The Association between Maternal Education Level and Infant Mortality Rates by Gestational Age among Black, White, and Hispanic Infants

This study aimed to determine if maternal educational attainment is associated with racial/ethnic disparities in gestational age (GA)-specific infant mortality rate (IMR). Cohort study using data from the Centers for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database, 2017 to 2019. We included hospital-born infants from 22 to 41 weeks' gestation without major congenital anomalies. We compared GA-specific IMR by maternal race/ethnicity (Black, Hispanic, or White) and maternal education level. There were 9,356,130 eligible infants during the study period; 16.1% Black, 25.7% Hispanic, and 58.2% White. Black infants born at 23 and 24 weeks' gestation had lower IMR at all maternal education levels than White infants. Black infants from 36 to 40 weeks' gestation had higher IMR except at the lowest maternal education level. Hispanic infants born at 23 and 24 weeks' gestation had lower IMR than White infants across all education levels. At 36 to 40 weeks' gestation, Hispanic infants also had lower IMR except at the highest education level. The association of maternal educational attainment on GA-specific IMR among late preterm and term infants differs by race and ethnicity. Disparities in IMR persist among Black infants despite educational attainment, while Hispanic infants had lower IMR at lower levels of educational attainment compared with White infants.