Widening ethnic disparities in infant mortality in southern Brazil: Comparison of 3 birth cohorts

Objectives. We analyzed trends in mortality among infants born to White and to Black or mixed-race women in 3 population-based cohorts representing all births in 1982, 1993, and 2004 in Pelotas, southern Brazil. Methods. Births were assessed during daily visits to all maternity hospitals. Maternal skin color was classified by the interviewers as White or Black or multiracial. We used logistic regression to adjust for socioeconomic, demographic, and health services variables. Results. The mortality rate among infants born to White mothers declined from 30.4 per 1000 live births in 1982 to 13.9 per 1000 in 2004, compared with 53.8 per 1000 to 30.4 per 1000 among those born to Black and mixed-race mothers. Differences for neonatal mortality were even more marked, with reductions of 47% and 11% for infants born to White and Black or mixed-race women, respectively. Adjusted analyses showed that ethnic group differences in neonatal and infant mortality were partly explained by differences in poverty and prenatal care. Conclusions. Over a 22-year period, improvements in health indicators were greater for infants born to White women than for other infants. The widening racial gap requires special attention from policymakers.