摘要：Objectives. We analyzed trends in mortality among infants born to White and to Black or mixed-race women in 3 population-based cohorts representing all births in 1982, 1993, and 2004 in Pelotas, southern Brazil. Methods. Births were assessed during daily visits to all maternity hospitals. Maternal skin color was classified by the interviewers as White or Black or multi-racial. We used logistic regression to adjust for socioeconomic, demographic, and health services variables. Results. The mortality rate among infants born to White mothers declined from 30.4 per 1000 live births in 1982 to 13.9 per 1000 in 2004, compared with 53.8 per 1000 to 30.4 per 1000 among those born to Black and mixed-race mothers. Differences for neonatal mortality were even more marked, with reductions of 47% and 11% for infants born to White and Black or mixed-race women, respectively. Adjusted analyses showed that ethnic group differences in neonatal and infant mortality were partly explained by differences in poverty and prenatal care. Conclusions. Over a 22-year period, improvements in health indicators were greater for infants born to White women than for other infants. The widening racial gap requires special attention from policymakers. Infant mortality, an often-used indicator of population health and well-being, received less public interest in the 1990s than in previous decades, 1 because the appearance of HIV/ AIDS and the growing recognition of malaria pushed it off the political agenda. 2 Over the last several years, however, the global community has given greater attention to mortality among young children. Reduction of infant and child mortality is 1 of 8 United Nations Millennium Development Goals to dramatically reduce world poverty by 2015. The fourth Millennium Development Goal focuses directly on child survival, and infant mortality rate is one of the indicators used to monitor progress toward this goal. 3 Socioeconomic disparities, as well as race and gender inequities, have been linked to health outcomes and access to and use of health care services. 4 In developed countries, although absolute infant mortality has fallen dramatically, huge disparities still persist among selected populations. 5 Ethnic disparities in infant mortality, which are well documented in many countries, have remained unchanged or have even increased over the past decades. 6 – 8 Infant mortality in Brazil has improved substantially, from 112 deaths per 1000 live births in 1960 to an estimated 25 deaths per 1000 live births in 2002. 9 Major changes in health systems occurred during these 2 decades, of which the most important was the creation of the Unified Health System ( Sistema Único de Saúde ) by the 1988 Brazilian Constitution. Access to maternal and child care was defined as a universal right in the constitution, and government health insurance became universal in 1989. Inequities in child health have been documented, however, and wide social differences still persist. 10 , 11 Many health disadvantages, such as high prevalence of low birth-weight and preterm births, poor nutritional status, and increased risk of death during the first year of life, have been found to be more prevalent among Black infants than among White ones. 12 , 13 The city of Pelotas in southern Brazil, although located in a relatively developed area of the country, has a highly inequitable income distribution. Infant mortality has remained almost stable over the last several years. During the years 1982, 1993, and 2004, birth cohort studies representing all births in the city were carried out, providing a unique opportunity for assessing ethnic group inequalities. We analyzed time trends in infant mortality between children born to White women and those born to Black or mixed-race women. We add a temporal dimension to existing analyses and explore pathways that may account for the ethnic differences in infant mortality in a middle-income setting.
