Perinatal Periods of Risk: Analytic Preparation and Phase 1 Analytic Methods for Investigating Feto-Infant Mortality
- First Online:
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
- 1.Mathews, T. J., & MacDorman, M. F. (2004). Infant mortality statistics from the period linked birth/infant death data set. National Vital Statistics Reports, 2007(55), 1–32.Google Scholar
- 2.Centers for Disease Control and Prevention. (2005). Racial/ethnic disparities in infant mortality—United States, 1995–2002. MMWR, 54, 553–556.Google Scholar
- 5.Pestronk, R. M., & Franks, M. L. (2003). A partnership to reduce African American infant mortality in Genesee County, Michigan. Public Health Report, 118, 324–335.Google Scholar
- 11.WHO, CDC, CARE. (2009). WHO Collaborating Center in Reproductive Health (CDC), CCHI Care, CDC Health Inititiative, and The Health Unit—CARE. Lawn, J., McCarthy, B., & Ross, S. R. The healthy newborn: a reference manual for program managers. http://www.careusa.org/careswork/whatwedo/health/hpub.asp. Accessed December 16, 2009.
- 12.Heaman, M., et al. (2002). Preventable feto-infant mortality application of a conceptual framework for perinatal health surveillance to Manitoba perinatal outcomes. Canadian Journal of Public Health, 93(Suppl 2), S27–S32.Google Scholar
- 13.Peck, M. G., Sappenfield, W. M., & Skala, J. (in press). Perinatal periods of risk: A community approach for using data to improve women and infants’ health. Maternal and Child Health Journal.Google Scholar
- 14.Sappenfield, W. M., Peck, M. G., Haynatzka, V. R., Gilbert, C. S., & Bryant, T. (in press). Phase 2 analytic methods for further investigating feto-infant mortality. Maternal and Child Health Journal.Google Scholar
- 15.CityMatCH. (2008). Training opportunities: perinatal periods of risk. http://www.citymatch.org/ppor_index.php . Accessed July 5, 2008.
- 17.Alexander, G. R., et al. (2008). Infant mortality assessment manual. http://www.soph.uab.edu/mch-imrm/. Accessed July 5, 2008.
- 19.National Center for Health Statistics. (1995). Division of vital statistics. Instruction manual part 12: Computer edits for natality data, effective 1993, Hyattsville, MD.Google Scholar
- 20.Taffel, S., Johnson, D., & Heuser, R. (1982). A method of imputing length of gestation on birth certificates. Vital and Health Statistics, Series 2, 93, 1–11.Google Scholar
- 21.Sappenfield, B., & Haynatzka, V. (2001). Periods of risk practice collaborative: Frequently asked data and analytic questions. http://webmedia.unmc.edu/community/citymatch/PPOR/howto/AnalyticIssuesextra.pdf. Accessed July 5, 2008.
- 22.Centers for Disease Control and Prevention. (2007). Unregistered deaths among extremely low birthweight infants—Ohio, 2006. MMWR, 56, 1101–1103.Google Scholar
- 25.Kung, H. C., Hoyert, D. L., Xu, J. Q., & Murphy, S. L. (2008). Deaths: Final data for 2005. National Vital Statistics Reports, 56(10), 117.Google Scholar
- 26.Beitsch, L. M., Mahan, C. S., & Cupoli, J. M. (1992). Healthy start strengthening public and private partnership. Florida Medical Association Journal, 79, 567–568.Google Scholar
- 27.Florida Department of Health. (2008). Florida’s healthy start. http://www.doh.state.fl.us/family/mch/hs/hs.html. Accessed July 6, 2008.
- 28.Coalition of Northeast Florida, Inc. (2008). Northeast Florida healthy start coalition. http://www.nefhealthystart.org/. Accessed July 6, 2008.
- 29.CityMatCH. (2008).Table 7A: The feto-infant mortality excess number and rate, and the excess number and rates for the four perinatal periods of risk components. http://webmedia.unmc.edu/community/citymatch/PPOR/NationalDataTables98-00/Table7A.pdf. Accessed July 5, 2008.
- 33.Martin, J. A., & Menacker, F. (2007). Expanded health data from the new birth certificate, 2004. National Vital Statistics Reports, 55(12), 1–22.Google Scholar