50-Year Trends and State Variation in Socioeconomic and Racial/Ethnic Inequalities in U.S. Infant Death Rates, 1960 to 2010

• Activity Number: 38
• Type: Contributed
• Date/Time: Sunday, August 9, 2015 : 2:00 PM to 3:50 PM
• Sponsor: Biometrics Section
• Author(s): Yuen Yi Lee* and Jarvis Chen and Brent Coull and Linda Valeri and Nakul Singh and Sofia Gruskin and Jason Beckfield and Nancy Krieger
• Companies: University of Technology, Sydney and Harvard University and Harvard University and Harvard University and Harvard University and Harvard University and Harvard University and Harvard University
• Keywords: Infant mortality ; Socioeconomic and racial/ethnic inequalities ; Temporal trend ; State variation

Abstract

The US infant death rate is among the highest in wealthy countries and exhibits substantial state-level variation. Using county infant mortality data and Bayesian multilevel Poisson log-linear regression models, we examined black-white inequities in infant death rates, overall and by state, from 1960 to 2010 (~2.5 million infant deaths; 189 million person-years at risk < 1 year old), with adjustment for county income and state gross domestic product. Annual infant death rates per 1000 fell for both groups (black infants: from 46 to 11; white infants: 24 to 5), and after adjustment for socioeconomic measures, the black-white rate difference decreased from 25 (95% confidence interval (CI) 23, 28) in 1960 to 6 (95% CI 6, 7) in 2010, while the rate ratio remained consistent at ~2, with a peak of 2.4 (95% CI 2.3, 2.6) in 1989. State variation in black-white rate differences was substantial in 1960 (-15 to 73), and has persisted, although noticeably reduced by 2010 (-1 to 13). Analyzing US state variation in racial/ethnic inequalities in infant death rates underscores their modifiability and potentially helps identify and prioritize strategies to ameliorate these inequities.