Persistent ethnic inequities in infant mortality in Peru, 2019-2024: a repeated cross-sectional analysis of ENDES...

Despite progress in reducing infant mortality in Peru, inequities persist by socioeconomic and ethnic characteristics. Documenting these disparities is essential to guide public health policy.

To quantify ethnic disparities in infant mortality in Peru, examine variation by socioeconomic level and timing of death, and estimate the fraction of deaths attributable to these inequities.

We conducted a repeated cross-sectional analysis of ENDES 2019-2024 birth-history data. The analytic sample included 100,807 live births to women aged 15-49 years with complete opportunity for ascertainment of death before 12 months of age. Infant mortality was defined as death before 12 months among live-born children. Maternal ethnicity (Mestizo, Afro-Peruvian, Indigenous) was based on self-identification. We estimated infant mortality rates per 1,000 live births, risk ratios (RR), and risk differences (RD) using survey-weighted Poisson regression with robust variance.

We recorded 1,178 infant deaths (overall infant mortality rate: 10.6 per 1,000; 95% CI: 9.8-11.3). The rate was 8.0 per 1,000 among Mestizo, 13.1 among Afro-Peruvian, and 13.6 among Indigenous births (p < 0.001). Children of Afro-Peruvian and Indigenous mothers had 65% (RR = 1.65; 95% CI: 1.31-2.07) and 71% (RR = 1.71; 95% CI: 1.46-2.00) higher risk of death before 12 months than Mestizo children. Disparities were more pronounced for postneonatal mortality (Indigenous RR = 2.53) and were observed across socioeconomic strata. The population attributable fraction for ethnic mortality disparities was 24.4%, under a counterfactual scenario in which all ethnic groups had the infant mortality rate observed among Mestizo births.

Marked ethnic disparities in infant mortality persist in Peru and are observed across socioeconomic strata. Approximately one quarter of infant deaths could be prevented under a counterfactual scenario in which ethnic mortality gaps were eliminated. Targeted interventions for Afro-Peruvian and Indigenous populations are needed.