State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013

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To assess state-level progress on eliminating racial disparities in infant mortality.


Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained.


We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained.


States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities.

Public Health Implications

Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.

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