Racial Disparities in Infant Health

The period 1980-2000 was important for infant health in Florida and the United States more generally. This period of dramatic social change and substantial improvements in therapeutic technology has produced striking improvements in infant health and survival. Despite overall declines in all-cause infant mortality, some evidence has suggested that racial disparities have persisted and even widened during this period. While the maternal socio- demographic factors associated with these racial disparities are well-established areas of research, several points remain unclear. First, it is not well-known which causes of death have contributed to the widening racial disparities in infant mortality. Second, it is uncertain how the changing social context may have affected these patterns. Finally, it is unknown which has been more influential, changes in the social context or changes in individual maternal socio- demographic characteristics. This study addresses these questions, using linked birth and infant death files on the 1980 and 2000 Florida birth cohorts. This investigation has three main findings. First, the racial disparity in infant mortality in Florida increased during the period 1980-2000. Black infants born in the earlier cohort had about 60% greater odds of infant death than white infants. Even though absolute rates of infant death declined for both groups between 1980 and 2000, the racial disparity increased over this period such that in the year 2000 black infants had 80% higher mortality risk than white infants. Second, maternal and socio-demographic variables are able to explain less of the black-white mortality differences in 2000 than in 1980. Third, changes in cause specific infant deaths have contributed to the increased racial disparity in infant mortality over the period 1980-2000. Deaths due to prematurity causes and maternal and obstetric conditions were the most important for changes in the racial disparity that occurred over the period 1980-2000. The findings of this research highlight the need to consider cause-specific infant mortality in understanding the racial disparity in infant death. Changes in individual causes of death due to advancing therapeutic technologies and improved distributions of maternal risk factors can influence the overall distribution of infant deaths by race. Additionally, social context should continue to be included in future studies, although new measures may need to be considered.