title: Differences in neonatal mortality by race, income, and prenatal care.
abstract: To determine the extent to which the social and physical environment affects the association between prenatal care and black pregnancy outcome in Chicago, we performed a stratified analysis of 1982-1983 Illinois vital records and 1980 United States census income data. Median family income of the mother's census tract was used as the ecologic variable. In very-low-income census tracts (less than $10,000 per year), 40% of blacks and 47% of whites received adequate prenatal care. There was no racial disparity in the percentage of low-birth-weight infants attributed to inadequate prenatal care among poor mothers. For mothers who resided in moderate-income areas ($20,001 to $30,000 per year), 50% of blacks and 67% of whites received adequate prenatal care. Although adequate (compared to inadequate) prenatal care was associated with improved birthweight distribution independent of community income, only in moderate-income areas was it related to black neonatal survival. For term black infants who received adequate prenatal care, residence in impoverished areas was associated with a nearly fourfold greater neonatal mortality rate (deaths per 1000 live births): 5/1000 vs 1/1000; RR = 3.8 (1.3-11.0). We conclude that place of residence is an important risk factor for black neonatal mortality.
authors.affiliation: Division of Neonatology, Children's Memorial Hospital, Chicago, Illinois 60614.
authors.forename: J W
authors.initials: JW
authors.lastname: Collins
authors.forename: R J
authors.initials: RJ
authors.lastname: David
mesh_terms: D001741:Black or African American; D001719:Birth Certificates; D002641:Chicago / Q000453:epidemiology; D003644:Death Certificates; D003710:Demography; D004522:Educational Status; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011159:Population Surveillance; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D015996:Survival Rate; D044465:White People