did not diminish in Appalachian counties compared to non-Appalachian counties. After accounting for poverty, rural/urban status, and health care resources, Appalachian counties were significantly associated with comparatively higher infant mortality during the late 1970s but not in the late 1990s. At the more recent time point, higher poverty rates, residence in more rural areas, and lower physician density were associated with greater infant mortality risk. Appalachian counties continue to experience relatively elevated infant mortality rates. Poverty and rurality remain important dimensions of health service need in Appalachia.