Risk Differences in Disease-Specific Infant Mortality Between Black and White US Children, 1968-2015: an...

Area of Science:

• Public Health
• Epidemiology
• Health Disparities

Background:

• Persistent survival disadvantage observed for Black/African American (AA) infants compared to White infants in the USA indicates excess mortality.
• Epidemiologic data illustrate these disparities, but a substantial explanation for observed rates and risk differences over six decades remains elusive.

Purpose of the Study:

• To examine temporal trends in infant mortality risk differences between Black/AA and White infants.
• To provide an ecologic and non-concurrent explanation for persistent infant mortality variability.

Main Methods:

• Retrospective design utilizing aggregate data from the Centers for Disease Control and Prevention (CDC).
• Risk difference in cause-specific mortality was accessed, with stratification analysis for risk ratio estimation.
• Estimated percent change for mortality trends between 1968 and 2015.

Main Results:

• Cumulative infant mortality (IM) incidence was approximately two times higher for Black/AA infants (RR, 2.05) compared to White infants.
• Upward trends in IM were observed between 1968 and 2015 for digestive, genito-urinary, muscle/skeleton/connective tissue disorders, congenital anomalies, and perinatal causes.
• Black/AA infants showed a survival disadvantage across most causes, except neoplasms, indicating excess mortality relative to White infants.

Conclusions:

• Disease-specific infant mortality is higher among Black/AA infants, with increasing trends in digestive, genito-urinary, and musculoskeletal disorders.
• Findings suggest the need to investigate social determinants of health and social inequity as root causes of these disparities.
• Risk-adapted interventions are crucial for achieving health equity in US infant mortality.