Maternal Social and Economic Factors and Infant Morbidity, Mortality, and Congenital Anomaly Are There Associations? Leanne Kosowan, MSc; Javier Mignone, PhD; Mariette Chartier, PhD; Caroline Piotrowski, PhD Experiences during infancy create durable and heritable patterns of social deprivation and illness producing health disparities. This retrospective cohort study of 71 836 infants from Winnipeg, Manitoba, assessed associations between maternal social and economic factors and infant mortality, morbidity, and congenital anomaly. This study found that newborn and postneonatal hospital readmissions are inversely associated with geography. Additionally, social context, including maternal history of child abuse, is associated with infant postneonatal hospital readmissions. Geography and education are associated with infant mortality. Income was not associated with infant mortality or morbidity following adjustment for social support. Interestingly, congenital anomaly rates are 1.2 times more common among 2 parent families and male infants. Understanding associations between infant health and maternal social and economic factors may contribute to interventions and policies to improve health equity. Key words: health services, infant health, infant mortality, social determinants of health, socioeconomic factors Author Affiliations: Department of Family Medicine (Ms Kosowan) and Department of Community Health Sciences (Drs Chartier, Piotrowski, and Mignone), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors acknowledge the contribution of Brenda Elias, who contributed to the design of this study. The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Manitoba Population Research Data Repository under project #2013-001 (HIPC#2012/2013-39). The results and conclusions are those of the author and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Data used in this study are from the Population Health Research Data Repository housed at the Man- itoba Centre for Health Policy, University of Manitoba, and were derived from data provided by Manitoba Health and Healthy Child Manitoba. Financial assistance for this project was received from the Network Environment for Aboriginal Health Research (NEAHR), Manitoba Health Research Council (MHRC), Evelyn Shapiro Award for Health Service Research, and the FGS Special Award. Addi- tional in-kind supports were provided for this project by the Mani- toba Metis Federation, Health and Wellness Department. Research was conducted according with prevailing ethical principles and re- viewed by an institutional review board. The study obtained access permissions from the MCHP, Health Information Privacy Committee of the Government of Manitoba, Healthy Child Manitoba Office, and the Health Research Ethics Board of the University of Manitoba. The authors declare no conflict of interest. Correspondence: Leanne Kosowan, MSc, Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Win- nipeg, MB R3T2N2, Canada (Leanne.kosowan@umanitoba.ca). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/FCH.0000000000000211 M ORTALITY, morbidity, and birth outcomes are associated with unequal access to eco- nomic, social, and health care resources. 1,2 Ma- ternal education, in particular, is related to infant mortality, birth outcomes, and access to health ser- vices, even within a publicly funded health system. 2 The rate of infant mortality doubles among low- income groups compared with the highest income groups. 3 Despite declines in Canadian infant mor- tality rates, disparities in mortality and morbid- ity between the lowest and highest income groups persist. 4 Low socioeconomic status is associated with stress and a variety of structural and behav- ioral factors such as housing, food security, living conditions, and access to health care that infuence the risk of infant mortality and morbidity. 5-7 The majority of child deaths occur during in- fancy, making the frst year of a child’s life partic- ularly vulnerable. Neonatal deaths (deaths between days 0 and 28 after birth) account for two-thirds of infant deaths. 8 Mortality during the neonatal pe- riod is often attributed to obstetric and neonatal care, with the level and quality of hospital services dictating mortality and complication rates. Preterm births contribute to neonatal morbidity, disability, and mortality. Preterm births are associated with socioeconomic status, geography, maternal age, and multiple births. 9 Mortality during the postneonatal period (28-365 days) has been attributed to social and environmental factors (ie, geography, ethnic- ity, income, education). 1-7,10 Within the postneona- tal period, mortalities are often associated with Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 54 Family and Community Health January–March 2019 ■ Volume 42 ■ Number 1