King County, Wash. Babies born to African-American and Native-American mothers in this county are nearly three times more likely to die within their first year than those born to white mothers, public health officials reported last month.

Although infant mortality rates in the county, which includes Seattle, have dropped to an all-time low of five deaths for every 1,000 births, the findings along ethnic lines reveal a stark disparity. For African Americans, the rate was 13.1 deaths in 1998 – the most recent year studied – and for whites it was 4.5. Rates for Native Americans were not reliable because of the small sample size (three to four deaths per year).

The gap also appears to be widening. The trend particularly concerns health officials, who saw the African-American infant mortality rate drop during the early 1990s from 20 deaths to 10 per 1,000 live births. Native-American babies showed a similar pattern.

Stress may be a contributing factor to the rise in infant deaths, said Kathy Carson, RN, administrator for parent and child health at Public Health–Seattle & King County. She noted that African-American and Native-American women were more likely than white women to have experienced homelessness, imprisonment, separation or divorce from their partners, or job loss during their pregnancies.

"There is some very compelling research about the effects of chronic stress on a variety of health issues, including pregnancy," Carson said.

The report found that the top causes of death for African-American babies were, in order of frequency, problems in labor and delivery including trauma and infections, premature births and Sudden Infant Death Syndrome. For whites, birth defects were responsible for most infant deaths, followed by labor and delivery problems, and premature births.

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