Title: Periods of Risk for Fetal and Infant Mortality
1Periods of Risk for Fetal and Infant Mortality
- C. Spice, K. Carson
- Seattle-King County Department of Public Health,
in collaboration with CityMatCH
- December 1998
2Purpose
- Explore the applicability of the Periods of
Risk approach for a large, urban health
department.
- Build on knowledge gained through three years of
Infant Mortality Review.
- Identify high risk groups for targeted assessment
and intervention.
3Study Population
- King County residents
- 1992-1995 birth cohort
- Fetal deaths 28 weeks gestation
- Infant deaths Early Neonatal (Neonatal (7-27 days), Postneonatal (28 days - 1
year)
- Survivors remainder of live birth cohort
4Distribution of Feto-Infant Deaths in Matrix
Late Fetal
Late Neonatal
Post Neonatal
Survivors
Early Neonatal
1000-1499g
1500-2499g
2500g
Unknown BW
5Study Population
- Stratify cohort by maternal race, maternal age,
and maternal education.
- Race White, African-American, and Other.
- Four age/education groups
- 20 years old with 12 years education
- 20 years old with
- Unclassified unknown age OR education
6Feto-Infant Deaths by Race Age/Education Group
183
Reference Group
131
111
40
38
33
35
29
24
14
8
5
7Exclusions
775 fetal and infant deaths
74 (10) cases with unknown birthweight excluded
701 fetal and infant deaths
50 (7) cases with unknown race excluded
651 fetal and infant deaths
186 (29) cases with unknown age and/or education
analyzed as unclassified
465 cases
8Percent Births and Feto-Infant Deaths With
Missing Values
9Excess Mortality for Total Cohort
Excess Mortality Rates
Number of Excess Deaths
10Excess Mortality Rates Maternal Health
11Excess Mortality Rates Maternal Care
12Excess Mortality Rates Newborn Care
13Excess Mortality Rates Infant Care
14Findings
- 225 fetal and infant deaths would have been
averted if all groups had the same mortality
rates as the standard group.
- Highest rate of excess mortality is in the
maternal care group (and infant deaths.
15Findings
- African-Americans have high excess mortality
rates, especially maternal health.
- For whites, excess deaths are concentrated in
infant care among mothers under 20.
- Other race group experienced low rates of
excess fetal-infant death.
- Unclassified group had the highest rates of
excess mortality across the matrix.
16Next Steps for Analysis
- Work with WA State Dept of Health and local
hospitals to improve completeness and quality of
birth data.
- Find an alternate proxy for SES
- Source of payment for prenatal care
- Poverty level of census tract in which mother
resides
- Use infant mortality review case write-ups to
help validate matrix categories.
17Lessons Learned
- Fetal deaths are a significant component of
fetal-infant mortality need to be analyzed.
- POR helps policy makers to see that infant
mortality prevention is complex there isnt a
single solution that will work in isolation.
- POR enables us to identify and focus on the
interventions that might affect excess death.
18Policy/Program Implications
- African-American teens have lower risk of excess
death due to infant care can we learn anything
from this?
- Nearly half of all excess deaths fall in the
maternal health group where interventions include
- Pregnancy planning
- Smoking and drug use
- Domestic violence
- STD treatment
- Nutritional status
- Stress lack of support