627 - The Association Between Maternal Race/Ethnicity and Education Level with Infant Mortality Rates By Gestational Age

Poster Number: 627
Publication Number: 627.141

Justina C. Goldman, UAB Heersink School of Medicine, Hoover, AL, United States; Mykaela J. Watt, University of Alabama School of Medicine, Tuscaloosa, AL, United States; Gracie Trulove, University of Alabama School of Medicine, Birmingham, AL, United States; Rachel Tindal, University of Alabama School of Medicine, San Antonio, TX, United States; Vivek Shukla, University of Alabama at Birmingham, Birmingham, AL, United States; Waldemar A. Carlo, University of Alabama School of Medicine, Birmingham, AL, United States; Colm P. Travers, University of Alabama School of Medicine, Birmingham, AL, United States

Background: Infant mortality rate (IMR) is an important indicator of the overall health of a population. Maternal education is associated with lower IMR. There is a difference in IMR when Black and Hispanic Infants are compared to White Infants.

Objective: This study aimed to determine if maternal educational attainment is associated with decreased racial/ethnic disparities in gestational age-specific IMR. We hypothesized that Black infants would have higher gestational age-specific IMR compared with White infants at each maternal education level from 27-41 weeks’ gestation.

Design/Methods: This ecological study used data from the Centers for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database 2017-2019. We included hospital-born infants from 22 to 41 weeks of gestational age. We excluded infants with major congenital anomalies and infants who died due to congenital anomalies. For each gestational age, we compared IMR by maternal race/ethnicity (Non-Hispanic Black, Hispanic, or Non-Hispanic White) and maternal education level (12th grade or less with no diploma, high school graduate or diploma, some college credit but no degree, or associate degree/bachelor’s degree/master’s degree/doctorate). We calculated the relative risk with 95% confidence intervals, using White infants as the reference group, and considered a p < 0.05 as statistically significant.

Results: There were 9,356,130 infants born during the study period; 1,504,230 (16.1%) Black infants; 2,406,327 (25.7%) Hispanic infants; and 5,445,573 (58.2%) White infants. Black infants born at 23 and 24 weeks’ gestation had lower IMR at all maternal education levels than White infants (Table 1, Figure 1). Black infants from 36 to 40 weeks’ gestation had a higher IMR at all education levels except at the lowest maternal education level. Hispanic infants born at 23 and 24 weeks’ gestation had a lower risk of IMR than White infants across all levels of education (Table 1, Figure 1). At higher gestational ages from 36 to 40 weeks’, Hispanic infants also had lower IMR but not at the highest education level, where there were no differences in IMR between groups.

Conclusion(s): This study using population-based data suggests that disparities in the risk of gestational age-specific IMR among late preterm and term Black infants compared with White infants persist despite educational attainment. Hispanic infants have a lower risk of IMR at many gestational ages except at the highest levels of educational attainment, consistent with the Hispanic paradox.