Maternal and Child Health Journal

, Volume 12, Supplement 1, pp 12–24

Progress Towards Narrowing Health Disparities: First Steps in Sorting Out Infant Mortality Trend Improvements Among American Indians and Alaska Natives (AI/ANs) in the Pacific Northwest, 1984–1997

Article

DOI: 10.1007/s10995-008-0366-9

Cite this article as:
Gaudino, J.A. Matern Child Health J (2008) 12(Suppl 1): 12. doi:10.1007/s10995-008-0366-9

Abstract

Background Most AI/AN infant mortality rates (IMRs) remain higher than white rates. The Northwest Portland Area Indian Health Board (NPAIHB), serving 43 tribes, CDC and the Washington, Oregon, and Idaho health departments investigated AI/AN infant survival. Methods NPAIHB completed linking computerized birth certificate and birth-death files. We used death and birth cohorts, StatXact and SAS to compare 3-state resident, single and multi-year IMRs, basing infant race on mother’s race, regardless of Hispanic origin. We used CDC’s National Infant Mortality Surveillance ICD-9 categories for cause-specific rates. Results From 1984 to 1997, about 2100–2800 AI/AN births occurred annually. From 1984 to 1990, AI/AN IMRs were 1.8–2.4 fold higher than white rates. Then aggregate-year IMRs significantly declined from 16.3 in 1984–1987 to 6.7 in 1994–1997 (P < 0.0001), approaching the 5.6 1994–1997 white rate. In 1998 the AI/AN IMR rate increased to 10.3. AI/AN SIDS and respiratory distress syndrome rates decreased significantly, respectively, from 8.1 in between 1984–1987 to 2.3 in 1994–1996 and from 1.8 in 1984–1987 to 0.3 in 1991–1993, then leveled off. Significant rate declines occurred among most demographic, risk behavior, birthweight, gestational-age, reproductive risk, birth spacing, and labor/delivery sub-groups. Among others, AI/AN residents in Idaho as well as those who received no prenatal care and who had 0–5 month birth spacing experienced no improvements. Conclusions These uncommon rate declines imply multi-factorial improvements among Northwest AI/ANs. Community-level surveillance and interventions before conception through post-partum may further improve health. Collaborative efforts need to be maintained to continue to monitor changes in AI/AN infant health and maternal characteristics.

Keywords

Infant mortalityAmerican Indians and Alaska NativesPregnancyRace and ethnic health disparitiesPerinatal mortalityNeonatal mortalityPostneonatal mortalitySurveillanceSudden infant death syndromeRespiratory distress syndrome

Abbreviations

ID

Idaho

OR

Oregon

WA

Washington

AI/AN

American Indian and Alaska Natives

IMR

Infant mortality rate

CDC

Centers for Disease Control and Prevention

NPAIHB

Northwest Portland Area Indian Health Board

CI

95% Confidence interval

RR

Relative risk

OR

Odds ratio

Copyright information

© GovernmentEmployee: at the time of this work, I worked for the Applied Sciences Branch, Division of Reproductive Health, National Centerfor Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention  2008

Authors and Affiliations

  1. 1.Department of Public Health and Preventive MedicineSchool of Medicine, Oregon Health and Sciences UniversityPortlandUSA