Public health

Researchers looking at disparity in infant mortality

UWF researches aim to find out why minority infants twice as likely to die before age 1 as white babies

Public domain photo.

In Escambia County, children born to minority parents are more than twice as likely as their white peers to die before their first birthday.

A team of researchers from the University of West Florida has launched a project to look at what influences this divide – which mirrors national trends. The project, funded by the Florida Department of Health, is one part of an effort called “Attack Infant Mortality,” or AIM Escambia.

It is important work in this community, where data from the Pensacola Metro Dashboard shows the difficulty children must overcome in terms of poverty and the impact it has on their educational prospects.

Healthy Start Coalition of Escambia County collects data about infant mortality and other factors related to the health status of a mother and baby. According to data they collected for 2014, three ZIP codes accounted for most of the infant deaths in the county.

Of the 30 infant deaths reported in Escambia County last year, 19 were in three ZIP codes — 32506, 32507 and 32514.

“It’s an issue of equal opportunity,” said Dr. Erica Jordan, an assistant professor of psychology at UWF who led the effort. “You can’t have equal opportunity if you’re already starting off with a significant disparity from the moment that you’re born.”

Researchers have noted such disparities for decades. Despite years of targeted interventions, though, the gap remains stubbornly wide – a fact Dr. John Lanza, a pediatrician who heads the Florida Department of Health in Escambia County, finds troubling.

“Every child deserves to live a full life,” Lanza said. “If there’s something that we don’t know right now that we need to know in order to keep those children alive, I want to find out what it is.”

Nationally, for every 1,000 infants born to white, American families in 2013, more than five died before their first birthday, according to the U.S. Department of Health and Human Services. For black families, the rate was more than twice as high.

The situation is no better for Escambia County families. From 2012 to 2014, 4.6 out of every 1,000 white infants born locally died before their first birthday, according to the Florida Department of Health. For black families, the rate was 13.1.

Lanza and his team, working in conjunction with the Escambia County Healthy Start Coalition, have spent two decades trying to answer this question, with limited success. A few years ago, they decided to analyze what they had learned.

“One of the things we found is that a black woman, regardless of where she lives in the state of Florida or her educational level or her income level, was always going to have an increased risk of a poor birth outcome,” Lanza said.

“In other words, it’s not all about the person moving,” Lanza said, though he added researchers have found moving can play a role. “It’s not all about the mother’s nutrition or the baby’s nutrition. It’s not all about underlying diseases. It’s not necessarily a physical, medical item I can identify or any item we had previously been able to identify.

“So I came to the conclusion that there was some other aspect we were missing, some social factor.”

Stress, discrimination could play role

Up until now, the work of AIM Escambia has focused mostly on encouraging young women to make healthier choices — things like quitting smoking, getting proper nutrition and exercise or taking folic acid — that can reduce their risk of losing a child.

Still, Jordan said such choices alone wouldn’t be enough to solve the problem. This summer Jordan and her team began a community-wide survey to document the experiences of Escambia County women in the early years of their life – long before they ever conceive a child.

“We’re really trying to paint a picture of life experiences in the preconception period for different groups of women in Escambia County,” Jordan said.

Their goal is to identify patterns in the data and, hopefully, suggest some answers as to why so many black babies are dying.

Researchers don’t know what picture the data will paint, but they have some hypotheses.

“There is a lot of research out there looking at stress and a concept called ‘weathering’ within the black female population, which deals with a summation of all these stressful factors a black woman has to deal with as opposed to a white woman in our society,” Lanza said.

Jordan said: “If you belong to a minority group, or if you belong to a group that has been traditionally disenfranchised, traditionally marginalized, kept from not only tangible health resources, but also sort of stigmatized and treated unfairly, this could present an additional layer of stress that can affect you from cradle to grave, (or) so the theory goes.”

Jordan said the idea that social forces can have a tangible effect on public health is not novel.

“More and more, this is being accepted,” Jordan said. “You have studies by the National Institute of Health that suggest stress, that suggest disenfranchised groups are differentially affected in terms of their health outcomes.”

Jordan now works at the University of Houston, but two of her colleagues, Dione King and Justice Mbizo, assumed responsibility for the project, with Jordan staying on as a consultant.

Depending upon what the researchers find, Lanza said lawmakers might need to consider taking a different approach to addressing existing health disparities.

Jordan said modifications to the health system might be necessary to close the gap.

“We can’t just undo our current system,” Jordan said. “But … if we were to find that we had significant risk across the life course that seemed to be contributing to babies being born already several steps behind in terms of health, we would have to take a look and see what kind of creative approaches we could take that fit within our system … to greater support moms, dads, infants so that we eventually have healthier citizens throughout the lifespan.”