Risk for Infant Mortality Among Childbearing Women in Alabama

Background: Infant mortality is an important indicator of the health of a population. From 2016 to 2020, the infant mortality rate in Alabama significantly decreased. However, disparities remain among different groups. The objective of this analysis is to evaluate risk factors and disparities of infant mortality for the past five years. Methods: We used the Alabama Center for Health Statistics database, a population-based state vital records registry. We included 290,832 births to women aged 15 to 44 years linked to 1,575 infant deaths from 2016 to 2020. We excluded births at less than 20 weeks of gestation and weighing 500 grams or less because these fetuses have uncertain viability. Bivariate analysis and multivariate logistic regression were used to determine the risk for infant mortality using SAS 9.4. Results: Out-of-hospital births had 3.4 times higher risk of infant mortality than hospital births after adjusting for gestational age, prenatal care use, tobacco use during pregnancy, method of delivery, marriage status and mother’s education level. Infants delivered by cesarean section were 1.4 times (95% confidence interval = 1.3, 1.6) more likely to die before one year of age than those delivered vaginally, and mothers with no college degree had a 42% increased risk of infant mortality compared to those with at least an associate degree after adjusting for the same variables. Conclusions: Maternal and child health professionals should encourage women to give birth in hospital settings and recommend cesarean section only in case of maternal and/or fetal indications. Prematurity remains the most important risk factor for infant mortality.