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Predictors of infant mortality among college-educated black and white women, Davidson County, Tennessee, 1990-1994
A O Scott-Wright1, R M Wrona, T M Flanagan
1Department of Family and Preventive Medicine, Meharry Medical College, Nashville, Tennessee, USA.
Strategies to reduce US infant mortality rates often focus on the black-white disparity in rates. Linked Infant Birth and Death Files for Davidson County, Tennessee, from 1990 through 1994 were used to determine infant outcomes for infants born to college-educated white and black women. Risks for adverse outcomes were identified by comparing infant deaths to live births using logistic regression analyses. The following variables entered the logistic model process: maternal and paternal age; race and education; nativity status; maternal risk factors; interpregnancy interval; parity; infant gender; tobacco or alcohol use; number of prenatal visits; trimester in which prenatal care began; marital status; gestational age; and birthweight. After adjustment for the effects of the other variables, a gestational age < 28 completed weeks of gestation was the most significant independent predictor of infant death. Black race was not identified as a significant predictor of infant mortality. Regardless of race, a decrease in infant mortality rates among college-educated women in this country depends on the prevention of preterm births. Strategies to diagnose early preterm labor must proceed from a comprehensive maternal care program for all women. Open channels of communication between patient and provider will form the cornerstone for preterm prevention-intervention programs. Analysis of state and local infant mortality data may identify regional differences in infant mortality rates and differences in risk factors associated with adverse infant outcomes.
Strategies to reduce US infant mortality rates often focus on the black-white disparity in rates. Linked Infant Birth and Death Files for Davidson County, Tennessee, from 1990 through 1994 were used to determine infant outcomes for infants born to college-educated white and black women. Risks for adverse outcomes were identified by comparing infant deaths to live births using logistic regression analyses. The following variables entered the logistic model process: maternal and paternal age; race and education; nativity status; maternal risk factors; interpregnancy interval; parity; infant gender; tobacco or alcohol use; number of prenatal visits; trimester in which prenatal care began; marital status; gestational age; and birthweight. After adjustment for the effects of the other variables, a gestational age < 28 completed weeks of gestation was the most significant independent predictor of infant death. Black race was not identified as a significant predictor of infant mortality. Regardless of race, a decrease in infant mortality rates among college-educated women in this country depends on the prevention of preterm births. Strategies to diagnose early preterm labor must proceed from a comprehensive maternal care program for all women. Open channels of communication between patient and provider will form the cornerstone for preterm prevention-intervention programs. Analysis of state and local infant mortality data may identify regional differences in infant mortality rates and differences in risk factors associated with adverse infant outcomes.