Maternal and Child Health Journal

, Volume 15, Issue 1, pp 42–48

Variation by State in Outcomes Classification for Deliveries Less Than 500 g in the United States

  • Deborah B. Ehrenthal
  • Martha S. Wingate
  • Russell S. Kirby
Article

Abstract

The purpose of this study is to explore state-level fetal death rates and <24 h infant mortality rates for deliveries less than 500 g in order to estimate outcomes classification differences at the edge of viability. We selected singleton deliveries to US resident mothers born <500 g and >20 weeks gestation from the NCHS live birth-infant death and fetal death files for 1999–2002 (n = 37,813). Infant deaths within 24 h of birth were selected to estimate odds of classification as a fetal death versus a live birth/infant death by state. Logistic regression was used to derive odds of classification as a fetal death and to adjust for maternal characteristics, calculating unadjusted and adjusted odds ratios. We identified 37,813 outcomes from 48 states reporting in this birthweight category. Unadjusted odds of classification of outcomes as a fetal death versus a live birth/death within 24 h by state ranged from OR = 0.38 (95% CI = 0.24–0.59) to OR = 2.93 (95% CI = 2.26–3.78); adjusted for maternal age and race, the range narrowed slightly to a OR = 0.31 (95% CI = 0.20–0.48) to aOR = 2.54 (95% CI = 1.96–3.30). Six states were more likely to classify outcomes as a live birth/infant death, while 14 states were more likely to classify as a fetal death, when compared to a large reference state. The remaining states did not differ significantly in their outcomes. The fraction of outcomes classified as fetal deaths varied by state during the years studied. This study suggests fetal death and early infant death outcomes reported for babies less than 500 g reflect differential classification thus influencing the validity of these vital statistics data at the state level. Further studies are needed to explore the factors that influence these differences.

Keywords

Vital statistics Perinatal mortality Fetal death Classification 

References

  1. 1.
    Lee, K. S., Khoshnood, B., Hsieh, H., Kim, B. I., Schreiber, M. D., & Mittendorf, R. (1995). Which birthweight groups contributed most to the overall reduction in the neonatal mortality rate in the United States from 1960 to 1986? Paediatric and Perinatal Epidemiology, 9(4), 420–430.CrossRefPubMedGoogle Scholar
  2. 2.
    Martin, J. A., Kochanek, K. D., Strobino, D. M., Guyer, B., & MacDorman, M. F. (2005). Annual summary of vital statistics—2003. Pediatrics, 115(3), 619–634.CrossRefPubMedGoogle Scholar
  3. 3.
    Hamilton, B. E., Minino, A. M., Martin, J. A., Kochanek, K. D., Strobino, D. M., & Guyer, B. (2007). Annual summary of vital statistics: 2005. Pediatrics, 119(2), 345–360.CrossRefPubMedGoogle Scholar
  4. 4.
    Joseph, K. S., Kramer, M. S., Allen, A. C., Cyr, M., Fair, M., Ohlsson, A., et al. (2000). Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985–94. Fetal and infant health study group of the canadian perinatal surveillance system. Paediatric and Perinatal Epidemiology, 14(4), 332–339.CrossRefPubMedGoogle Scholar
  5. 5.
    Paul, D. A., Mackley, A., Locke, R. G., Stefano, J. L., & Kroelinger, C. (2009). State infant mortality: An ecologic study to determine modifiable risks and adjusted infant mortality rates. Maternal and Child Health Journal, 13(3), 343–348.CrossRefPubMedGoogle Scholar
  6. 6.
    Centers for Disease Control and Prevention. (2004). Racial/ethnic trends in fetal mortality—United States, 1990–2000. MMWR Morbidity and Mortality Weekly Report, 53(24), 529–532.Google Scholar
  7. 7.
    MacDorman, M. F., Hoyert, D. L., Martin, J. A., Munson, M. L., & Hamilton, B. E. (2007). Fetal and perinatal mortality, United States, 2003. National Vital Statistics Reports, 55(6), 1–17.Google Scholar
  8. 8.
    MacDorman, M. F., Munson, M. L., & Kirmeyer, S. (2007). Fetal and perinatal mortality, United States, 2004. National vital statistics reports. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  9. 9.
    MacDorman, M. F., & Kirmeyer, S. (2009). Fetal and perinatal mortality, United States, 2005. National Vital Statistics Reports, 57(8), 1–19.PubMedGoogle Scholar
  10. 10.
    Kochanek, K. D., & Martin, J. A. (2005). Supplemental analyses of recent trends in infant mortality. International Journal of Health Services, 35(1), 101–115.CrossRefPubMedGoogle Scholar
  11. 11.
    Martin, J. A., Kung, H. C., Mathews, T. J., Hoyert, D. L., Strobino, D. M., Guyer, B., et al. (2008). Annual summary of vital statistics: 2006. Pediatrics, 121(4), 788–801.CrossRefPubMedGoogle Scholar
  12. 12.
    Joseph, K. S., & Kramer, M. S. (1996). Recent trends in Canadian infant mortality rates: effect of changes in registration of live newborns weighing less than 500 g. CMAJ, 155(8), 1047–1052.PubMedGoogle Scholar
  13. 13.
    Joseph, K. S., & Kramer, M. S. (1997). Recent trends in infant mortality rates and proportions of low-birth-weight live births in Canada. Cmaj, 157(5), 535–541.PubMedGoogle Scholar
  14. 14.
    Phelan, S. T., Goldenberg, R., Alexander, G., & Cliver, S. P. (1998). Perinatal mortality and its relationship to the reporting of low-birthweight infants. American Journal of Public Health, 88(8), 1236–1239.CrossRefPubMedGoogle Scholar
  15. 15.
    Alexander, G. R., Himes, J. H., Kaufman, R. B., Mor, J., & Kogan, M. (1996). A United States national reference for fetal growth. Obstetrics and Gynecology, 87(2), 163–168.CrossRefPubMedGoogle Scholar
  16. 16.
    MacDorman, M. F., Martin, J. A., Mathews, T. J., Hoyert, D. L., & Ventura, S. J. (2005). Explaining the 2001–2002 infant mortality increase in the United States: Data from the linked birth/infant death data set. International Journal of Health Services, 35(3), 415–442.CrossRefPubMedGoogle Scholar
  17. 17.
    Petersen, D. J., & Alexander, G. R. (1997). Threats to accurate interpretation of secondary data. In J. B. Kotch (Ed.), Maternal and child health: Programs, problems and policy in public health (pp. 395–404). Gaithersburg: Aspen Press.Google Scholar
  18. 18.
    Alexander, G. R., Petersen, D. J., Wingate, M. S., & Kirby, R. S. (2005). Research issues in maternal and child health. In J. B. Kotch (Ed.), Maternal and child health: Programs, problems and policy in public health (2nd ed., pp. 493–533). Sudbury: Jones and Bartlett.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Deborah B. Ehrenthal
    • 1
  • Martha S. Wingate
    • 2
  • Russell S. Kirby
    • 3
  1. 1.Department of Obstetrics & Gynecology, Room 1901EChristiana Care Health Services, IncNewarkUSA
  2. 2.Department of Health Organization and PolicyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Community and Family HealthUniversity of South FloridaTampaUSA

Personalised recommendations