Infant mortality trends and differences between American Indian/Alaska Native infants and white infants in the United States, 1989-1991 and 1998-2000

Objectives. To describe changes in infant mortality rates, including birthweight-specific rates and rates by age at death and cause. Methods. We analyzed US linked birth/infant-death data for 1989-1991 and 1998-2000 for American Indians/Alaska Native (AIAN) and White singleton infants at ≥20 weeks' gestation born to US residents. We calculated birth weight-specific infant mortality rates (deaths in each birthweight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100 000 live births) in infancy (0-364 days) and in the neonatal (0-27 days) and postneonatal (28-364 days) periods. Results. Birthweight-specific infant mortality rates declined among AIAN and White infants across all birthweight categories, but AIAN infants generally had higher birthweight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998-2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated postneonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. Conclusions. Although birthweight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities.