Reducing black neonatal mortality. Will improvement in birth weight be enough?

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.