Perinatal Periods of Risk: Analytic Preparation and Phase 1 Analytic Methods for Investigating Feto-Infant Mortality
The Perinatal Periods of Risk (PPOR) methods provide the necessary framework and tools for large urban communities to investigate feto-infant mortality problems. Adapted from the Periods of Risk model developed by Dr. Brian McCarthy, the six-stage PPOR approach includes epidemiologic methods to be used in conjunction with community planning processes. Stage 2 of the PPOR approach has three major analytic parts: Analytic Preparation, which involves acquiring, preparing, and assessing vital records files; Phase 1 Analysis, which identifies local opportunity gaps; and Phase 2 Analyses, which investigate the opportunity gaps to determine likely causes of feto-infant mortality and to suggest appropriate actions. This article describes the first two analytic parts of PPOR, including methods, innovative aspects, rationale, limitations, and a community example. In Analytic Preparation, study files are acquired and prepared and data quality is assessed. In Phase 1 Analysis, feto-infant mortality is estimated for four distinct perinatal risk periods defined by both birthweight and age at death. These mutually exclusive risk periods are labeled Maternal Health and Prematurity, Maternal Care, Newborn Care, and Infant Health to suggest primary areas of prevention. Disparities within the study community are identified by comparing geographic areas, subpopulations, and time periods. Excess mortality numbers and rates are estimated by comparing the study population to an optimal reference population. This excess mortality is described as the opportunity gap because it indicates where communities have the potential to make improvement.
KeywordsPerinatal periods of risk (PPOR) Feto-infant mortality Health disparities methodology
Thanks to Dr. Brian McCarthy for developing and sharing his original methods and encouraging us to modify the approach for use in U.S. cities. Thanks to the Perinatal Periods of Risk City Teams, Pat Simpson and Jennifer Skala for their help in developing and adapting the methods for use in urban communities. Special thanks to Dr. Milton Kotelchuck and Dr. Laurin Kasehagen for their advice in writing these articles for publication. This work was supported in part by the following Cooperative Agreements: Merging Research and Practice for Urban Child Health—TS-283-14/16 (under CDC Cooperative Agreement U50/CCU300860); Building Urban MCH Capacity—TS 0922 (under CDC Cooperative Agreement U50/CCU300860); Toward Greater Science Use in Urban Health Agencies—TS-1337 (under CDC Cooperative Agreement U50/CCU300860); and the Maternal, Infant, and Reproductive Health: Science-Based Capacity Building for Major Urban Public Health Agencies (5 U65 DP724969-05) between CityMatCH at the University of Nebraska Medical Center and the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, with supplemental support from the National Center for Birth Defects and Developmental Disabilities, and the Health Resources and Services Administration, Maternal and Child Health Bureau. Additional support was provided by the National March of Dimes Birth Defects Foundation, and the University of Nebraska Medical Center, Department of Pediatrics.
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