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Perinatal Disparities Between American Indians and Alaska Natives and Other US Populations: Comparative Changes in Fetal and First Day Mortality, 1995–2008

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Abstract

To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth–infant death cohort and fetal deaths files from 1995–1998 and 2005–2008. We examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day (<24 h), and cause-specific deaths. We calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods (4.6 and 6.5 %). Over time, late fetal death for AIANs decreased 17 % (aOR = 0.83, 95 % CI 0.72–0.97), but we noted a 47 % increased risk over time for Hispanics (aOR = 1.47, 95 % CI 1.40–1.55). Our data indicated no change over time among AIANs for first day death. For AIANs compared to whites, increased risks and disparities persisted for mortality due to congenital anomalies (ROR = 1.28, 95 % CI 1.03–1.60). For blacks compared to AIANs, the increased risks of fetal death (2005–2008: aOR = 0.60, 95 % CI 0.53–0.68) persisted. For Hispanics, lower risks compared to AIANs persisted, but protective effect declined over time. Disparities between AIAN and other groups persist, but there is variability by race/ethnicity in improvement of perinatal outcomes over time. Variability in access to care and pregnancy management should be considered in relation to health equity for fetal and early infant deaths.

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Acknowledgments

Dr. Wingate was supported in part by CDC IPA 1003335 and DHHS, HRSA, MCHB Grant MC00008. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention.

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The authors have no conflicts.

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Authors and Affiliations

  1. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, RPHB 3301530 3rd Avenue South, Birmingham, AL, 35294-0022, USA

    Martha S. Wingate

  2. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia

    Wanda D. Barfield & Ruben A. Smith

  3. Department of Medical Education and Research, Danbury Hospital, Danbury, CT, USA

    Joann Petrini

  4. Office of the President, March of Dimes Foundation, White Plains, NY, USA

    Joann Petrini

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  1. Martha S. Wingate
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  2. Wanda D. Barfield
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  4. Joann Petrini
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Correspondence to Martha S. Wingate.

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Wingate, M.S., Barfield, W.D., Smith, R.A. et al. Perinatal Disparities Between American Indians and Alaska Natives and Other US Populations: Comparative Changes in Fetal and First Day Mortality, 1995–2008. Matern Child Health J 19, 1802–1812 (2015). https://doi.org/10.1007/s10995-015-1694-1

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