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Tackling Persistent and Large Disparities in Birth Outcomes in Allegheny County, Pennsylvania

Abstract

Objectives

Based in Allegheny County, a coalition of local stakeholders took note of the region’s infant mortality rates, particularly the stark disparities observed by race, and established a vision to reduce infant mortality in the region. The group undertook a multi-faceted effort to (1) develop predictive models of infant mortality risk; (2) evaluate the effectiveness of available interventions; and (3) combine these tools in order to tailor intervention referrals based on maternal risk profiles. With this effort, the coalition sought to address the apparent disconnect between the region’s robust maternal and child health care system and relatively poor birth and infant outcomes and racial disparities.

Methods

The effort started with the integration of data from a variety of sources into an integrated database built specifically for this research effort covering the period 2003 to 2013. With the database, researchers linked each individual’s data across multiple data sources, including the Allegheny County Health Department, the University of Pittsburgh Medical Center, the Allegheny County Department of Human Services Data Warehouse, and individual programs. With these data, we used a standard method for comparing outcomes and measuring the racial disparity between Black and white infants that involved calculating a ratio by dividing the rate or percentage for Black infants by the rate or percentage for white infants.

Results

Overall, the results showed that between 2003 and 2013 in Allegheny County disparities were more pronounced for infant mortality (3.25) than low birthweight (1.88) or preterm birth (1.49). Among the different potential causes of infant mortality, the most pronounced disparity was for SIDS (1.78). Among maternal health factors, pre-pregnancy obesity and gestational diabetes had the highest infant mortality disparity. The low birthweight disparity was similar and lower than the infant mortality disparity across all of the maternal health factors, while the preterm birth disparity was even lower. For the maternal behavioral and contextual factors, the infant mortality disparity ranged from 1.5 to 2.3.

Conclusion

The 11-year span of data reported in the IMPreSIv database and the breadth of intervention data included allowed us to report granular information on birth outcomes within Allegheny County over this time period. The database also allowed us to summarize the various factors associated with the range of birth outcomes and describe the participation rates in the medical and community setting interventions. Against this backdrop of pronounced disparities in birth outcomes across a range of factors, we examined the effectiveness of interventions for women with different risk factors (e.g. substance use disorders) in order to develop a tool to facilitate individualized referrals to the interventions that will help the most for a specific risk profile.

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References

  • Behnke, M., & Smith, V. C. (2013). Committee on substance abuse, and committee on fetus and newborn, “prenatal substance abuse: short- and long-term effects on the exposed fetus.” Pediatrics, 131(3), e1009–e1024.

    Article  PubMed  Google Scholar 

  • Burris, H. H., & Hacker, M. R. (2017). Birth outcome racial disparities: a result of intersecting social and environmental factors. Seminars in Perinatology, 41(6), 360–366.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention, “Leading Causes of Death Reports, 1981–2017,” on WISQARS online database, n.d.a. As of June 27, 2019: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html

  • El-Sayed, A. M., Finkton, D. W., Jr., Paczkowski, M., Keyes, K. M., & Galea, S. (2015). Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA. Preventive Medicine, 76, 8–13.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ely, D. M., & Driscoll, A. K. (2019). Infant mortality in the United States, 2017: data from the period linked birth/infant death file.

  • Haider, B. A., Olofin, I., Wang, M., Spiegelman, D., Ezzati, M., & Fawzi, W. W. (2013). Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: syStematic review and meta-analysis. BMJ, 336, f3443.

    Article  Google Scholar 

  • Huang, Q. T., Huang, Q., Zhong, M., Wei, S. S., Luo, W., Li, F., & Yu, Y. H. (2015). Chronic Hepatitis C virus infection is associated with increased risk of preterm birth: A meta-analysis of observational studies. Journal of Viral Hepatitis, 22(12), 1033–1042.

    Article  PubMed  Google Scholar 

  • Kochanek, K. D., S. L. Murphy, J. Q. Xu, and E. Arias, Mortality in the United States, 2016, NCHS Data Brief, No 293, Hyattsville, Md.: National Center for Health Statistics, 2017.

  • Koren, G. (2013). Systematic review of the effects of maternal hypertension in pregnancy and antihypertensive therapies on child neurocognitive development. Reproductive Toxicology, 39, 1–5.

    CAS  Article  PubMed  Google Scholar 

  • Kozuki, N., Lee, A. C., Silveira, M. F., Sania, A., Vogel, J. P., Adair, L., & Humphrey, J. (2013a). The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: A meta-analysis. BMC Public Health, 13(3), S2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kozuki, N., Lee, A. C., Silveira, M. F., Victora, C. G., Adair, L., Humphrey, J., & Katz, J. (2013b). The associations of birth intervals with small-for-festational-age, preterm, and neonatal and infant mortality: A meta-analysis. BMC Public Health, 13(3), S3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lemon, L. S., Naimi, A. I., Abrams, B., Kaufman, J. S., & Bodnar, L. M. (2016). Prepregnancy obesity and the racial disparity in infant mortality. Obesity, 24(12), 2578–2584.

    Article  PubMed  Google Scholar 

  • MacDorman, M. F., Mathews, T. J., Mohangoo, A. D., & Zeitlin, J. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010, National Vital Statistics Reports, Vol. 10, No. 5, Hyattsville, Md.: National Center for Health Statistics.

  • Marchi, J., Berg, M., Dencker, A., Olander, E. K., & Begley, C. (2015). Risks associated with obesity in pregnancy, for the mother and baby: A systematic review of reviews. Obesity Reviews, 16(8), 621–638.

    CAS  Article  PubMed  Google Scholar 

  • Parks, S. E., Lambert, A. B. E., & Shapiro-Mendoza, C. K. (2017). Racial and ethnic trends in sudden unexpected infant deaths: United States, 1995–2013. Pediatrics, 139(6), e20163844.

    Article  PubMed  Google Scholar 

  • Schultz, D., Lovejoy, S.L., Peet, E.D. Examining Interventions to Address Infant Mortality in Allegheny County, Pennsylvania. Santa Monica, CA: RAND Corporation, 2020. https://www.rand.org/pubs/research_reports/RRA858-1.html.

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Correspondence to Dana Schultz.

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Schultz, D., Lovejoy, S. & Peet, E. Tackling Persistent and Large Disparities in Birth Outcomes in Allegheny County, Pennsylvania. Matern Child Health J 26, 978–984 (2022). https://doi.org/10.1007/s10995-021-03289-y

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  • DOI: https://doi.org/10.1007/s10995-021-03289-y

Keywords

  • Infant mortality
  • Birth outcomes
  • Racial disparities
  • Maternal health
  • Maternal behavior
  • Maternal health care