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http://publhealth.annualreviews.org/cgi/content/abstract/24/1/341

Posted online on December 2, 2002 as 10.1146/annurev.publhealth.24.100901.140816

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Annu. Rev. Public Health 2003. 24:341-362.
 

THE ANATOMY OF A DISPARITY IN INFANT MORTALITY

Paul H. Wise
Department of Pediatrics, Boston Medical Center and Boston University of School of Medicine; Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02118; email: pwise@bu.edu

KEY WORDS: inequalities, prematurity, low birth weight, social status

This article suggests that while disparities in infant mortality have been longstanding, the mechanisms of disparity creation are undergoing intense change. This dynamic character is explored by first developing an analytic model that examines the interaction between social factors and the public health and clinical capacity to intervene. Disparities in infant mortality are then broken down into their component parts and linked to specific arenas of intervention. Disparities in postneonatal mortality are being shaped by differential access to interventions designed to prevent infant death from congenital anomalies and the Sudden Infant Death Syndrome. Disparities in neonatal mortality are primarily determined by factors that influence the birthrate of extremely premature infants and access to specialized obstetrical and pediatric care. This analysis suggests that the epidemiology and social meaning of disparities in infant mortality are intensely dynamic and increasingly reflect the interaction between social forces and technical innovation.

Copyright © 2003 by Annual Reviews.

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