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
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.
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.
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.
CDC. Infant mortality -- United States, 1991. MMWR
1993;42:926-30.
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.
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.
Hogue CJR, Yip R. Preterm delivery: can we lower the black
infant's first hurdle? JAMA 1989;262:548-50.
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.
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. Figure_1
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