Differential Survival: Do Racial And Socioeconomic Disparities Persist Beyond "Poor Birth Outcomes"?
BACKGROUND: In Kalamazoo County, significant racial and socioeconomic disparities are evident in infant mortality rates. The greater prevalence of poor birth outcomes (PBO) (prematurity, low birthweight, small for gestational age) among infants of color and poor infants is a significant contributor. It is unknown, however, whether these disparities continue to impact the survival of PBO infants.
OBJECTIVE: To examine whether there are racial or socioeconomic differences in the one-year-survival of PBO infants, controlling for other health contributors.
METHODS: This was a secondary analysis study utilizing county birth and death records from 2008-2015 of 21,633 deliveries. Generalized estimating equation was used to assess predictive relationship between demographics and mortality outcomes, accounting for repeated mother births.
RESULTS: Overall, 4528/21,633 deliveries (20.9%) resulted in a PBO. Substantial racial and socioeconomic disparities were seen in the PBO prevalence: 30.3% for infants of color versus 17.9% of white infants (p<.001), and 25.6% for Medicaid infants versus 16.5% for privately-insured infants (p<.001). Among PBO infants, death is a relatively rare event: 115 of 4528 (2.5%) died before their first birthday. Neither race nor socioeconomic status was a significant predictor of infant: race aOR 0.95, CI 0.59 & 1.52, and socioeconomic aOR 0.99, CI 0.524 & 1.88. Factors that were significantly associated with mortality included prenatal care level, history of poor birth outcomes, maternal chronic disease condition, and maternal prenatal weight gain.
CONCLUSION: Although racial and socioeconomic disparities are present in the likelihood of a poor birth outcome, these disparities do not persist beyond that.