Maternal educational attainment and infant mortality in the United States: Does the gradient vary by race/ethnicity and nativity?

BACKGROUND Maternal education-infant health gradients are flatter among foreign-born mothers than U.S.-born mothers; However, because common metrics of infant health are less predictive of infant mortality for some racial/ethnic and nativity groups, further study of maternal education-infant mortality gradients is necessary. OBJECTIVE We investigate whether maternal education-infant mortality gradients vary by race/ethnicity and nativity among infants born to mothers in the United States. METHODS We use data from the 1998-2002 National Vital Statistics Birth Cohort Linked Birth/Infant Death Data published by the National Center for Health Statistics (N = 17,520,140) to estimate logistic regression models predicting infant, neonatal, and postneonatal mortality by race/ethnicity and nativity. RESULTS The negative associations between maternal education and infant mortality are stronger for US-born mothers than foreign-born mothers. Among both groups, Non-Hispanic whites have the highest returns to education and Non-Hispanic blacks have the lowest returns. While foreign-born mothers are less likely to have an infant die than their native-born counterparts, this advantage is largest at the lowest levels of education and converges at the highest levels of education. For most racial/ethnic groups, the maternal education-infant mortality gradient is steeper during the postneonatal period than during the neonatal period. CONCLUSIONS The maternal education-infant mortality gradient varies substantially by the timing of infant death, race/ethnicity, and nativity. CONTRIBUTION This study extends the literature on nativity disparities in infant health by documenting how the maternal education-infant mortality gradient varies by nativity within racial/ethnic groups. To our knowledge, this is the first study to produce these estimates.