A Retrospective Population Based Cohort Study Examining the Black White Gap in Infant Mortality
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Black women in one US City have more than a 2-fold likelihood of experiencing a death in the womb or an infant death within the first year of life when compared to Whites. The purpose of this retrospective population based cohort study was to examine the unexplained high rates of Black fetal and infant (feto-infant) mortality in this city. The study was built on the perinatal periods of risk (PPOR) model. The PPOR model maps each death in a geographic region into four distinct periods of risk based on birth weight and age at death. The study relied upon 51,303 linked fetal death, live birth and infant death secondary data records for the years 1999-2008. PPOR results identified excess feto-infant death amongst infants with birth weights between 500-1,499 grams regardless of the age at death. PPOR results also identified that fewer feto-infant deaths occurred during the 2004-2008 temporal periods. A multiple logistic regression was used to test whether independent variables of gestational age, education, marital status, maternal age, race, Medicaid status, plurality, prenatal care initiation, and smoking status predicted low birth weight. Of those, gestational age less than 37 weeks was identified as a risk factor for feto-infant death. Implications for positive social change include identifying periods of increased risk of feto-infant deaths and allowing stakeholders to develop targeted strategic interventions that can potentially improve birth outcomes for these women.