Disparities/Minority Health

Advantage of high survival rates among low-weight black infants has waned over time

Black infants who are born with very low birth weights have puzzled researchers for some time because these children have lower mortality rates in their first month of life than white infants born at the same low weights. However, a new study finds that, over time, this reported advantage has actually shifted into a disparity for black infants in California.

Using State birth-weight data from 1989 to 2004 for black and white infants who weighed 3.3 pounds or less at birth, researchers found that about a quarter of all babies born with very low birth weights did not survive a month after birth. Although black babies had lower mortality rates in 1989 and 1990, this advantage disappeared after 1991. In fact, beginning in 2002 the mortality rate rose for black babies born with very low birth weights, but it decreased for white babies born at similarly low weights.

The authors suggest that the advantage black infants once had may have been eliminated once better access to high-quality prenatal care and therapeutic innovations, such as surfactant therapy to treat respiratory distress, became prevalent—technologies they may have less access to. This new disparity may also be a result of more black than white infants being born with extremely low birth weights (1.1 pounds or higher) or the economic downturn in California that resulted in high rates of uninsurance, which may have limited black mothers' access to prenatal care. The authors note that it is important to determine if this trend has continued since 2004. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00086).

See "From paradox to disparity: Trends in neonatal death in very low birth weight non-Hispanic black and white infants, 1989-2004," by Tim A. Bruckner, Ph.D., M.P.H., Katherine B. Saxton, M.P.H., Elizabeth Anderson, M.P.H., and others in the October 2009 The Journal of Pediatrics 155(4), pp. 482-487.

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