Racial Disparities in Gestational Age-Specific Infant Mortality Among College-Educated Women Público

Abstract

Objective: To evaluate whether differences in gestational age-specific mortality explain racial disparities in infant mortality seen among non-anomalous infants born to college-educated women in the United States.

Methods: In this population-based retrospective cohort study, we linked 2016 and 2017 birth cohort and infant death datasets from the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). Our outcome of interest was infant death as a dichotomized variable. Our primary exposure was maternal race (non-Hispanic Black [NHB], non-Hispanic White [NHW]). We used multivariable logistic regression models to evaluate associations between maternal race and infant death for women with at least some college education, with and without adjustment for covariates (education level beyond high school, marital status, age, live birth order, timing of prenatal care).

Results: The sample included 2,961,752 liveborn infants (37.9%) born in 2016 or 2017; 14.4% of infants were born to college-educated NHB mothers and 85.7% were born to college-educated NHW mothers. Infants born to college-educated NHB mothers had twice the odds of death after controlling for maternal age, marital status, parity, prenatal care, and education (aOR: 2.017; 95% CI: 1.923 – 2.116). The adjusted odds ratios remained significant when stratifying by gestational age, with worse outcomes for infants born to NHB mothers at < 32 weeks (aOR: 1.411; 95% CI: 1.316 – 1.514), 37 – 40 weeks (aOR: 1.267; 95% CI: 1.161 – 1.382), and 41 weeks or greater (aOR: 1.367; 95% CI: 1.097 – 1.703). Comparing standardized gestational ages, infants born to NHB mothers had greater odds of death up to 1 standard deviation above the mean.

Conclusion: Despite education being a protective factor for infant mortality, racial disparities in infant mortality exist among highly educated women and cannot be explained by individual-level maternal characteristics or differential distribution of gestational age at birth among infants born to NHB and NHW women.

Table of Contents

Table of Contents

CHAPTER I (Literature Review) ……………………………………………………………….1

CHAPTER II (Journal Article) ………………………………………………………………….6

CHAPTER III (Conclusion and Public Health Implications) …………………………...26

References ………………………………………………………………………………………...29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Public Health
Palavra-chave	Infant mortality Racial Disparities Women's Health
Committee Chair / Thesis Advisor	Carol Hogue, Emory University
Committee Members	Mohammed Ali, Emory University

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