HLTH 5043 Module 1 Health Disparity Documentation Example

Twelve Versus Five per Thousand: Measuring the Racial Gap in Infant Deaths in One County With Current and Pooled Data

Student Name

American College of Education

HLTH5043: Evaluation of Determinants of Health

Module 1 Assignment

Instructor Name

October 5, 2026

The Disparity and Why It Matters

Infant mortality, the death of a baby before its first birthday, is one of the oldest measures of a community's health because it reflects the health of mothers, the quality of care, and the conditions in which families live. It is also one of the starkest measures of inequality in the United States. In 2022, the national infant mortality rate was 5.6 deaths per 1,000 live births, but it was 10.9 for babies born to non-Hispanic Black mothers, compared with 4.5 for non-Hispanic White mothers and 4.9 for Hispanic mothers (Centers for Disease Control and Prevention [CDC], 2024). A Black infant in the United States was about 2.4 times as likely as a White infant to die before age one, and the ratio has changed little in decades.

This paper documents the same disparity in a composite Midwestern county of about 640,000 people, using local vital records, and sets out the measures the county health department should use to track it. Later modules will examine its causes and a program to reduce it.

Data and Methods

The county's data come from the state's linked birth and infant death files, which connect each infant death to the infant's birth certificate so that deaths can be attributed to the mother's race and ethnicity as recorded at birth. Because a single year produces small numbers of infant deaths, and small numbers produce unstable rates, the analysis pools three years, 2021 through 2023. Rates are expressed per 1,000 live births, with 95% confidence intervals calculated from the Poisson distribution, which is appropriate for counts of rare events. The disparity is described with both a rate ratio, which shows relative inequality, and a rate difference, which shows its absolute size and allows an estimate of excess deaths.

The County's Rates

From 2021 through 2023, there were 4,860 live births to non-Hispanic Black mothers in the county and 60 infant deaths, a rate of 12.3 per 1,000, with a 95% confidence interval of 9.2 to 15.5. Births to non-Hispanic White mothers numbered 9,420, and 43 of those babies died, or 4.6 deaths for every 1,000 births, with an interval of 3.2 to 5.9. Births to Hispanic mothers numbered 3,150, with 16 deaths, a rate of 5.1 and a wide interval of 2.6 to 7.6.

The Black-White rate ratio is 2.7, with a confidence interval of about 1.8 to 4.0, somewhat larger than the national ratio. The rate difference is 7.8 deaths per 1,000 births. Applied to the 4,860 births to Black mothers, that difference means roughly 38 Black infants died over three years who would have lived had their risk been the same as White infants in the county. Behind a ratio of 2.7 are about a dozen families a year in one county whose babies did not reach their first birthday.

When and Why Infants Died

Timing gives the first clue to causes. Of the 60 deaths among Black infants, 38 occurred in the neonatal period, the first 27 days of life, and 22 in the postneonatal period from 28 days to one year. Among White infants, the split was 27 and 16. Neonatal deaths are dominated by preterm birth, low birth weight and complications of pregnancy and delivery; postneonatal deaths are more often linked to sudden unexpected infant death, infections and injuries, and so to conditions in the home and community.

Causes point the same way. Among Black infants, 21 deaths were attributed to disorders related to short gestation and low birth weight, 12 to sudden unexpected infant death, 9 to congenital anomalies, 7 to maternal complications, 4 to injuries and 7 to other causes. Among White infants, congenital anomalies were the leading cause, with 12 deaths, followed by preterm-related causes with 8 and sudden unexpected infant death with 7. The largest absolute gap is in preterm and low birth weight deaths, the same pattern national research has found; a consensus review of the Black-White disparity in preterm birth concluded that no single downstream or midstream factor explains it (Braveman et al., 2021).

What the Data Rule Out

Documenting a disparity well also means testing easy explanations. One common assumption is that the gap reflects differences in education or income alone. A classic national study found that even among infants of college-educated parents, the mortality rate was 10.2 per 1,000 for Black infants and 5.4 for White infants, and that the excess was explained by higher rates of low birth weight among Black infants (Schoendorf et al., 1992). In the county data, stratifying by the mother's education shows the same pattern: Black mothers with a bachelor's degree had a higher infant mortality rate than White mothers without a high school diploma, although the small numbers make that comparison imprecise. Socioeconomic position matters, but it does not account for the disparity by itself, which is why the next module must look further.

Limits of the Data

The figures carry limits that should travel with them. Race and ethnicity on the birth certificate are usually reported by the mother, which is the preferred approach, but they are sometimes filled in by hospital staff, and multiracial mothers may be classified in different ways over time. The linked files depend on matching death records to birth records; a small share of infant deaths, often among babies born in another county or state, cannot be linked and are missing from these counts. Cause of death on death certificates varies in quality, particularly for sudden unexpected infant deaths, where the distinction between sudden infant death syndrome, accidental suffocation and undetermined causes depends on how thoroughly the death scene and autopsy were investigated. Even with three pooled years, the number of deaths among Hispanic infants is too small for firm conclusions, as the wide confidence interval shows. None of these limits comes close to accounting for a disparity this wide, but they mean the county's cause-specific numbers should be read as approximate and compared with state and national patterns before being used to set priorities.

Tracking the Disparity

The health department should adopt four measures to track the disparity each year. It should report three-year rolling infant mortality rates by race and ethnicity with confidence intervals, so that random year-to-year swings are not mistaken for real change. It should report both the rate ratio and the rate difference, because a falling ratio can hide a rising absolute gap if overall rates rise. It should report preterm birth and low birth weight rates by race and ethnicity annually, since these respond sooner than infant mortality and account for much of the gap. And it should map infant deaths by neighborhood, since county-wide averages can hide concentrated risk. Each measure should be published in a short annual brief shared with community partners, not only with the board.

References

Braveman, P., Dominguez, T. P., Burke, W., Dolan, S. M., Stevenson, D. K., Jackson, F. M., Collins, J. W., Driscoll, D. A., Haley, T., Acker, J., Shaw, G. M., McCabe, E. R. B., Hay, W. W., Thornburg, K., Acevedo-Garcia, D., Cordero, J. F., Wise, P. H., Legaz, G., Rashied-Henry, K., ... Waddell, L. (2021). Explaining the Black-White disparity in preterm birth: A consensus statement from a multi-disciplinary scientific work group convened by the March of Dimes. Frontiers in Reproductive Health, 3, Article 684207. https://doi.org/10.3389/frph.2021.684207

Centers for Disease Control and Prevention. (2024, September 16). Infant mortality. https://www.cdc.gov/maternal-infant-health/infant-mortality/index.html

Schoendorf, K. C., Hogue, C. J. R., Kleinman, J. C., & Rowley, D. (1992). Mortality among infants of Black as compared with White college-educated parents. New England Journal of Medicine, 326(23), 1522-1526. https://doi.org/10.1056/NEJM199206043262303