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To study some of the factors contributing to the higher rate of black neonatal mortality in the United States, we used matched cohort records for California between 1980 and 1981 and for Georgia between 1979 and 1981. We found that at any combination of birth weight and gestational age, black neonates weighing less than 3,000 g had lower mortality rates than whites, but this survival advantage was outweighed by considerably higher rates of low birth weight among blacks. At 3,000 g or more, whites had the survival advantage; even at optimal survival weight, the black mortality rate was nearly twice that for whites. If a reduction in the black mortality rate is to occur, improvements are needed both in the black birth-weight distribution and in birth-weight-specific mortality rates, particularly in the normal birth-weight ranges.

We compared pregnancy outcomes among United States-born and Mexican-born women having Spanish surnames with US-born Whites and Blacks using California's 1981 matched birth-death cohort file. Maternal risk characteristics between US-born Black women and US-born women with Spanish surnames were similar. In contrast, Latino women, regardless of national origin, delivered small proportions of low weight infants as compared to Blacks. Birthweight-specific mortality rates during the fetal and neonatal periods for the offspring of Mexican-born Spanish surname women were generally higher than those for other ethnic groups. Our findings are consistent with the underreporting of postneonatal deaths among Mexican-born Latinos, yet suggest that their relatively low reported infant mortality rates compared to Blacks can be explained by a more favorable birthweight distribution.

To examine further the differences in birth-weight-specific neonatal mortality rates between ethnic groups, we studied causes of death for infants of white, black, United States-born Hispanic, and Mexican-born Hispanic women using linked California birth-death records from 1981 to 1983. Black infants of low birth weight had considerably lower neonatal mortality rates from respiratory distress syndrome and congenital abnormalities. In the normal birth-weight category, however, black neonatal mortality rates for most conditions were higher than those for whites. The greatest differences between Mexican-born Hispanic and white neonatal mortality rates were seen for other respiratory conditions and trauma/hypoxia/asphyxia. These differences were most marked in the 1500- to 2499-g and greater than or equal to 2500-g birth-weight categories. Attempts to lower the neonatal mortality rate for black infants of normal birth weight may require providers to focus on both broad preventive measures and improved perinatal management. In contrast, improvements in perinatal management among Mexican-born Hispanics may produce improvement in the neonatal mortality rate for this group.