Racial differences in post‐neonatal mortality in Chicago: What risk factors explain the black infant's disadvantage?

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Abstract
Objectives. To investigate the extent to which the place of residence affects the black to white differential in post‐neonatal (28–365 days) mortality, we performed a univariate analysis and multivariate logistic regression of the 1982–1983 Illinois vital records, Chicago Police violent crime information and 1980 US Census income data. Methods. Four environmental predictors of post‐neonatal death were examined: a median family income of < $10 000 per year, a poverty prevalence of > 50%, violent crime rates of > 11/1000 and limited community access to primary medical care based on physician supply ratios. Results. The post‐neonatal mortality rate of black (n = 50 765) infants was three times that of white (n = 50 690) infants: 10/1000 versus 3/1000, respectively. Thirty‐six percent of the white infants had none of the environmental risk factors, whereas only 13% of the black infants had none of the risk factors. For black infants, the presence of any one factor was associated with a slightly increased risk of post‐neonatal mortality (9/1000 as compared to 7/1000 with no risk factors), whereas the presence of two or more risk factors was associated with a higher risk (11/1000). When the number of these environmental risk factors were taken into account, the OR for black infants declined from 3.0 (95% CI 2.5–3.6) to 1.7 (95% Cl 1.5–1.9). When the differences in maternal age, education, marital status and infant birth weight were also taken into account the odds ratio of post‐neonatal death for blacks was 1.5 (95% CI 1.3–1.7). Conclusions. We conclude that a substantial proportion of the black to white difference in post‐neonatal mortality is associated with specific environmental conditions.

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