California Infant Mortality Rate Declining But Wide Disparities Persist Interview with:

Anura Ratnasiri PhD Senior Research Scientist (Epidemiology and Biostatistics) Benefits Division Department of Health Care Services Sacramento, CA 95899-7417

Dr. Ratnasiri

Anura Ratnasiri PhD
Senior Research Scientist
(Epidemiology and Biostatistics) Benefits Division
Department of Health Care Services
Sacramento, CA 95899-7417 What is the background for this study?

Response: Infant mortality rate (IMR) is a widely-reported indicator of population health and is used as a standardized measurement of deaths in the first year of life per thousand live births. While IMR has been steadily declining in the United States, it remains relatively high compared with other developed countries.

Even though significant improvements have been made in the quality and access to neonatal and infant care during the past decade, large educational, socioeconomic, racial, ethnic, geographic and behavioral disparities persist, and appear to be responsible for significant differences in IMR among different subgroups. Certain maternal and infant characteristics have important associations with IMR, and this study attempted to quantify major maternal and infant predictors, and trace associated mortality trends during the study period.

There were no recent studies on infant mortality using a large data set such as California State. Moreover, gestational age based on obstetric estimates from fetal ultrasound, prepregnancy obesity, and smoking during pregnancy were not available in prior population-based studies in California. What are the main findings?

Response: The infant mortality rate (IMR) for singleton births decreased significantly from 4.68 in 2007 to 3.90 (per 1,000 live births) in 2015. However, significant disparities in IMR were uncovered in different population groups depending upon maternal sociodemographic, economic, racial and ethnic, and other maternal characteristics during pregnancy. Children of African American mothers had almost twice the risk of infant mortality when compared with children of White mothers. Infants of women with Bachelor’s degrees or higher were 89% less likely to die when compared to infants of women with educational attainment less than high school. Infants of maternal smokers were 75% more likely to die than infants of nonsmokers. Infants of women who were overweight and obese during pregnancy accounted for 55% of all infant mortality. More than half of the infant deaths were to children of women with lower socioeconomic status; infants of WIC participants were 59% more likely to die than infants of non-WIC participants. With respect to infant predictors, infants born preterm or low birth weight were more than four times and almost six times more likely to die than infants who had normal births, respectively, once controlling for all the study covariates. What should readers take away from your report?

Response: While the overall infant mortality rate in California is declining, wide disparities persist in different groups, and these disparities are increasing. Our data indicate that maternal sociodemographic and economic factors, as well as maternal prepregnancy obesity and smoking during pregnancy, have a prominent effect on infant mortality rate, though no causality can be inferred with the current data. These predictors are not typically addressed by direct medical care. The highest valued interventions to reduce IMR may be social and public health initiatives that mitigate disparities in sociodemographic, economic and behavioral risks for mothers. There are preventable morbidities. What recommendations do you have for future research as a result of this work?

Response: Future research should explore reducing race/ethnic disparities while using education as a tool. There may be a role for health education to encourage women to stay in school and improve their employment opportunities while advancing both their education and biological maturity. These healthier behaviors and attitudes have been shown to be passed on to future offspring, which may then benefit society. This would be a better solution to minimize teen pregnancies which is a risk factor for infant mortality.

The leading cause of neonatal deaths (occurring in the first month) is prematurity while the leading cause of postneonatal deaths is sudden infant death syndrome (SIDS). These deaths are more common among African Americans. Educational and health interventions focused on supporting racial and ethnic minorities may further reduce disparities in IMR. Is there anything else you would like to add?

Response: I have no financial interests to disclose.

Thank you for your interest in this paper and the topic!

Views expressed in this article do not necessarily reflect the official policies of the California Department of Health Care Services.


Ratnasiri, Anura & Lakshminrusimha, Satyan & Dieckmann, Ronald & Lee, Henry & Gould, Jeffrey & Parry, Steven & Arief, Vivi & Delacy, I. & DiLibero, Ralph & Basford, K.. (2020). Maternal and infant predictors of infant mortality in California, 2007–2015. PLOS ONE. 15. e0236877. 10.1371/journal.pone.0236877.

Aug 19, 2020 @ 12:10 pm

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