Epidemiological Risk Factors for Neonatal and Postneonatal Mortality among black and white women in Virginia

Background: The infant mortality rate (IMR) is the primary indicator of a nation’s health. Virginia’s rate in 2005 was 7.3 /1000 live births, higher than the national average of 6.7. After years of improvements, the IMR has plateaued due to persistent ethnic disparities. The complex nature of these disparities is poorly understood. The objective of this study was to identify the risk factors for neonatal and postneonatal mortality and the differences among black and white infants in Virginia.

Methods: Secondary analysis was conducted using the 2000-2004 Virginia Vital Statistics linked birth-infant death data. The dependent variables were neonatal death (N=2,189) and postneonatal death (N=964). Logistic regression was used to compute odds ratios and 95% confidence intervals to estimate the relationship between various risk factors identified from the birth certificate and neonatal and postneonatal mortality for black and white infants.

Results: Maternal factors such as young maternal age, education less than 12 years, unmarried, inadequate prenatal care, coverage under Medicaid and risk behaviors (e.g., alcohol and cigarette use during pregnancy) significantly increased risk for infant mortality in both whites and black infants. Overall, black infants were at a higher risk for death. The strongest predictors of mortality were birth weight less than 2,499g and gestational age less than 33 weeks.

Conclusion: Understanding the interplay between these factors and targeting “culturally-sensitive” interventions can help achieve national goals for reducing the IMR.