African-American:White Disparity in Infant Mortality due to Congenital Heart Disease.
To determine the importance of infant factors, maternal prenatal care use, and demographic characteristics in explaining the racial disparity in infant (age <365 days) mortality due to congenital heart defects (CHD).



In this cross-sectional population-based study, stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files of term infants with non-Hispanic white (n = 3 684 569) and African-American (n = 782 452) US-born mothers. Infant mortality rate, including its neonatal (<28 day) and postneonatal (28-364 day) components, due to CHD was the outcome measured.



The infant mortality rate due to CHD for African-American infants (296 deaths; 3.78 per 10 000 live births) exceeded that of white infants (1025 deaths; 2.78 per 10 000 live births) (relative risk [RR], 1.36; 95% CI, 1.20-1.55). The racial disparity was wider in the postneonatal period (2.08 per 10 000 vs 1.42 per 10 000; RR, 1.53; 95% CI, 1.29-1.83) compared with the neonatal period (1.70 per 10 000 vs 1.44 per 10 000; RR, 1.20; 95% CI, 0.99-1.45). Compared with white mothers, African-American mothers had a higher percentage of high-risk characteristics. In multivariable logistic regression models, the adjusted OR of postneonatal and neonatal mortality due to CHD for African-American mothers compared with white mothers was 1.20 (95% CI, 0.98-1.48) and 0.95 (95% CI, 0.77-1.19), respectively.



The racial disparity in infant mortality rate due to CHD among term infants with US-born mothers is driven predominately by the postneonatal survival disadvantage of African-American infants. Commonly cited individual-level risk factors partly explain this phenomenon. The study is limited by the lack of information on neighborhood factors.
Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: jcollins@northwestern.edu.
James W
JW
Collins
Division of Critical Care Medicine, University of California San Francisco, Benioff Children's Hospital Oakland, Oakland, CA.
Gayle
G
Soskolne
Department of Epidemiology, University of Illinois School of Public Health, Chicago, IL.
Kristin M
KM
Rankin
Department of Epidemiology, University of Illinois School of Public Health, Chicago, IL.
Alexandra
A
Ibrahim
Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Nana
N
Matoba
D001741:Black or African American / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006330:Heart Defects, Congenital / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D044465:White People / Q000706:statistics & numerical data
neonatal mortality; postneonatal mortality