Mortality among Infants of Black as Compared with White College-Educated Parents

BACKGROUND: In the United States, black infants are twice as likely to die as white infants; this difference reflects both black infants' higher rates of low birth weight and the higher mortality among black infants of normal birth weight. We studied mortality in infants born to college-educated parents in order to investigate this gap while controlling for sociodemographic variables. METHODS: We used the National Linked Birth and Infant Death Files for 1983 through 1985 to calculate infant mortality rates for children born to college-educated parents. The study population consisted of 865, 128 white infants and 42,230 black infants. A separate effect of birth weight was assessed by examining mortality rates before and after the exclusion of infants weighing less than 2500 g at birth (low-birth-weight infants). RESULTS: In this population, the infant mortality rate was 10.2 per 1000 live births for black infants and 5.4 per 1000 live births for white infants; the adjusted odds ratio for death among black infants was 1.82 (95 percent confidence interval, 1.64 to 2.01). The rate of low birth weight was more than twice as high among blacks (7 percent) as among whites (3 percent), although the mortality rate in this group was not higher among blacks than among whites. Black infants were three times as likely as white infants to die of causes attributable to perinatal events, including prematurity. They were no more likely to die of the sudden infant death syndrome. After the exclusion of low-birth-weight infants, the mortality rates for black and white infants were equal. CONCLUSIONS: In contrast to black infants in the general population, black infants born to college-educated parents have higher mortality rates than similar white infants only because of their higher rates of low birth weight. Black and white infants of normal birth weight have equivalent mortality rates.