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PubMed1989

[The intercensal comparability problems in the retrospective infant mortality statistics].

In infant mortality estimates, using the Coale-Trussell procedure with information from 2 successive population censuses of a country, reveals differences in the levels for the overlapping years of periods. This paper deal with this problem using the 1974 and 1982 censuses of Ecuador. The contribution of his analysis consists in demonstrating that infant mortality in a given year--estimated from a specific age group--is a weighted average between zero mortality--women declaring no deaths among their children and mortality with a value different from zero--women declaring some child dead. The weighing values are the age structure of women according to the condition of having dead children and corrected by the mean parity of the corresponding age group. Looking at the structure--women with or without dead children--of both censuses, a strong increase in the proportion of women without dead children occurred in 1982 as compared with the proportion in 1974. In order to eliminate this lack of comparability a reweighing was introduced in the 1982 information. New estimates were obtained, and these are much closer to the estimates obtained from the 1974 census.

Age Factors↗
PubMed2004

Generations of loss: contemporary perspectives on black infant mortality.

The U.S. black infant mortality rate (IMR) remains a significant public health concern. Although improved during the last four decades, the U.S. IMR remains within the lowest tier of IMRs for all industrialized countries, and black American infants remain disproportionately represented in low birthweight (LBW) and infant death statistics. Numerous risk factors have been analyzed for their relative contributions to the U.S. IMR and black-white infant survival health disparities. Those factors include prenatal care quality and access, maternal socioeconomic status (SES), HIV/AIDS status, infections, intrapartum risk factors, existing comorbidities, social support, and nutritional status. However, the role of these and other factors have not fully explained the higher infant mortality risks for black infants. This review will discuss a variety of risk factors that contribute to infant mortality disparities between non-Hispanic black and white infants. Among those factors, the goal will be to review selected topics pertaining to maternal SES, LBW, preterm birth, perinatology advances, birth record data quality, maternal stress, prenatal care adequacy, and physical and substance abuse, and the relationships of those topics to black-white IMR health disparities.

Black or African American↗
PubMed2003

Increasing infant mortality among very low birthweight infants--Delaware, 1994-2000.

One of the national health objectives for 2010 is to reduce the U.S. infant mortality rate (IMR) to </=4.5 deaths per 1,000 live births (objective no. 16-1c). Historically, Delaware's IMR exceeded the national average; however, during the early 1990s, Delaware's IMR decreased, reaching the U.S. average in 1993. During 1995--2000, the overall U.S. IMR decreased from 7.6 to 6.9; since 1996, Delaware's IMR has increased, and the state now has the seventh highest IMR nationally. To understand the cause of this increase, the Delaware Division of Public Health and CDC analyzed Delaware birth and death data. This report summarizes the results of the investigation, which attributed the Delaware IMR increase primarily to increased mortality among very low birthweight (VLBW) infants born to older, married, suburban mothers who were insured privately and who received early prenatal care. Further study, including collection of data on method of conception, is required to determine the etiology of the increased mortality in this subpopulation.

Delaware↗
PubMed2003

The impact of congenital malformations and Mendelian diseases on infant mortality in Israel.

BACKGROUND: Infant mortality in Israel is twofold higher among non-Jews than Jews. OBJECTIVES: To determine the impact of congenital malformations and Mendelian diseases on infant mortality. METHODS: We compared the causes of infant mortality in a 4 year period among Jewish and non-Jewish Israeli citizens. Classification was done by analyzing all the death reports according to whether or not the child had any known major malformation, Mendelian disease and/or a syndrome, irrespective of the immediate cause of death. RESULTS: The infant mortality among non-Jews was double that among Jews (9 versus 4.4 per 1,000 live births). The rate of children with malformations/genetic syndromes was 3.1 times higher among non-Jews than among Jews (2.94 vs. 1.25 per 1,000 live births). The most significant difference was in the rate of Mendelian diseases, which were 8.3 times more frequent in non-Jewish children (0.16 vs. 1.33 per 1,000 live births respectively). A Mendelian disease was diagnosed in almost 15% of the non-Jewish infants and in less than 5% of the Jewish infants. CONCLUSIONS: The most striking difference between the Jewish and non-Jewish infants was the incidence of congenital malformations and Mendelian diseases parallel to the differences in the consanguinity rates between the two populations.

Abortion, Therapeutic↗
PubMed1982

Area variations in infant mortality 1975-7.

Infant mortality rates vary from area to area. Part of this variation is due to the socioeconomic characteristics of the area and part to other factors including the obstetric, paediatric, and community health services. Four social indicators associated with infant deaths are used to control for some of the variations in socioeconomic characteristics and residual variation is then examined. The four social indicators are the level of unemployment, the proportion of large families, the proportion of lone-parent families, and the level of overcrowding.

Crowding↗
PubMedDate not supplied

Native American infant mortality in Wisconsin.

An infant mortality rate is an important public health measure because it may indicate unmet health needs or unfavorable environmental factors. The infant mortality rate for Native Americans in Wisconsin has decreased over the past several years, although there remains a discrepancy between Native Americans, all races combined and the Healthy People 2000 goal. The Wisconsin American Indian Infant Mortality Review Project (WAIIMR) conducted a study to understand local underlying factors that contributed to infant deaths and to recommend local health initiatives that could be developed to have a positive impact on the health of infants and mothers. The results from the WAIIMR Project and more recent Wisconsin birth record data are discussed in this paper. Two risk factors, levels of prenatal care and maternal smoking during pregnancy, show discrepancies between races and warrant further investigation. Native American communities in Wisconsin are addressing risk factors affecting maternal and child health through projects such as Honoring Our Children and The Michigan/Wisconsin Epidemiology Center.

Humans↗
PubMedDate not supplied

The use of logit models to investigate social and biological factors in infant mortality. II: Stillbirths.

Infant mortality data for England and Wales cross-classified by mother's age, parity and social class have only been published for 1949/50 and 1975. Appropriate statistical methodology for the analysis of such data has been described in Paper I, which used the 1975 stillbirth data for illustration. This paper examines the stillbirth data from both years by formally incorporating the year of data collection into the statistical model, enabling changes in the age, parity and social class effects with time to be investigated. Despite a marked reduction in stillbirth mortality from 21.1 to 10.1 per thousand over the period, the relative contribution of social class has increased. In particular there has been a relative increase in risk for mothers in the lower social classes. By contrast the effects of age and parity, although remaining important, have diminished over the period.

Adolescent↗
PubMed1987

Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.

The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonatal mortality rates did not increase in the target areas following initiation of RICP, indicating that deaths were not merely being postponed. Nine of ten individual sites showed reductions in infant mortality following program initiation. Birthweight-specific mortality data indicated that the decline was due mainly to reductions in neonatal mortality among low-birthweight infants. No reductions in the incidence of low birthweight were observed in the target areas. Substantial gaps in the delivery of prenatal care remained due to the continuing poverty of the population and the resultant lack of financial coverage for health services. We conclude that improved perinatal medical care can reduce infant mortality in poor rural areas to average levels experienced in the United States, and that the high rates still observed in some rural counties are unnecessary.

Black or African American↗
PubMedDate not supplied

[Survey of infant mortality in Mirebalais, Haiti].

Infant mortality remains high in Haiti, at 74 deaths per 1,000 live births. In this study, we aimed to assess infant mortality in Mirebalais and to identify the associated risk factors. We carried out a census of pregnant women in Mirebalais, at the beginning of the study, over a three-week period. Twelve researchers visited the homes of the newborns to enroll the families in the study and to collect demographic data. Further visits were scheduled for two, four, six, nine and twelve months after birth. If the child died during this time, the investigator asked the mother about all the steps taken to prevent the death of the child, and an autopsy was carried out. The survey began on July 12 1994 and ended on December 31 1995. During that time, about 2,151 pregnant women were enrolled. Seven of these women died and 16 had abortions. In total, 2,069 children were born to the enrolled women. We enrolled 515 other children after birth or following referral by health workers or midwives. We therefore followed 2,584 children. We found that 10% of the mothers were aged between 15 and 19 years, 66.3% had had one to three pregnancies and 73% were entirely uneducated. The early neonatal mortality rate was 4.64 per 1,000 live births, late neonatal mortality was 6.96 per thousand and post-neonatal mortality was 45.6 per thousand live births. Diarrhea was responsible for 60% of the deaths and acute respiratory infections for 11%, these two causes accounting for 71% of the deaths of children aged 1 to 12 months. Thus, although infant mortality has decreased it remains high in Mirebalais, largely due to diarrhea and acute respiratory infections in the post-neonatal period.

Adolescent↗
PubMed1989

Infant mortality among moderately low birth weight infants in Alabama, 1980 to 1983.

A previous study of postneonatal deaths among normal birth weight infants in Alabama indicated that rural residence increased the risk of postneonatal death, the magnitude of the excess risk in the black population, and the risk of death from preventable causes. To determine whether this pattern persisted in a group presumably at higher than usual risk of infant death, patterns of mortality among infants weighing 1500 to 2499 g at birth and born in Alabama between 1980 and 1983 were examined by race, residence, and cause of death. Neonatal and infant mortality rates were higher for black infants; postneonatal mortality rates were higher for black infants. Neonatal mortality was highest for white infants from the rural part of the state; post-neonatal mortality was highest for black infants from the rural part of the state. There was little variation in the proportion of preventable postneonatal deaths by race or residence (17.6% for all) but almost twice as many white deaths were not preventable as black ones (39.0 vs 21.9%). It is posited that rural residence may actually be a surrogate measure for lack of access to health services.

Black or African American↗