BMC Public Health Research article Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths? Barry P Markovitz*1,4, Rebeka Cook1, Louise H Flick1,3 and Terry L Leet1,2 BioMed Central Open Access Address: 1Saint Louis University School of Public Health, St. Louis, Missouri, USA, 2Saint Louis University School of Medicine, St. Louis, Missouri, USA, 3Saint Louis University School of Nursing, St. Louis, Missouri, USA and 4Washington University School of Medicine, St. Louis, Missouri, USA Email: Barry P Markovitz* - markovitz@wustl.edu; Rebeka Cook - rebekacook@yahoo.com; Louise H Flick - flicklh@slu.edu; Terry L Leet - LEETTL@slu.edu * Corresponding author Published: 25 July 2005 BMC Public Health 2005, 5:79 doi:10.1186/1471-2458-5-79 This article is available from: http://www.biomedcentral.com/1471-2458/5/79 Received: 16 December 2004 Accepted: 25 July 2005 © 2005 Markovitz et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study. Methods: We conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997–1999. Infant mortality rates for all singleton births to adolescent women (12–17 years, n = 10,131; 18–19 years, n = 18,954) were compared to those for older women (20–35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations. Results: The risk of infant (OR 1.95, CI 1.54–2.48), neonatal (1.69, 1.24–2.31) and post-neonatal mortality (2.47, 1.70–3.59) were significantly higher for younger adolescent (12–17 years) than older (20–34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14–2.64) but not neonatal mortality (1.43, 0.98–2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18–19 years) mothers. Conclusion: Socioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk. Background Adolescent pregnancy has long been considered to increase the likelihood of adverse infant outcomes [1]. The infant mortality rate in the United States (U.S.) for young women has remained persistently high despite widespread study of this phenomenon. In 1999, the infant mortality rate for women under 20 years of age was 10.3 deaths per 1,000 live births compared to 7.0 per 1,000 live births for all ages [2] Although the U.S. teenage (ages 15–19) birth rate has declined substantially during the last decade, from 62.1 to 48.7 per 1,000 women in 2000 [3], this country still leads the developed countries by wide margins. Simple calculations would suggest that, with an estimated 470,000 births to teen mothers in the Page 1 of 7 (page number not for citation purposes)