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Racial differences in post-neonatal mortality in Chicago: what risk factors explain the black infant's disadvantage?
1Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA.
Insights
Environmental factors significantly contribute to the racial disparity in post-neonatal infant mortality. Addressing these conditions could reduce the gap in infant death rates between Black and White infants.
Area of Science:
- Environmental Health
- Epidemiology
- Public Health
Background:
- Post-neonatal (28-365 days) mortality rates show a significant disparity between Black and White infants.
- Place of residence and associated environmental factors are potential contributors to this disparity.
Purpose of the Study:
- To investigate the impact of residential environmental factors on the Black to White differential in post-neonatal mortality.
- To quantify the association between specific environmental risk factors and infant mortality across racial groups.
Main Methods:
- Analysis of 1982-1983 Illinois vital records, including Chicago Police violent crime data and 1980 US Census income data.
- Univariate and multivariate logistic regression models were employed.
- Examined environmental predictors: low median family income (< $10,000/year), high poverty prevalence (> 50%), high violent crime rates (> 11/1000), and limited access to primary medical care.
Main Results:
- Black infants experienced a post-neonatal mortality rate three times higher than White infants (10/1000 vs. 3/1000).
- Thirty-six percent of White infants had no environmental risk factors, compared to only 13% of Black infants.
- After accounting for environmental risk factors and demographic variables (maternal age, education, marital status, birth weight), the odds ratio for Black infant post-neonatal death decreased from 3.0 to 1.5.
Conclusions:
- Specific environmental conditions are substantially associated with the Black to White difference in post-neonatal mortality.
- Interventions targeting these environmental disparities may help reduce racial inequalities in infant mortality.
Objectives:
To investigate the extent to which the place of residence affects the black to white differential in post-neonatal (28-365 days) mortality, we performed a univariate analysis and multivariate logistic regression of the 1982-1983 Illinois vital records. Chicago Police violent crime information and 1980 US Census income data.
Methods:
Four environmental predictors of post-neonatal death were examined: a median family income of < $10,000 per year, a poverty prevalence of > 50%, violent crime rates of > 11/1000 and limited community access to primary medical care based on physician supply ratios.
Results:
The post-neonatal mortality rate of black (n = 50,765) infants was three times that of white (n = 50,690) infants: 10/1000 versus 3/1000, respectively. Thirty-six percent of the white infants had none of the environmental risk factors, whereas only 13% of the black infants had none of the risk factors. For black infants, the presence of any one factor was associated with a slightly increased risk of post-neonatal mortality (9/1000 as compared to 7/1000 with no risk factors), whereas the presence of two or more risk factors was associated with a higher risk (11/1000). When the number of these environmental risk factors were taken into account, the OR for black infants declined from 3.0 (95% CI 2.5-3.6) to 1.7 (95% CI 1.5-1.9). When the differences in maternal age, education, marital status and infant birth weight were also taken into account the odds ratio of post-neonatal death for blacks was 1.5 (95% CI 1.3-1.7).
Conclusions:
We conclude that a substantial proportion of the black to white difference in post-neonatal mortality is associated with specific environmental conditions.