Relationship of education to the racial gap in neonatal and postneonatal mortality

Objective: To examine the impact of education on race differences in neonatal and postneonatal mortality. Methods: Data were from North Carolina's Linked Birth and Infant Death File for 1988 through 1993. The study population included 169 601 African American births and 400 359 European American births, with 2606 and 3060 deaths, respectively. Multiple logistic regression was used to assess the effects of race and education on neonatal and postneonatal mortality, adjusting for sociodemographic, lifestyle, and medical risk factors. Results: Risks of death were higher for African Americans than for European Americans, more so in the neonatal than in the postneonatal period. Odds ratios (with 95% confidence intervals in parentheses) comparing African Americans to European Americans were as follows: neonatal deaths, 2.2 (1.9-2.5), 2.3 (2.1-2.6), and 2.8 (2.5-3.2) for less than 12, 12, and more than 12 years of education; and postneonatal deaths, 1.3 (1.1-1.6), 1.5 (1.3-1.7), and 2.1 (1.7-2.6), respectively. The biggest gap was for deaths in the first day of life, with odds ratios ranging from 2.8 to 3.6. Education had no impact on neonatal mortality in either race. Medical factors were more influential in the neonatal than in the postneonatal period, whereas environmental and social factors appeared to play a greater role in the postneonatal period. Conclusions: Racial differences in neonatal death are increasing and may be related to inequities in the provision of health care. The racial gap in the postneonatal period, although declining, has not disappeared and may be more related to environmental, social, and economic factors.