MCH Alert: Focus on Infant Mortality


Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden Infant Death Resource Center. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.


January 25, 2008

1. RAND'S Promising Practices Network Features Effective Home-Visiting Program
2. Framework Outlines Recommendations for State Policies That Support Healthy Growth and Development in Early Child Care Settings
3. Article Examines Trends in Infant Mortality Among African Americans and Whites
4. Study Evaluates Relationship Between Air Pollution and Postneonatal Infant Mortality
5. Authors Assess Relationship Between Neighborhood Deprivation and Preterm Birth by Race

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1. RAND'S PROMISING PRACTICES NETWORK FEATURES EFFECTIVE HOME-VISITING PROGRAM

An updated summary for Healthy Families New York (HFNY) was recently posted to RAND's Promising Practices Network (PPN) Web site. HFNY is a community-based prevention program that seeks to improve the health and well-being of children by delivering intensive home-visiting services to expectant parents and to parents with an infant ages 3 months or younger who is considered to be at high risk for child abuse and neglect. The study on which the updated program summary was based found that this "proven" program continued to reduce child abuse and neglect in the second year of the study. The study is noteworthy because it is one of the few evaluations of home-visiting programs that have used a rigorous randomized control design. Additionally, it is the only study of a program using the Healthy Families America guidelines that meets PPN study design criteria, and it finds significant and sizeable effects at a much lower cost than models that rely exclusively on nurses. More information is available at
http://www.promisingpractices.net/program.asp?programid=147.

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2. FRAMEWORK OUTLINES RECOMMENDATIONS FOR STATE POLICIES THAT SUPPORT HEALTHY GROWTH AND DEVELOPMENT IN EARLY CHILD CARE SETTINGS

Charting Progress for Babies in Child Care: Policy Framework Summary sets forth four key principles that establish the foundation of supports that all infants and young children in child care need, as well as 15 recommendations that state child care licensing, quality, and subsidy policies should address. The summary was developed by the Center for Law and Social Policy (CLASP) and the Zero to Three Policy Center during the first year of a multi-year effort to identify state policies that support the healthy development of infants and young children in child care settings and to build an online resource to help states implement these policies. Future products will include research-based rationales supporting each recommendation and a new section on the CLASP Web site that presents the full framework with sets of policies that may help states move toward each recommendation. The summary is available at http://www.clasp.org/publications/cp_framework_sum.pdf.

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3. ARTICLE EXAMINES TRENDS IN INFANT MORTALITY AMONG AFRICAN AMERICANS AND WHITES

"For this study population, IMRs [infant mortality rates] declined over time for both race groups," write the authors of an article published in the January 2008 issue of the American Journal of Obstetrics & Gynecology. Although the rate of infants born at low birthweights (LBWs) has increased in the United States over the past few decades, IMRs have declined dramatically. The decrease has been observed for both white and African-American (AA) infants. However, the racial disparity in IMR rates has increased. The study described in this article examines temporal changes in birthweight (BW)-gestational age (GA) distributions and BW-GA-specific IMRs for AAs and whites during the periods 1985-1988 and 1995-2000. The study sought to better understand how the proportion of high-risk births and their survival by race group contribute to the growing racial disparity in infant mortality. Within the two groups, the authors assessed trends in infant survival by BW-GA categories and then examined how relative racial differences in survival had changed. Finally, the authors calculated the estimated annual number of excess AA infant deaths for the final period to quantify the magnitude of the observed racial disparity.

The authors used data from the National Center for Health Statistics' linked live birth-infant death cohort files for the study. The final sample included 10,620,735 live births from the 1985-1988 cohort and 21,687,542 live births from the 1995-2000 cohort.

The authors found that
The authors conclude that "states, communities, and providers must remain vigilant in their efforts to assure timely access to high-quality, risk-appropriate prenatal services. But, until effective preterm prevention strategies emerge, dramatic reductions in these racial disparities should not be expected in the near future."

Alexander GR, Wingate MS, Bader D. 2008. The increasing racial disparity in infant mortality rates: Composition and contributors to recent US trends. American Journal of Obstetrics & Gynecology 189(1):51.e1-51.e9. Available at http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937807007351.pdf.

Readers: More information is available from the following MCH Library resources:

- Knowledge Path: Infant Mortality at
http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html

- Knowledge Path: Racial and Ethnic Disparities in Health at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html

- Infant Mortality (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_infmortality.html&-MaxRecords=all&-DoScript=auto_search_infmortality&-search

- Infant Mortality Prevention (organizations resource list) at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_infmort.html&-MaxRecords=all&-DoScript=auto_search_infmort&-search

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4. STUDY EVALUATES RELATIONSHIP BETWEEN AIR POLLUTION AND POSTNEONATAL INFANT MORTALITY

"A recent review of air pollution and children’s health in Europe by the World Health Organization concludes that 'the evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the post-neonatal period' (World Health Organization 2005). This study, in conjunction with previous U.S. studies, suggests this statement remains true at PM [particulate matter] levels found in the United States," state the authors of an article published in the January 2008 issue of Environmental Health Perspectives. Several studies have found a relationship between PM air pollution and infant mortality in countries with relatively high levels of PM air pollution as well as in countries with lower pollution levels, such as Canada and the United States. Most studies of air pollution and postneonatal infant mortality (deaths occurring after 28 days of life) have focused on larger particles, and few have evaluated the contribution of other pollutants to infant mortality. Although relatively consistent results have been found for PM and respiratory postneonatal infant mortality, varying results have been found for the association between PM and sudden infant death syndrome (SIDS). Given the uncertainty in findings for different particle size, the varied findings for studies with multiple pollutants, and the variability in the results for SIDS, further evaluation is warranted. This article examines the relationships between chronic exposure to particulate matter (course vs. fine) and gaseous (carbon monoxide, sulfur dioxide, and ozone) air pollutants and postneonatal respiratory and SIDS infant mortality.

The researchers matched birth and death records for infants born between 1999 and 2002 in the United States and matched them to county-specific monitoring data for air pollution. Counties with less than 250,000 residents were excluded from the study. For each infant, the researchers calculated the average concentration of each pollutant over the first 2 months of life. Odds ratios (ORs) were estimated for each pollutant in single- and multi-pollutant models for overall postneonatal mortality and for each cause of death (respiratory, SIDS). ORs are reported after adjustment for maternal characteristics (race and ethnicity, marital status, age, education, and primiparity), county-level poverty and per capita income levels, year and month of birth, and region of the country. ORs are also reported for a range increase in the pollutant to help standardize comparisons across pollutants. The study population comprised 6,639 postneonatal deaths occurring in 96 counties throughout the United States.

The authors found that
The authors conclude that "this study provides further support for PM air pollution as a risk factor for respiratory-related postneonatal infant mortality and suggests that [ozone] may play a role in SIDS."

Woodruff TJ, Darrow LA, Parker JD. 2008. Air pollution and postneonatal infant mortality in the United States, 1999-2002. Environmental Health Perspectives 116(1):110-115. Full text available at http://www.ehponline.org/members/2007/10370/10370.pdf.

Readers: More information about air pollution is available from the MCH Library's organizations resource list, Environmental Health, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_environ.html&-MaxRecords=all&-DoScript=auto_search_environ&-search.

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5. AUTHORS ASSESS RELATIONSHIP BETWEEN NEIGHBORHOOD DEPRIVATION AND PRETERM BIRTH BY RACE

"We found a significant but moderate-to-weak association between neighborhood deprivation and risk of preterm birth among both non-Hispanic White women and non-Hispanic Black women," state the authors of an article published in the January 2008 issue of the American Journal of Epidemiology. Despite efforts to reduce racial disparities in adverse birth outcomes between blacks and whites, such disparities—specifically in infant mortality, low birthweight, and preterm birth—persist in the United States. National infant mortality data from 2002 reveals rates for non-Hispanic black mothers (13.9 per 1,000 births) that are 2.4 times higher than those for non-Hispanic white mothers (5.8 per 1,000 births). Preliminary data for 2004 show that 13.7% of infants born to non-Hispanic black mothers were low birthweight, 3.1% were very low birthweight, and 17.9% were preterm. Additional research focused on two provinces in Canada found that lower neighborhood socioeconomic status, as measured by income level, adversely affected birth outcomes, including preterm birth. This article presents findings from a study to examine the relationship between neighborhood deprivation and preterm birth (delivery before 37 weeks' completed gestation) across a range of geographic areas and explores what happens to the relationship after controlling for maternal age and education. Because previous research on pregnancy outcomes demonstrated substantial effect modification for neighborhood and race, the researchers stratified the analyses by maternal race and examined the relationship between neighborhood deprivation and preterm birth separately for non-Hispanic white women and non-Hispanic black women.

A total of eight geographic areas in four states were represented in the study. Singleton births were obtained from the vital statistics records of each study site’s government health department. Census tract data from the 2000 U.S. Census were used to characterize neighborhoods. A neighborhood-deprivation index was created using census variables; lower values on the neighborhood deprivation index indicate less deprivation, while higher values indicate more deprivation. Unadjusted and adjusted models for preterm birth containing neighborhood deprivation were fitted, controlling for individual-level potential confounders of maternal age and education.

The authors found that
The authors state, "in conclusion, results from our analysis are consistent with past research and demonstrate that an indicator of neighborhood deprivation based on a broad set of area-level characteristics is useful, even after accounting for individual-level factors, for understanding risk of preterm birth in different racial groups and a wide variety of geographic settings."

O’Campo P, Burke JG, Culhane J, et al. 2008. Neighborhood deprivation and preterm birth among non-Hispanic black and white women in eight geographic areas in the United States. American Journal of Epidemiology 167(2):155-163. Abstract available at http://aje.oxfordjournals.org/cgi/content/abstract/167/2/155?etoc.

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MCH Alert © 1998-2008 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert: Focus on Infant Mortality is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreements (U02MC00001 and U48MC08717) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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