Ethnic Differences in Causes of Infant Mortality: Texas Birth, 1989 through 1991

The mortality rate of African-American infants in Texas is about twice those of Anglo and Hispanic infants, due at least partly to their increased risk of preterm and low-weight birth. We examined the underlying causes of infant deaths from 1989 through 1991 for specific causes that accounted for the racial difference and for those that were associated with those adverse pregnancy outcomes. The overall infant mortality rate was 8.27 per 1000 live births (6.80 for Anglo, 7.72 for Hispanic, and 15.32 for African-American infants). About 37% of all infant deaths (but 48% of African-American deaths) were associated with adverse pregnancy outcomes; excluding these deaths reduced the overall rate to 5.20 per 1000 (4.59 for Anglo, 5.03 for Hispanic, and 8.05 for African-American infants). Accordingly, reducing adverse pregnancy outcomes in African-American women will reduce but not resolve the discrepancy in racial infant mortality rates. Infant mortality rates for 30 of the top 59 causes of death were at least 1.5 times higher in African-American than in Anglo and Hispanic infants, while a comparable excess in Hispanic infants was noted only for anencephaly; Anglo infants did not have an excessive mortality rate for any of the 59 causes. Reduction of the racial infant mortality rate discrepancy in Texas will require clarification and correction of factors that place pregnancies of African-American women at increased risk for adverse pregnancy outcomes and those that place their infants at increased risk for death from a wide range of causes