Document Detail


Ethnic differences in neonatal and postneonatal mortality.
MedLine Citation:
PMID:  15629965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Ethnic disparities in infant mortality have been consistently documented in the United States, but these disparities are poorly understood. Although the infant mortality rate in the United States has fallen to record low rates, since 1971 the ethnic disparity between black and white infants has remained unchanged or increased. In 2001, the infant mortality rate among black infants was approximately 2.5 times higher than the rate among white and Hispanic infants. The objective of this study was to identify ethnic differences in neonatal and postneonatal mortality as well as the causes and risk factors among infants born in California. METHODS: Secondary analysis was performed of 1,277,393 singleton infants live-born to black, Latina, and white women from the California linked birth-infant death certificate from 1995 to 1997. The dependent variables were infant death (defined as an infant who died in the first year of life [death <365 days]), neonatal death (death during the first 27 days of life), and postneonatal death (death between 28 and 364 days of life). Cause-specific neonatal and postneonatal infant mortality rates (per 100,000 live births) were calculated for each ethnic group. Chi(2) and exact test statistics were used to compare the distribution of maternal and infant characteristics and cause-of-death rates by maternal ethnicity. Logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationship between maternal ethnicity, maternal and infant factors, and risk of infant mortality. RESULTS: In both the neonatal and postneonatal periods, black women had higher infant mortality rates than Latina or white women for conditions originating in the perinatal period (including respiratory distress syndrome) and symptoms, signs, and ill-defined conditions (including sudden infant death syndrome). After adjusting for maternal and infant characteristics, there were no significant ethnic differences for neonatal mortality. For postneonatal mortality, black women had a higher risk (OR: 1.25; 95% CI: 1.10-1.42) and Latina women had a lower risk (OR: 0.80; 95% CI: 0.71-0.89) compared with white women after adjusting for maternal and infant factors. In analyses of all ethnic groups combined, as well as ethnic-specific analyses, the strongest predictors of neonatal and postneonatal death were infant birth weight of <2499 g and gestational age of <33 weeks. CONCLUSIONS: Causes of infant mortality and risk factors for infant mortality differed by maternal ethnicity, indicating a need to tailor prevention and education efforts, especially during the postneonatal period. To achieve national infant mortality goals, health professionals and policy makers should continue to emphasize the importance of early and continuous prenatal care and develop new strategies to reduce the incidence of low birth weight and premature infants. Ethnic-specific approaches may be needed to further reduce infant mortality rates and achieve our national goal to eliminate ethnic disparities in perinatal outcomes.
Authors:
Nancy A Hessol; Elena Fuentes-Afflick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  115     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-04     Completed Date:  2005-04-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e44-51     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of California, 405 Irving St, 2nd Floor, San Francisco, CA 94122, USA. nancyh@itsa.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
African Americans
California / epidemiology
Ethnic Groups*
European Continental Ancestry Group
Female
Hispanic Americans
Humans
Infant
Infant Mortality*
Infant, Newborn
Male
Mothers
Odds Ratio
Risk Factors
Socioeconomic Factors
Grant Support
ID/Acronym/Agency:
HS07373/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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