Research shows that rising infant mortality in the US has the greatest impact on Black and Native American youth

Researchers from Virginia Commonwealth University and VCU’s Children’s Hospital of Richmond are shedding new light on how rising infant mortality in the United States has disproportionately affected certain racial and ethnic groups.

Their previous research found that death rates among children and adolescents in the United States rose 18.3% between 2019 and 2021, the largest increase in at least half a century.

In their latest studypublished on May 4 in the Journal of the American Medical Association (JAMA), their analysis revealed that Black and Native American (American Indian and Alaska Native) youth died at significantly higher rates than white youth – primarily due to injuries-related deaths – and that the gap is widening.

Death rates among young Americans had been declining for decades thanks to breakthroughs in medicine and greater access to health care. However, these public health gains have since been overshadowed by the increase in deaths from injuries, including homicide, drug overdoses, car accidents, and suicide.

“Once you start looking at these trends with a magnifying glass, it becomes clear that mortality rates are not consistent across racial and ethnic groups,” says Elizabeth Wolf, MD, associate professor in the Department of Pediatrics at VCU School of Medicine, a pediatrician at Children’s Hospital of Richmond at VCU and lead author of the study.

“While we saw the overall infant mortality rate from all causes in the United States begin to rise around 2020 and 2021, infant mortality rates for Native American, Black and Hispanic populations began to rise as early as 2014.”

“Our previous research into child mortality has revealed a great tragedy in that deaths from injuries are reversing the progress we have made in child care. This latest study exposes a new layer of tragedy, namely that deaths from injuries are also reversing our progress in closing pediatrics. racial disparities in mortality,” added Steven Woolf, MD, director emeritus of the VCU Center on Society and Health and professor in the Department of Family Medicine at the VCU School of Medicine.

Wolf and Woolf are part of a research team that reviewed more than two decades of death certificate data from the Centers for Disease Control and Prevention to assess how the risk of death from ages 1 to 19 varied by race and ethnicity.

The data showed that disparities in infant mortality rates between racial and ethnic groups improved through 2013. However, in recent years, disparities in mortality rates have widened, especially among black and Native American populations.

Between 2014 and 2020, death rates among Black youth increased 36.7% and among Native American youth 22.3%, while among white youth they increased 4.7%.

This shift was mainly driven by differences in injury-related deaths, according to the analysis. Between 2016 and 2020, nearly 13 in 100,000 Black youth died from homicide, which is more than ten times the rate among white youth. During the same period, about 11 in 100,000 Native American youth died by suicide, more than twice the rate among white youth.

The data also showed that many of the recorded homicide-suicide deaths involved firearms. Between 2016 and 2020, approximately 13 in 100,000 Black youth and 7 in 100,000 Native American youth died from gun-related injuries. These death rates were four and two times higher, respectively, than among white youth.

The data also showed that firearm fatalities are increasing over time for both groups. Between 2013 and 2020, the risk of death from gun violence increased by 108% among Black youth and 124% among Native American youth.

The observed differences are not only limited to deaths from injuries, but also to deaths from diseases such as asthma, influenza and heart failure. About 1 in 100,000 black youth died of asthma, nearly eight times higher than the rate among white youth.

In addition, 1 in 100,000 Native American youth died from pneumonia and influenza, more than three times the rate among white youth.

Wolf and Woolf said a number of factors may be linked to the country’s rise in infant mortality and related disparities between racial and ethnic groups. For example, the racial imbalance in suicide rates may be partly due to differences in poverty levels, childhood experiences, and access to mental health care.

On the other hand, racial disparities in asthma deaths may be related to differences in exposure to tobacco smoke and other air pollutants, as well as unequal access to asthma medications.

The researchers also emphasized that the various conditions contributing to the growing racial gap in infant mortality ultimately reflect the legacy of systemic racism in the United States.

“Ultimately, this country’s history of systemic racism is at the root of this tragedy, by creating gaps in the social, economic and environmental conditions in which children are raised,” Woolf said.

“Addressing these systemic factors is essential to reducing the disproportionate risks of injury and illness that children of color experience.”

According to the researchers, the most effective way to reverse the country’s infant mortality trends is through bold policy measures. For example, they noted the importance of enacting sensible gun policies to prevent children’s access to firearms and providing greater access to behavioral health care to address the current mental health crisis affecting children and adolescents.

“As physicians, we tend to focus on the health care system first, but many of the issues causing these death rate spikes cannot simply be treated in a hospital or clinic, such as a person’s income level, education and environment,” Wolf said .

“We need to look beyond the sphere of health care and into the sphere of public policy.”

“There are many clear policy recommendations on how we can save the lives of our children,” Woolf added. “We just have to take action on it.”