Introduction: The infant mortality rate (IMR) is defined as the number of deaths per 1000 live births and is often considered the most sensitive indicator of the overall health of a society. Although the United States is at the forefront of many medical advances, the national IMR is among the lowest of industrialized countries. In addition, the IMR of Non-Hispanic Black infants in the United States is almost double the national average. This study aims to identify differences in non-Hispanic Black women’s social determinants between those who experienced infant mortality compared to those whose infant lived beyond 12 months.

Methods: This study was conducted as a population-based case-control study using publicly available US birth-death records (2014—2017). Factors potentially associated with infant mortality and considered indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women with and without infant death, ≤ 12 months. Multivariate logistic regression, reported as odds ratios (95% confidence interval, CI), quantified the association between infant mortality and social determinants such as maternal age, education level, and amount of prenatal care.

Results: Of 2,219,025 live births to Non-Hispanic Black women in the US from 2014 - 2017, 22,696 experienced infant mortality (1.0%). Factors most strongly associated with infant mortality, presented as odds ratio (95% CI), were no prenatal care 3.83 (3.66 – 4.01), smoking during pregnancy 1.68 (1.61 – 1.76), father of baby information not provided on birth certificate 1.66 (1.61 – 1.70), unmarried 1.35 (1.31- 1.40), Black paternal race 1.21 (1.14 – 1.29), maternal age < 18 years 1.20 (1.11 – 1.30), and did not complete high school 1.26 (1.21 – 1.30). Factors protective for infant mortality were higher education - bachelor’s degree or greater 0.65 (0.64-0.71), WIC use 0.69 (0.67 - 0.71), and maternal age 18 – 34 years 0.94 (0.91 – 0.97).