Persistent ethnic inequities in infant mortality in Peru, 2019–2024: a repeated cross-sectional analysis of ENDES birth histories

BACKGROUND: Despite progress in reducing infant mortality in Peru, inequities persist by socioeconomic and ethnic characteristics. Documenting these disparities is essential to guide public health policy. OBJECTIVE: To quantify ethnic disparities in infant mortality in Peru, examine variation by socioeconomic level and timing of death, and estimate the fraction of deaths attributable to these inequities. METHODS: We conducted a repeated cross-sectional analysis of ENDES 2019-2024 birth-history data. The analytic sample included 100,807 live births to women aged 15-49 years with complete opportunity for ascertainment of death before 12 months of age. Infant mortality was defined as death before 12 months among live-born children. Maternal ethnicity (Mestizo, Afro-Peruvian, Indigenous) was based on self-identification. We estimated infant mortality rates per 1,000 live births, risk ratios (RR), and risk differences (RD) using survey-weighted Poisson regression with robust variance. RESULTS: We recorded 1,178 infant deaths (overall infant mortality rate: 10.6 per 1,000; 95% CI: 9.8-11.3). The rate was 8.0 per 1,000 among Mestizo, 13.1 among Afro-Peruvian, and 13.6 among Indigenous births (p < 0.001). Children of Afro-Peruvian and Indigenous mothers had 65% (RR = 1.65; 95% CI: 1.31-2.07) and 71% (RR = 1.71; 95% CI: 1.46-2.00) higher risk of death before 12 months than Mestizo children. Disparities were more pronounced for postneonatal mortality (Indigenous RR = 2.53) and were observed across socioeconomic strata. The population attributable fraction for ethnic mortality disparities was 24.4%, under a counterfactual scenario in which all ethnic groups had the infant mortality rate observed among Mestizo births. CONCLUSIONS: Marked ethnic disparities in infant mortality persist in Peru and are observed across socioeconomic strata. Approximately one quarter of infant deaths could be prevented under a counterfactual scenario in which ethnic mortality gaps were eliminated. Targeted interventions for Afro-Peruvian and Indigenous populations are needed.