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PubMed1998

Maternal education and fetal and infant mortality in Quebec. Fetal and Infant Mortality Study Group of the Canadian Perinatal Surveillance System.

OBJECTIVES: This article examines differences in fetal and infant mortality by maternal education in the province of Quebec, where the rates are among the lowest in Canada. DATA SOURCE: The data are from linked birth and infant death records (including stillbirths) for the 1990-1991 birth cohorts in Quebec. MAIN RESULTS: Fetal and infant mortality rates were greater for the offspring of mothers with less than 12 years of education, compared with mothers with at least 14 years, even after adjusting for maternal age, parity, marital status and infant's sex. When intermediate factors such as birthweight or both gestational age and fetal growth were taken into account, the differentials in mortality by education diminished. If all education groups had experienced the low rates attained by the higher education group, the number of fetal and infant deaths would have been reduced by approximately 20%.

Adolescent↗
PubMed1999

Decrease in infant mortality and sudden infant death syndrome among Northwest American Indians and Alaskan Natives--Pacific Northwest, 1985-1996.

Although the infant mortality rate (IMR) has steadily declined in the United States since the early 1900s, the rate varies among racial/ethnic populations. A goal of the national health objectives for 2010 is to eliminate racial/ethnic health disparities (U.S. Department of Health and Human Services, unpublished data, 1999). Historically, IMRs among American Indians and Alaskan Natives (AI/AN) have been high. In addition, IMRs have varied among AI/AN populations. To determine recent trends in infant mortality among Northwest AI/AN, the Northwest Portland Area Indian Health Board (NPAIHB) analyzed annual IMRs among AI/AN in Idaho, Oregon, and Washington. In addition, because sudden infant death syndrome (SIDS) is the major contributor to excess infant mortality in Northwest AI/AN, NPAIHB analyzed SIDS rates to determine whether the decline in SIDS rates in the United States also was occurring among Northwest AI/AN. This report summarizes the results of this analysis and documents dramatic decreases in both SIDS and non-SIDS infant mortality.

Humans↗
PubMed1998

Causal pathways to infant mortality: linking social variables to infant mortality through intermediate variables.

Using a conceptual model that integrates social and biomedical models of causation, this paper delineates the pathways through which social factors ultimately influence infant mortality in the African-American community. Two social factors, maternal education and marital status, are shown to influence the risk of infant death through the following intermediate variables: bio-demographic (maternal age, birth order, birth interval and outcome of last pregnancy), health care (prenatal care utilization) and proximate infant health status at birth (preterm delivery and low birth weight). While the impact of maternal education is largely explained by the intermediate variables, marital status remains a significant, albeit a weak, predictor net of all other variables.

Black or African American↗
PubMed1989

Postneonatal mortality, sudden infant death syndrome: factors preventing the decline of infant mortality in France from 1979 to 1985.

The sudden infant death syndrome (SIDS) is known to be associated with a peak in mortality rates at 3 months of age, and a seasonal peak in winter. The aim of this study was to analyse the relationship between the month of death, month of birth and age at death for cohorts of monthly births in France between 1979 and 1985. Statistics concerning the causes of death were collected and used to calculate life-tables firstly from SIDS and secondly from all other causes. They show that the specific age distribution at death was not the same for babies born in late summer or autumn as for other newborns. Total infant death rates were higher for cohorts born in the autumn, because of the peak in deaths from SIDS at about three months of age.

Actuarial Analysis↗
PubMed1998

[Infant mortality and sudden infant death in Navarra between 1985 and 1996].

OBJECTIVE: The objective of this study was to obtain an accurate register of the deaths of children less than one year of age in order to discover the real infant mortality (IM) rate in Navara and its trend during the period between 1985 and 1996, a well as to investigate the deaths by sudden infant death (SID) in the same period and their relationship to the prone position during sleep. PATIENTS AND METHODS: Infant mortality was determined by detailed examination of all certified deaths. Research into possible nonregistered deaths was also carried-out. The sources of information included the archives and registers of the pediatric and obstetric wards and pathology departments of all hospitals. Deaths codified as 798.0 (CIE9 infinity R) were included in the study as death by SID. To determine sleeping posture. In the second semester of 1996, a survey was carried out on a sample of 285 children of under 6 months of age. The survey's model is the same as that published previously. RESULTS: In the period of 1985 to 1992, IM was 12.33 per thousand live births. The SID rate was 1.30/1,000 live births. The prevalence of the prone position is unknown. In the period between 1993 and 1996, IM decreased to 5.84/1,000 live births and this decrease was proportional in both the neonatal and postneonatal components. The rate of SIM decreased to 0.44/1,000 live births. At the beginning of 1993, 86% of the children slept in the prone position, in 1994, 38% and in 1996, only 23%. CONCLUSIONS: Trustworthy data in Navarra shows a decrease in IM of more than 50% from 1993 on. The SID rate also decreased by 65%, coinciding with a massive drop in the use of the prone position during sleep.

Humans↗
PubMed2002

Why do foreign-born blacks have lower infant mortality than native-born blacks? New directions in African-American infant mortality research.

OBJECTIVE: This study focuses attention on maternal nutrition and stress as possible reasons for excess black infant mortality after exploring lower infant mortality for the infants of foreign-born black mothers compared to native-born black mothers. METHODS: All births to non-Hispanic black women in New York City from 1988-1992 were examined and infant mortality for the infants of native-born women was compared to infant mortality for the infants of foreign-born women. RESULTS: Before controlling for potential confounders on the birth certificate, the infants of native-born black women had a greater risk of infant mortality than the infants of foreign-born black women: OR = 1.48 (95% confidence interval [CI] = 1.38, 1.58). After controlling for potential confounders, the infants of native-born black women still had a greater risk of infant mortality than the infants of foreign-born black women: OR(a) = 1.32 (95% Cl = 1.21, 1.43). CONCLUSIONS: Maternal nutrition and stress are possible causes of excess black infant mortality. They should be topics for research and program development.

Black or African American↗
PubMed2003

[Impact estimates of breastfeeding over infant mortality].

OBJECTIVE: Infant mortality in the state of São Paulo has decreased in the last years and it seems to be leveling off at a limit beyond which further reductions are challenging. Early neonatal causes account for 50% of these deaths and the remaining are mostly due to pneumonia and diarrhea. This study is to assess the impact of breastfeeding over death reduction. METHODS: Fourteen municipalities of greater São Paulo were studied. Data on breastfeeding was collected through surveys conducted on national immunization campaign days and mortality data was taken from 1999 and 2000 official records. Drawing from literature parameters on risk for death from respiratory infection and diarrhea in non-breastfed infants, fractions of mortality preventable by breastfeeding were calculated. These figures applied to the number of recorded deaths allowed assessing the impact of breastfeeding over mortality for each municipality. RESULTS: Fractions of respiratory infection mortality preventable by breastfeeding varied according to locality and age group between 33% and 72%. As to diarrhea, variation was between 35% and 86%. The impact of breastfeeding over infant mortality was an average reduction of 9.3% with values raging from 3.6% to 13%, depending on the locality considered. CONCLUSIONS: Breastfeeding in the first year of life might be the most feasible strategy to further reduce the current levels of infant mortality in the state of São Paulo.

Brazil↗
PubMed1988

Infant mortality increase despite high access to tertiary care: an evolving relationship among infant mortality, health care, and socioeconomic change.

In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.

Birth Rate↗
PubMed1975

The effect of availability and utilization of prenatal care and hospital services on infant mortality rates. Summary of the findings of the Louisiana Infant Mortality Study. Part II.

A total of 69,556 birth and 1,541 death certificates from Louisiana, 1972, were reviewed. Infant, neonatal, and postneonatal mortality rates were computed for number of prenatal visits, type of hospital of delivery, hospital vs. nonhospital delivery, and geographical access to health care. The mortality rates were twice as great for infants born outside of hospitals. With no prenatal care, the infant mortality rates were between four- and tenfold greater than the rates of women receiving more than nine visits even when race, poverty, geography, and birth weight were considered. Infant mortality rates were twice as high in the neonatal period and three times greater in the postneonatal period among the poor who utilized charity hospitals. This study illustrates a method which could be incorporated into state vital statistics reports which would detect populations at risk of excess infant deaths and would provide a more refined analysis of birth and infant death data to monitor improvements in care of high-risk groups.

Black or African American↗
PubMed2004

The X-linkage hypotheses for SIDS and the male excess in infant mortality.

Sudden Infant Death Syndrome is characterized globally by a 50% excess in males per 1000 live births of each gender. We previously hypothesized that this male excess may arise from a single X-linked gene locus with a dominant allele (p = 1/3) that is protective against potentially terminal cerebral anoxia by catalyzing anaerobic oxidation and a recessive allele (q = 2/3) that is unprotective. We now hypothesize this same terminal mechanism for all other causes of infant respiratory death (50% male excess) and that infant cardiac death is equally probable for males and females (0% male excess). With these hypotheses, we model the male excess of all infant mortality (under 5 years) as 25% per 1000 live births of each gender. We show for the USA (1979-2000) that this model of a 25% male excess accurately predicts the male excess mortality under 1 year (24.15%), from 1 to 4 years (25.42%), and under 5 years (24.51%).

Cause of Death↗
PubMed2000

The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.

CONTEXT: The World Health Organization defines preterm birth as birth at less than 37 completed gestational weeks, but most studies have focused on very preterm infants (birth at <32 weeks) because of their high risk of mortality and serious morbidity. However, infants born at 32 through 36 weeks are more common and their public health impact has not been well studied. OBJECTIVE: To assess the quantitative contribution of mild (birth at 34-36 gestational weeks) and moderate (birth at 32-33 gestational weeks) preterm birth to infant mortality. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study using linked singleton live birth-infant death cohort files for US birth cohorts for 1985 and 1995 and Canadian birth cohorts (excluding Ontario) for 1985-1987 and 1992-1994. MAIN OUTCOME MEASURES: Relative risks (RRs) and etiologic fractions (EFs) for overall and cause-specific early neonatal (age 0-6 days), late neonatal (age 7-27 days), postneonatal (age 28-364 days), and total infant death among mild and moderate preterm births vs term births (at >/=37 gestational weeks). RESULTS: Relative risks for infant death from all causes among singletons born at 32 through 33 gestational weeks were 6.6 (95% confidence interval [CI], 6.1-7.0) in the United States in 1995 and 15.2 (95% CI, 13.2-17.5) in Canada in 1992-1994; among singletons born at 34 through 36 gestational weeks, the RRs were 2.9 (95% CI, 2.8-3.0) and 4.5 (95% CI, 4.0-5.0), respectively. Corresponding EFs were 3.2% and 4.8%, respectively, at 32 through 33 gestational weeks and 6.3% and 8.0%, respectively, at 34 through 36 gestational weeks; the sum of the EFs for births at 32 through 33 and 34 through 36 gestational weeks exceeded those for births at 28 through 31 gestational weeks. Substantial RRs were observed overall for the neonatal (eg, for early neonatal deaths, 14.6 and 33.0 for US and Canadian infants, respectively, born at 32-33 gestational weeks; EFs, 3.6% and and 6. 2% for US and Canadian infants, respectively) and postneonatal (RRs, 2.1-3.8 and 3.0-7.0 for US and Canadian infants, respectively, born at 32-36 gestational weeks; EFs, 2.7%-5.8% and 3.0%-7.0% for the same groups, respectively) periods and for death due to asphyxia, infection, sudden infant death syndrome, and external causes. Except for a reduction in the RR and EF for neonatal mortality due to infection, the patterns have changed little since 1985 in either country. CONCLUSIONS: Mild- and moderate-preterm birth infants are at high RR for death during infancy and are responsible for an important fraction of infant deaths. JAMA. 2000;284:843-849

Canada↗
PubMed2001

The main determinants of infant mortality in Nepal.

Infant mortality has reached a low stable rate in developed countries while it is still high and on a slow decline in developing countries. There are many factors that contribute to the incidence of a high or low level of infant mortality. Although credit for contributing to the lowering of infant mortality has been given to health programs by public health personnel and to the improvement in socio-economic status by social scientists, in a traditional and agricultural country such as Nepal, both these factors are found to influence infant mortality. Data on infant mortality obtained by the 1991 Demographic Health Survey of Nepal are analyzed in this study. A logistic regression model is used for analyzing the data. Several hypotheses are tested to explain the incidence of infant mortality in Nepal. The various reasons for the persistence of high infant mortality and the difficulties in lowering it are discussed. The findings suggest that among all the variables analyzed in the study, parity, place of residence, immunization, and ethnicity influence infant mortality the most.

Cultural Characteristics↗
PubMed1975

The effect of maternal demographic factors on infant mortality rates. Summary of the findings of the Louisiana Infant Mortality Study. Part I.

Birth and infant death certificates for Louisiana in 1972 were matched and reviewed to identify groups particularly in need of close medical support and counselling during the identify groups particularly in need of close medical support and counselling during the life phases of preparation for reproduction, gestation, and parenthood. From all recorded birth and infant death certificates for 1972 (69,556 birth and 1,541 death certificates) infant, neonatal, and postneonatal mortality rates were computed for maternal demographic (intrinsic patient physiocal and life-style characteristics) factors including age, race, parity by age cohort, education, and legitimacy. Excessive infant deaths were found among illegitimate offspring, except in mothers less than 15 years of age or nonwhites over 35 years of age; the less educated; those having too many children too soon; those of low birth weight; and whites relying on Charity Hospitals. An increased mortality rate was seen with nonwhites and with the younger and older mothers.

Black or African American↗