Changes in the black-white infant mortality gap from 1983 to 1991 in the United States

  • Suzan L. Carmichael
    Address Correspondence to: Suzan L. Carmichael, PhD, California Birth Defects Monitoring Program, 1900 Powell St., Suite 1050, Emeryville, California 94608
    Epidemic Intelligence Service, Epidemiology Program Office (Carmichael), Centers for Disease Control and Prevention, Atlanta, Georgia USA30341-3724

    Division of Reproductive Health (Carmichael, Iyasu), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia USA30341-3724
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  • Solomon Iyasu
    Division of Reproductive Health (Carmichael, Iyasu), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia USA30341-3724
    Search for articles by this author


      Background: The long-standing difference in infant mortality in the United States between black and white infants has increased in recent years. To help identify the cause, we evaluated changes in birthweight distributions (BDs) and birthweight-specific mortality rates (BSMRs) among black and white infants born in the United States between 1983 and 1991.
      Methods: Using national linked birth and death certificate data, we limited analyses to singleton births that occurred in the United States to resident, non-Hispanic black and white women. Birthweight data were analyzed in 500 g increments. The black-white gap was partitioned into deaths due to differences in BDs and BSMRs.
      Results: The black-white infant mortality rate ratio increased from 2.1 in 1983 to 2.4 in 1991. Decreases in BSMRs among infants weighing from 500 to 2499 g occurred in both groups but were smaller among black than white infants; consequently, the percentage of excess deaths to black infants due to differences in BSMRs almost doubled during the study period, from 6.5% to 11.9%. Rates of very low birthweight (VLBW, <1,500 g) increased for black infants, but the BD for white infants changed little. Although about 90% of the excess deaths to black infants resulted from differences in BDs, the changes in BDs had a minimal effect on the widening infant mortality gap.
      Conclusions: A significant reduction in the black-white infant mortality gap will require a reduction in VLBW and low birthweight (LBW, <2,500 g). To keep the gap from growing, we must also investigate why decreases in BSMRs were smaller among black than white infants between 1983 and 1991.


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        • Guyer B.
        • Strobino D.M.
        • Ventura S.J.
        • MacDorman M.
        • Martin J.A.
        Annual summary of vital statistics, 1995.
        Pediatrics. 1996; 98: 1007-1019
        • Singh G.K.
        • Yu S.M.
        Infant mortality in the United States.
        Am J Public Health. 1995; 85: 957-964
        • Iyasu S.
        • Becerra J.E.
        • Rowley D.L.
        • Hogue C.J.R.
        Impact of very low birthweight on the black-white infant mortality gap.
        Am J Prev Med. 1992; 8: 271-277
      1. Linked Birth/Infant Death Data Set: 1983–1991 Birth Cohorts, Public Use Data Tape Documentation, Hyattsville, MD: Public Health Service; 1983–1991.

        • Stroup D.F.
        • Hahn R.A.
        Current use of race and ethnicity in public health surveillance.
        MMWR. 1993; 42: 5-6
        • Williams D.R.
        Race in the health of America.
        MMWR. 1993; 42: 8-10
        • Kitagawa E.
        Components of a difference between two rates.
        J Am Stat Assoc. 1955; 50: 1168-1194
        • Buehler J.W.
        • Kleinman J.C.
        • Hogue C.J.R.
        • Strauss L.T.
        • Smith J.C.
        Birth weight-specific infant mortality, United States, 1960 and 1980.
        Public Health Rep. 1987; 102: 151-161
        • Swartz K.
        Dynamics of people without health insurance.
        JAMA. 1994; 271: 64-66
        • Short P.F.
        • Banthin J.S.
        New estimates of the underinsured younger than 65 years.
        JAMA. 1995; 274: 1302-1306
        • Elam-Evans L.D.
        • Adams M.M.
        • Gargiullo P.M.
        • Kiely J.L.
        • Marks J.S.
        Trends in the percentage of women who received no prenatal care in the United States, 1980–1992.
        Obstet Gynecol. 1996; 87: 575-580
        • Council on Ethical and Judicial Affairs
        Black-white disparities in health care.
        JAMA. 1990; 263: 2344-2346
        • Brett K.M.
        • Schoendorf K.C.
        • Kiely J.L.
        Differences between black and white women in the use of prenatal care technologies.
        Am J Obstet Gynecol. 1994; 170: 41-46
        • Hamvas A.
        • Wise P.H.
        • Yang R.K.
        • Wampler N.S.
        • Noguchi A.
        • et al.
        The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites.
        N Engl J Med. 1996; 334: 1635-1640
        • Langkamp D.L.
        • Foye H.R.
        • Roghmann K.F.
        Does limited access to NICU services account for higher neonatal mortality rates among blacks?.
        Am J Perinatol. 1990; 7: 227-231
        • Geronimus A.T.
        The weathering hypothesis and the health of African-American women and infants.
        Ethnicity Dis. 1992; 2: 207-221
        • Geronimus A.T.
        Black/white differences in the relationship of maternal age to birthweight.
        Soc Sci Med. 1996; 42: 589-597
        • Crowley P.
        • Chalmers I.
        • Keirse M.J.N.C.
        The effects of corticosteroid administration before preterm delivery.
        Br J Obstet Gynaecol. 1990; 97: 11-25
      2. National Institutes of Health. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH consensus statement 1994;12:1–24.

        • Jobe A.H.
        Pulmonary surfactant therapy.
        N Engl J Med. 1993; 328: 861-868
        • Philip A.G.S.
        Neonatal mortality rate.
        J Pediatr. 1995; 126: 427-433
        • Wegman M.E.
        Annual summary of vital statistics, 1990.
        Pediatrics. 1991; 88: 1081-1092
        • Wilson A.L.
        • Fenton L.J.
        • Munson D.P.
        State reporting of live births of newborns weighing less than 500 grams.
        Pediatr. 1986; 78: 850-854
        • Hack M.
        • Fanaroff A.A.
        Outcomes of extremely-low-birth-weight infants between 1982 and 1988.
        N Engl J Med. 1989; 321: 1642-1647
        • Adams M.M.
        • Read J.A.
        • Rawlings J.S.
        • Harlass F.B.
        • Sarno A.P.
        • Rhodes P.H.
        Preterm delivery among black and white enlisted women in the United States Army.
        Obstet Gynecol. 1993; 81: 65-71
        • McGrady G.
        • Sung J.F.C.
        • Rowley D.L.
        • Hogue C.J.R.
        Preterm delivery and low birth weight among first-born infants of black and white college graduates.
        Am J Epidemiol. 1992; 136: 266-276
        • Schoendorf K.
        • Hogue C.
        • Kleinman J.
        • Rowley D.L.
        Mortality among infants of black as compared to white college-educated parents.
        N Engl J Med. 1992; 326: 1522-1526
        • Shiono P.
        • Klebanoff M.
        Ethnic differences in preterm and very preterm delivery.
        Am J Public Health. 1986; 76: 1317-1321
        • Fiscella K.
        Racial disparities in preterm births.
        Public Health Rep. 1996; 111: 104-113
        • Hauth J.
        • Goldenberg R.L.
        • Andrews W.W.
        • DuBard M.B.
        • Copper R.L.
        Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis.
        New Engl J Med. 1995; 333: 1732-1736
        • Morales W.J.
        • Schorr S.
        • Albritton J.
        Effect of metronidazole in patients with preterm birth in preceing pregnancy and bacterial vaginosis.
        Am J Obstet Gynecol. 1994; 171: 345-349
        • McLean D.
        • Hatfield-Timajchy K.
        • Wingo P.A.
        • Floyd R.L.
        Psychosocial measurement.
        Am J Prev Med. 1993; 9: 39-81
        • Norbeck J.S.
        • DeJoseph J.F.
        • Smith R.T.
        A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African-American women.
        Soc Sci Med. 1996; 43: 947-954
        • Collins J.W.
        • David R.J.
        The differential effect of traditional risk factors on infant birthweight among blacks and whites in Chicago.
        Am J Public Health. 1990; 80: 679-681
      3. NCHS. Healthy People 2000 Review, 1995–1996. DHHS Publication No. (PHS) 96-1256. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC; 1995.

        • James S.
        Racial and ethnic differences in infant mortality and low birth weight.
        Ann Epidemiol. 1993; 3: 130-136
        • Krieger N.
        • Rowley D.L.
        • Herman A.A.
        • Avery B.
        • Phillips M.T.
        Racism, sexism, and social class.
        Am J Prev Med. 1993; 9: 82-122
        • Rowley D.L.
        • Hogue C.J.R.
        • Blackmore C.A.
        • Hatfield-Timajchy K.
        • et al.
        • CD Ferre
        Preterm delivery among African-American women.
        Am J Prev Med. 1993; 9: 1-6
        • Berkowitz G.S.
        • Papiernik E.
        Epidemiology of preterm birth.
        Am J Epidemiol. 1993; 15: 415-443
        • Kempe A.
        • Wise P.H.
        • Barkan S.E.
        • Sappenfield W.M.
        • Sachs B.
        • et al.
        Clinical determinants of the racial disparity in very low birth weight.
        N Engl J Med. 1992; 327: 969-973
        • Zhang J.
        • Savitz D.A.
        Preterm birth subtypes among blacks and whites.
        Epidemiology. 1992; 3: 428-433
        • Heinonen K.
        • Hakulinen A.
        • Jokela V.
        Survival of the smallest.
        Lancet. 1988; 2: 204-207