Birthweight‐Specific Mortality: Important Inequalities Remain*

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Abstract
Optimal birthweight‐specific neonatal mortality has not yet been achieved in the United States, particularly in rural states. A comparison of 1983 data from Massachusetts, an urban state with low infant mortality, and South Carolina, a rural state with a higher infant mortality rate, shows that, for whites, two‐thirds of the difference in infant mortality between the two states is due to differences in birthweight‐specific mortality. For blacks, all of the difference in infant mortality is due to the difference in birthweight‐specific mortality. Birthweight‐specific mortality rates are lower in Massachusetts than in South Carolina across the birthweight spectrum generally for both races. It is likely that some portion of these differences are due to the urban‐rural difference between the states, compounded by the difference in poverty rates. The birthweight‐specific mortality difference, particularly at higher birthweights, indicates that outcomes in South Carolina could be improved with better access to perinatal care and the more aggressive follow‐up of high‐risk babies who do not require neonatal intensive care unit (NICU) services. This study suggests that, while efforts to improve the birthweight distribution should certainly be pursued, we should also work to complete the improvement of birthweight‐specific mortality in rural states.