Trend and racial disparities in infant mortality rate in Texas from 1990 to 2004.
OBJECTIVE
To determine the trend and disparities in infant mortality rate (IMR) from 1990 to 2004 in Texas, which is one of the few states with severe physician shortage in the United States.


METHODS
Trend analysis and Poisson regression were performed with data from Texas Department of State for Health Services and other Web sites.


RESULTS
IMR decreased from 1990 to 2000 followed by a trend of increase from 2000 to 2004 in Texas. The recent trend of increase in IMR was observed in all ethnic groups. IMR was associated with ethnicity, area of residence in Texas (rural vs urban areas in east vs south vs west), median income index, and primary care physician supply (primary care physician to population ratio). IMR in blacks was more than 2 times that of other ethnic groups, and the gap had been increasing since 1997. The recent increasing trend in IMR coincided with a decreasing trend in primary care physician supply and a decrease or a slower increase in median income index.


CONCLUSIONS
IMR increased in recent years, particularly in African Americans in Texas. Measures should be taken to reverse the worsening trend in IMR and to reduce regional and racial disparities.
Gong
Gordon
G
The F. Marie Hall Institute for Rural Community Health, Texas Tech University Health Science Center, Box 45013 Stop 5013, Lubbock, TX 79430, USA. gordon.gong@ttuhsc.edu
Braddock
Erin
E
Zhang
Yan
Y
Hudson
Catherine
C
Lefforge
David
D
O'Bryant
Sid
S
D054624:Health Status Disparities; D006801:Humans; D007182:Income; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology* / Q000639:trends*; D010821:Physicians, Family; D016012:Poisson Distribution; D013781:Texas / Q000453:epidemiology; D013997:Time Factors