Abstract
Objective
This study aimed to determine if maternal educational attainment is associated with
racial/ethnic disparities in gestational age (GA)-specific infant mortality rate (IMR).
Study Design
Cohort study using data from the Centers for Disease Control and Prevention (CDC)
WONDER expanded linked birth and infant death records database, 2017 to 2019. We included
hospital-born infants from 22 to 41 weeks' gestation without major congenital anomalies.
We compared GA-specific IMR by maternal race/ethnicity (Black, Hispanic, or White)
and maternal education level.
Results
There were 9,356,130 eligible infants during the study period; 16.1% Black, 25.7%
Hispanic, and 58.2% White. Black infants born at 23 and 24 weeks' gestation had lower
IMR at all maternal education levels than White infants. Black infants from 36 to
40 weeks' gestation had higher IMR except at the lowest maternal education level.
Hispanic infants born at 23 and 24 weeks' gestation had lower IMR than White infants
across all education levels. At 36 to 40 weeks' gestation, Hispanic infants also had
lower IMR except at the highest education level.
Conclusion
The association of maternal educational attainment on GA-specific IMR among late preterm
and term infants differs by race and ethnicity. Disparities in IMR persist among Black
infants despite educational attainment, while Hispanic infants had lower IMR at lower
levels of educational attainment compared with White infants.
Key Points
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The protective effect of maternal education on infant outcomes may vary by race/ethnicity.
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Black late preterm and term infants have higher GA-specific IMRs than White infants,
even with similar education levels.
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Hispanic late preterm and term infants show lower mortality rates than White infants
at lower education levels.
Keywords
infant - ethnicity - gestational age - infant mortality - educational status
