Document Detail


Perinatal periods of risk: analysis of fetal-infant mortality rates in Kansas City, Missouri.
MedLine Citation:
PMID:  15965626     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The Perinatal Periods of Risk (PPOR) technique was used to analyze resident fetal and infant death data from Kansas City, Missouri, for the period 1998-2002. Results offer important information that can be used to develop community-based prevention strategies related to racial/ethnic disparities in infant mortality rates (IMR). METHODS: The PPOR approach for fetal and infant mortality can be mapped by birthweight at delivery and time of death into four strategic prevention areas: 1) Maternal Health/Prematurity (MHP), 2) Maternal Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). For this analysis, all fetal and infant death certificates from the metropolitan Kansas City area were linked to their birth certificates and those associated with residents of Kansas City, Missouri, proper were used to create the dataset used in this analysis. Due to the small number of fetal and infant deaths among other ethnic groups, the analysis was restricted to a comparison of the disparity of IMR between Blacks, Whites, and a national non-Hispanic white reference group. The Kitagawa formula was used to determine contribution to excess deaths from birthweight-specific mortality and birthweight distribution rates. Logistic regression techniques were used to identify risk factors for death among Black fetuses and infants with very low birthweights and also deaths due to sudden infant death syndrome (SIDS). RESULTS: The PPOR analysis showed that of the excess deaths among black infants, when compared to a national reference group, 47% was attributable to MHP and another 29% was attributable to IH. Differences in MC and NC only accounted for 27 and 8% of the total excess deaths. During the study period, rates of sudden infant death syndrome (SIDS) were found to be significantly higher among Blacks as compared to Whites (2.12 vs. 0.81 per 1,000). An analysis of maternal characteristics for SIDS deaths among blacks using a step-wise logistic regression model, found that maternal age less than 20 years old, previous births, inadequate prenatal care, and being a Medicaid recipient were significant-adjusted odds ratios of 23.7 (95% Cl 10.48, 53.67), 8.4 (95% Cl 3.64, 19.21), 2.9 (95% Cl 1.38, 6.05) and 2.5 (95% Cl 1.04, 5.84), respectively. CONCLUSIONS: PPOR is an easy to use approach that helps focus community initiatives for improving maternal and infant health. In Kansas City, Missouri, efforts to further lower IMR in blacks can be achieved through the reduction of risk factors affecting maternal health and through maternal education to improve infant health.
Authors:
Jinwen Cai; Gerald L Hoff; Paul C Dew; V James Guillory; Josie Manning
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Maternal and child health journal     Volume:  9     ISSN:  1092-7875     ISO Abbreviation:  Matern Child Health J     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-20     Completed Date:  2005-10-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9715672     Medline TA:  Matern Child Health J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  199-205     Citation Subset:  IM    
Affiliation:
Kansas City Health Department, Office of Epidemiology and Community Health Monitoring, Kansas City, MS, USA. Jinwen_Cai@kcmo.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Ethnic Groups
Female
Fetal Mortality / trends*
Humans
Infant Mortality / trends*
Infant, Newborn
Logistic Models
Missouri / epidemiology
Perinatal Care*
Pregnancy
Risk Factors
Sudden Infant Death
Urban Population

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


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