Large inequalities in US infant mortality by race and socioeconomic status have persisted for over a century, despite the massive decline in mortality over time, according to a major new study published in the International Journal of MCH and AIDS (IJMA).

The study entitled “Infant Mortality in the United States, 1915-2007: Large Social Inequalities Have Persisted for Over a Century,” is the first comprehensive attempt to empirically examine infant mortality disparities in the US by race/ethnicity, socioeconomic status, geographic area, and cause of death by using more than 100 years of vital statistics data.

The following are some of the key findings from the study:

  • The US ranks 31st in the infant mortality rate when compared to 36 other industrialized nations. The 2015 data show a 3-to-4 times higher infant mortality rate in the US compared to Hong Kong, Singapore, and Finland and a 31-to-51% higher rate compared to Canada and England & Wales.
  • During 1915-2017, the infant mortality rate declined dramatically overall and for black and white infants. However, racial disparities in mortality increased through 2000 due to a slower decline in mortality for black infants. In 2017, black infants had a 122% higher risk of infant mortality than white infants.
  • Detailed comparisons show an approximately five-fold difference in infant mortality among ethnic groups, with rates ranging from a low of 2.3 infant deaths per 1,000 live births for Chinese infants to a high of 8.5 for American Indian/Alaska Natives and 11.2 for black infants.
  • Infant mortality from major causes of death such as perinatal conditions, birth defects, sudden infant death syndrome, respiratory distress syndrome, and pneumonia and influenza showed a downward trend during the past 5 decades. However, infant mortality from prematurity/low birthweight and unintentional injury has increased in recent years.
  • Educational disparities in infant mortality widened between 1986 and 2016. In 2016, mothers with less than a high school education experienced 2.4, 1.9, and 3.7 times higher risk of infant, neonatal, and post-neonatal mortality than those with a college degree.
  • Geographic disparities were marked and widened across regions and states during 1969-2016, with states in the Southeast region having higher infant mortality rates than those in New England and Pacific regions.

    According to the authors, improvements in living conditions, advances in neonatal medicine and infant healthcare, reductions in smoking during pregnancy, and increased access to and use of prenatal care were responsible for decreases in infant mortality rates over the past several decades.

However, they argue that increases in mortality from prematurity and low birthweight, widening socioeconomic disparities, and a continuing gap in access to high-quality neonatal and infant health care have stalled the progress made in reducing infant mortality.

“Large and increasing social disparities in infant mortality, particularly in recent decades, are a major factor contributing to the worsening international standing of the United States,” said Dr. Singh, adding that “these disparities pose a significant barrier to further improvements in population health.”

About IJMA: The International Journal of Maternal and Child Health and AIDS (IJMA) is a multidisciplinary, peer-reviewed, global health, open access journal that publishes original research articles, review articles, methodology articles, field studies or field reports, policy papers, and commentaries in all areas of maternal and child health (MCH) and human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).

Study Contact: For a
dditional information, please contact the study’s lead author, Dr. Gopal Singh of the Health Resources and Services Administration, US Department of Health and Human Services (email: [email protected]).