The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58097

Dyan Simon, MD¹, Aimee Drolet, PhD², and James W. Collins, MD, MPH¹. (1) Pediatrics/Neonatology, Northwestern University/Children's Memorial Hospital, 2300 Children's Plaza, Box 45, Chicago, IL 60614, 773-880-4142, d-simon@northwestern.edu, (2) The Anderson School, UCLA, Box 951481, B406 Gold Hall, Los Angeles, CA 90095-1481

Objective. To determine the extent to which infant birth weight and residential environment account for the racial disparity in preventable postneonatal mortality rates (day 28-365 deaths due to SIDS, injuries, infections; PNMR) of urban infants.

Methods. We analyzed a linked dataset of 1992-1995 Illinois vital records, 1990 US census income data, and 1995 Chicago public health information. Chicago neighborhoods with 1 or more ecologic factors (low median family income, high rates of unemployment, homicide and lead poisoning) were classified as impoverished.

Results. In Chicago, African-Americans (N=104,626, AA) had nearly a three-fold greater PNMR than whites (N=52,940): 7.5/1,000 vs.2.7/1,000, RR= 2.8 (2.3-3.3). In non-impoverished neighborhoods, the preventable PNMR of very low birth weight (<1500g, VLBW) AA infants approximated that of VLBW white infants: 47/1,000 vs.45/1,000, RR= 1.0 (0.6-1.8). Most striking, the preventable PNMR of non-low birth weight (>2500g, non-LBW) AA infants exceeded that of non-LBW white infants in both impoverished and non-impoverished neighborhoods: 5.6/1,000 vs. 2.6/1,000, RR= 2.1 (1.2-3.9); and 4.3/1,000 vs. 1.9/1,000, RR= 2.2 (1.7-3.7), respectively. In non-impoverished neighborhoods, the population attributable risk of VLBW for preventable PNM equaled 23% for AA and 18% for whites.

Conclusions. We conclude that 1) the racial disparity in preventable PNMR widens as infant birth weight increases and neighborhood poverty abates; and 2) non-impoverished AA (compared to whites) have a slightly greater percentage of preventable postneonatal deaths attributable to VLBW.

Learning Objectives:

• To understand that the racial disparity in preventable postneonatal mortatlity rates persists among non-LBW infants
• To understand that the racial disparity in preventable postneonatal moratality rates persists among non-impoverished infants
• To understand that Mexican-Americans have a lower preventable postneonatal mortality than African-Americans indenpendent of infant birth weight and urban impoverishment

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.