Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.
Advertisement
Journal of Perinatology (2023)
4
Metrics details
Racial disparity exists in U.S. neonatal mortality; Black, non-Hispanic neonates are at higher risk of death. We aim to examine overall and race-specific neonatal mortality within the Military Health System (MHS).
Retrospective cohort study of infants delivered within the MHS between 2013–2015. Variables were extracted from the Military Health System Data Repository.
There were 320,283 live births within the MHS from 2013–2015; 588 neonates died, a death rate of 1.84/1000. Cohort neonatal mortality and incidence of preterm delivery (7.2%) were lower than concurrent U.S. statistics. Black, non-Hispanic neonates had a 2-fold increased risk of death (OR: 2.11; 95% CI 1.73–2.56, p < 0.001) over White, non-Hispanic neonates. Officer versus enlisted rank conferred no difference in neonatal mortality (OR: 0.88; 95% CI 0.74–1.03).
Neonatal mortality within the MHS is lower than in the U.S. Despite universal insurance coverage and access to care, racial disparity persists. Risk of death is not modified by socioeconomic status. These findings highlight the need for critical examination of healthcare equity within neonatal-perinatal medicine.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
118,99 €
only 9,92 € per issue
Tax calculation will be finalised during checkout.
Buy article
Get time limited or full article access on ReadCube.
$32.00
All prices are NET prices.
Available upon request
Ely DM, Driscoll AK. Infant mortality in the United States, 2017: Data from the period linked birth/infant death file. Natl Vital- Stat Rep. 2019;68:1–20.
Google Scholar
UNICEF, UNICEF Global Databases; Child mortality estimates: Country-specific neonatal mortality rate. Available at https://data.unicef.org/topic/child-survival/neonatal-mortality/, accessed September, 2022.
Govande V, Ballard AR, Koneru M, Beeram M. Trends in the neonatal mortality rate in the last decade with respect to demographic factors and health care resources. Bayl Univ Med Cent Proc. 2015;28:304–6.
Article Google Scholar
Matthews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital- Stat Rep. 2015;64:1–30.
CAS Google Scholar
Euro-Peristat Project. European Perinatal Health Report. Core indicators of the health and care of pregnant women and babies in Europe in 2015. November 2018. Available at www.europeristat.com
MacDorman MF, Mathews TJ. Behind international rankings of infant mortality: how the United States compares with Europe. NCHS Data Brief. 2009;23:1–8.
Google Scholar
Mathews TJ, Driscoll AK. Trends in infant mortality in the United States, 2005-2014. NCHS Data Brief. 2017;279:1–8.
Google Scholar
Grobman WA, Parker CB, Willinger M, Wing DA, Silver RM, Wapner RJ, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network*. Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress. Obstet Gynecol. 2018;131:328–35.
Article Google Scholar
Wallace ME, Mendola P, Kim SS, Epps N, Chen Z, Smarr M, et al. Racial/ethnic differences in preterm perinatal outcomes. Am J Obstet Gynecol. 2017;216:306.e1–306.
Article Google Scholar
He X, Akil L, Aker WG, Hwang HM, Ahmad HA. Trends in infant mortality in the United States: a brief study of the Southeastern states from 2005-2009. Int J Enivorn Res Public Health. 2015;12:4908–20.
Article Google Scholar
Elder TE, Goddeeris JH, Haider SJ. Racial and ethnic infant mortality gaps and the role of socio-economic status. Labour Econ. 2016;43:42–54.
Article Google Scholar
Matoba N, Collins JW Jr. Racial disparity in infant mortality. Semin Perinatol. 2017;41:354–9.
Article Google Scholar
Owens-Young J, Bell CN. Structural racial inequities in socioeconomic status, urban-rural classification and infant mortality in US counties. Ethn Dis. 2020;30:389–98.
Article Google Scholar
DHA. (2022). Patient Care Numbers for the Military Health System. Defense Health Agency. Available at https://www.health.mil/Military-Health-Topics/MHS-Toolkits/Media-Resources/Media-Center/Patient-Care-Numbers-for-the-MHS, accessed September, 2022.
DHA. (2021). Evaluation of the TRICARE Program: Fiscal Year 2021 Report to Congress. Access, Cost, and Quality Data through Fiscal Year 2020. Washington, DC: Defense Health Agency. Available at https://www.health.mil/I-Am-A/Media/Media-Center/MHS-Health-Facilities, accessed September, 2022.
GAO. (2016). Availability and quality measurement of women’s health care services in US Military Hospitals. (GAO-16-596). U.S. GAO. Available at https://www.gao.gov/assets/gao-16-596.pdf, accessed September, 2022.
Engelhardt K, Hisle-Gorman E, Gorman GH, Dobson NR. Lower preterm birth rates but persistent racial disparities in an open-access health care system. Mil Med. 2018;183:e570–e575.
Article Google Scholar
Rawlings JS, Weir MR. Race- and rank-specific infant mortality in a US military population. Am J Dis Child. 1992;146:313–6.
CAS Google Scholar
Alexander GR, Baruffi G, Mor JM, Kieffer EC, Hulsey TC. Multiethnic variations in the pregnancy outcomes of military dependents. Am J Public Health. 1993;83:1721–5.
Article CAS Google Scholar
Stahlman S, Witkop CT, Clark LL, Taubman SB. Pregnancies and live births, active component service women, U.S. Armed Forces, 2012-2016. MSMR 2017;24:2–9.
Google Scholar
Office of the Secretary of Defense. Maternal and infant mortality rates in the military health system. 2019. Requested by: Conference Report 115-874, Page 861 to Accompany the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Public Law 115-232).
Thakrar AP, Forrest AD, Maltenfort MG, Forrest CB. Child mortality in the US and 19 OECD comparator nations: A 50-year time-trend analysis. Health Aff (Millwood). 2018;37:140–9.
Article Google Scholar
MacDorman MF, Matthews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. Natl Vital- Stat Rep. 2014;63:1–6.
Google Scholar
Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA. The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol. 2002;186:1011–6.
Article Google Scholar
Bhatt CB, Beck-Sagué CM. Medicaid expansion and infant mortality in the United States. Am J Public Health. 2018;108:565–7.
Article Google Scholar
Morriss FH Jr. Increased risk of death among uninsured neonates. Health Serv Res. 2013;48:1232–55.
Article Google Scholar
Debiec KE, Paul KJ, Mitchell CM, Hitti JE. Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol. 2010;203:122.e1–6.
Article Google Scholar
Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA. The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol. 2002;187:1254–7.
Article Google Scholar
Partridge S, Balayla J, Holcroft CA, Abenhaim HA. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years. Am J Perinatol. 2012;29:787–93.
Article Google Scholar
Singh GK, Yu SM. Infant Mortality in the United States, 1915-2017: Large social inequalities have persisted for over a century. Int J MCH AIDS. 2019;8:19–31.
Article Google Scholar
Alexander GR, Wingate MS, Bader D, Kogan MD. The increasing racial disparity in infant mortality rates: composition and contributors to recent US trends. Am J Obstet Gynecol. 2008;198:51.e1–9.
Article Google Scholar
MacDorman MF, Mathews TJ. Understanding racial and ethnic disparities in U.S. infant mortality rates. NCHS Data Brief. 2011;74:1–8.
Google Scholar
Pabayo R, Cook DM, Harling G, Gunawan A, Rosenquist NA, Muennig P. State-level income inequality and mortality among infants born in the United States 2007-2010: A Cohort Study. BMC Public Health. 2019;19:1333.
Article Google Scholar
Braveman PA, Heck K, Egerter S, Marchi KS, Dominguez TP, Cubbin C, et al. The role of socioeconomic factors in Black-White disparities in preterm birth. Am J Public Health. 2015;105:694–702.
Article Google Scholar
Kothari CL, Paul R, Dormitorio B, Ospina F, James A, Lenz D, et al. The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community. SSM Popul Health. 2016;2:859–67.
Article Google Scholar
Colen CG, Geronimus AT, Bound J, James SA. Maternal upward socioeconomic mobility and black-white disparities in infant birthweight. Am J Public Health. 2006;96:2032–9.
Article Google Scholar
Montoya-Williams D, Fraiman YS, Pena MM, Burris HH, Pursley DM. Antiracism in the field of neonatology: A foundation and concrete approaches. Neoreviews. 2022;21:e1–e12.
Article Google Scholar
Haas DM, Parker CB, Marsh DJ, Grobman WA, Ehrenthal DB, Greenland P, et al. Association of adverse pregnancy outcomes with hypertension 2 to 7 Years Postpartum. J Am Heart Assoc. 2019;8:e013092.
Article Google Scholar
Manuck TA. Racial and ethnic differences in preterm birth: A complex, multifactorial problem. Semin Perinatol. 2017;41:511–8.
Article Google Scholar
Hall C, Romano CJ, Bukowinski AT, Gumbs GR, Dempsey KN, Poole AT, et al. Severe maternal morbidity among women in the U. S. military, 2003-2015. Am J Perinatol. 2021. https://doi.org/10.1055/s-0041-1740248. Epub ahead of print.
Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, et al. Explaining the Black-White disparity in preterm birth: A consensus statement from a multi-disciplinary scientific work group convened by the March of Dimes. Front Reprod Health. 2021;3:684207.
Article Google Scholar
Saluja B, Bryant Z. How Implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States. J Women’s Health (Larchmt). 2021;30:270–3.
Article Google Scholar
Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S–28S.
Article Google Scholar
Download references
N/A
Department of Pediatrics, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
Rasheda J. Vereen & Matthew Nestander
Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
Gayle Haischer-Rollo & Caitlin M. Drumm
Research Division, Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
James K. Aden
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
RJV designed the study, participated in analysis, contributed to manuscript creation and revision; MN participated in analysis, contributed to manuscript creation and revision; GHR designed the study, participated in analysis, contributed to manuscript creation and revision; JKA designed the study, performed statistical analysis, contributed to manuscript creation and revision; CMD designed the study, participated in analysis, contributed to manuscript creation and revision.
Correspondence to Caitlin M. Drumm.
The authors declare no competing interests.
The study was deemed exempt by the Brooke Army Medical Center Institutional Review Board (reference number C.2019.096n).
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Reprints and Permissions
Vereen, R.J., Nestander, M., Haischer-Rollo, G. et al. Neonatal mortality and disparities within the military health system. J Perinatol (2023). https://doi.org/10.1038/s41372-022-01598-w
Download citation
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41372-022-01598-w
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
Advertisement
© 2023 Springer Nature Limited
