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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
2.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 56-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123058

RESUMO

OBJECTIVE: To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN: National birth cohort study. SETTING: England and Wales 2006-2012. SUBJECTS: Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES: Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS: Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS: Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade Infantil/etnologia , Recém-Nascido Prematuro , Grupos Minoritários/estatística & dados numéricos , Pobreza , Causas de Morte , Estudos de Coortes , Anormalidades Congênitas/mortalidade , Inglaterra/epidemiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , País de Gales/epidemiologia
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46891

RESUMO

Plataforma com dados indicadores sobre a mortalidade neonatal de 2000 a 2015. Agenda 2030 - objetivo 3 - Saúde e bem estar


Assuntos
Mortalidade Infantil/etnologia , Brasil/etnologia , Desenvolvimento Sustentável
4.
Aust N Z J Public Health ; 43(6): 570-576, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667984

RESUMO

OBJECTIVE: To investigate the under-identification of Indigenous∗ infants in death records and examine the impact of a multi-stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). METHODS: Data on SUDI in Queensland between 2010 and 2014 were linked to birth and death registrations, health data, and child protection and coronial records. An algorithm was applied to cases of SUDI and population data to derive Indigenous status. Numbers, proportions and rates of SUDI were compared. RESULTS: Using multiple sources of Indigenous status resulted in a 64.9% increase in the number of infants identified as Indigenous. The Indigenous SUDI rate increased by 54.3%, from 1.38 to 2.13 per 1,000 live births after applying the algorithm to SUDI and live births data. CONCLUSIONS: Applying an algorithm to both numerator and denominator data reduced numerator-denominator incompatibility, to more accurately report rates of Indigenous SUDI and measure the gap in Indigenous infant mortality. Implications for public health: Estimation of the true magnitude of the disparity is restricted by under-identification of Indigenous status in death records. Data linkage improved the reporting of Indigenous infant mortality. Accuracy in reporting of measures is integral to determining genuine progress towards Closing the Gap.


Assuntos
Mortalidade Infantil/etnologia , Grupo com Ancestrais Oceânicos , Morte Súbita do Lactente/etnologia , Algoritmos , Causas de Morte , Atestado de Óbito , Documentação/normas , Feminino , Humanos , Lactente , Recém-Nascido , Armazenamento e Recuperação da Informação , Masculino , Queensland/epidemiologia , Fatores de Risco , Morte Súbita do Lactente/epidemiologia
5.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31405887

RESUMO

OBJECTIVES: To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers. METHODS: Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models. RESULTS: Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants. CONCLUSIONS: Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Morbidade , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Disparidades em Assistência à Saúde/tendências , Humanos , Lactente , Mortalidade Infantil/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Gravidez , Complicações na Gravidez/epidemiologia , Porto Rico/epidemiologia , Fatores Raciais , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
6.
Aust N Z J Public Health ; 43(4): 340-345, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339611

RESUMO

OBJECTIVES: To assess whether progress is being made towards reducing Aboriginal and Torres Strait Islander inequality in life expectancy and under-five mortality in the Northern Territory. METHODS: Life tables for five-year periods from 1966-71 to 2011-16 were calculated using standard abridged life table methods with Aboriginal and Torres Strait Islander deaths and population estimates as inputs. The latter were calculated using reverse cohort survival. RESULTS: In 2011-16, life expectancy at birth for the Aboriginal and Torres Strait Islander population was 68.2 years for females and 64.9 years for males. Limited progress in under-five mortality rates has been made in recent years. CONCLUSIONS: Although Aboriginal and Torres Strait Islander life expectancy has increased in the long run, the gap with all-Australian life expectancy has not narrowed. The gap in under-five mortality rates is much lower than it was in the 1960s and 1970s, but progress has been limited over the past decade. Implications for public health: The 'Closing the Gap' target of halving the gap in under-five mortality by 2018 will not be met in the Northern Territory, and there is no evidence yet of progress on the target to eliminate the gap in life expectancy by 2031.


Assuntos
Mortalidade da Criança/etnologia , Mortalidade Infantil/etnologia , Expectativa de Vida , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Austrália/epidemiologia , Pré-Escolar , Feminino , Disparidades nos Níveis de Saúde , Humanos , Lactente , Recém-Nascido , Expectativa de Vida/tendências , Masculino , Grupo com Ancestrais Oceânicos/etnologia
7.
Matern Child Health J ; 23(12): 1670-1678, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31243626

RESUMO

Objectives (a) Update previous descriptions of trends in ASSB; (b) determine if factors previously associated with ASSB are replicated by updated data; and (c) generate new hypotheses about the occurrence of ASSB and racial inequalities in ASSB mortality. Methods National Center for Health Statistics files (International Classification of Diseases, Tenth Edition) Code W75 to describe race-ethnicity-specific ASSB occurrence. Results (a) ASSB mortality continues to increase significantly; for 1999-2016, 4.4-fold for NHB girls (45.8 per 100,000 in 2016), 3.5-fold for NHB boys (53.8), 2.7-fold for NHW girls (15.8) and 4.0-fold for NHW boys (25.9); (b) F actors previously associated with ASSB (unmarried mothers and mothers with low educational attainment, low infant birth weight, low gestational age, lack of prenatal care, male infant, multiple birth, high birth order) continue to be associated with both overall ASSB and inequalities adversely affecting NHB; (c) (1) geographic differences and similarities in ASSB occurrence support hypotheses related to positive deviance; (2) lower ASSB mortality for births attended by midwives as contrasted to physicians generate hypotheses related to both medical infrastructure and maternal engagement; (3) high rates of ASSB among infants born to teenage mothers generate hypotheses related to the possibility that poor maternal health may be a barrier to ASSB prevention based on education, culture and tradition. Conclusions for Practice These descriptive data may generate new hypotheses and targets for interventions for reducing both ASSB mortality and racial inequalities. Analytic epidemiologic studies designed a priori to do so are required to address these hypotheses.


Assuntos
Asfixia/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade Infantil/etnologia , Morte Súbita do Lactente/etnologia , Acidentes Domésticos/mortalidade , Acidentes Domésticos/estatística & dados numéricos , Adolescente , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Idade Materna , Vigilância da População , Gravidez , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
8.
Int J Circumpolar Health ; 78(1): 1629784, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31221048

RESUMO

Seasonal patterns of neonatal mortality and stillbirths have been found around the world. However, little is known about the association between season of birth and infant mortality of pre-industrial societies in a subarctic environment. In this study, we compared how season of birth affected the neonatal and stillbirth risk among the Sami and non-Sami in Swedish Sápmi during the nineteenth century. Using digitised parish records from the Demographic Data Base at Umeå University, we applied logistic regression models for estimating the association of season of birth with stillbirths and neonatal mortality, respectively. Higher neonatal mortality was found among the winter- and autumn-born Sami, compared to summer-born infants. Stillbirth risk was higher during autumn compared to summer among the Sami, whereas we found no seasonal differences in mortality among the non-Sami population. We relate the higher neonatal mortality risk among winter-born Sami to differences in seasonality of living conditions associated with reindeer herding.


Assuntos
Mortalidade Infantil/etnologia , Mortalidade Infantil/tendências , Estações do Ano , Natimorto/etnologia , Regiões Árticas/epidemiologia , Aleitamento Materno/etnologia , Feminino , Humanos , Lactente , Masculino , Fatores Socioeconômicos , Suécia/epidemiologia
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(4): 411-414, 2019 Apr 06.
Artigo em Chinês | MEDLINE | ID: mdl-30982278

RESUMO

We collected death data of children under 5-year-old in China from the national child mortality surveillance system from 2010 to 2016. The change of mortality rate and causes of death were described. The mortality rate of Chinese children under 5-year-old decreased from 16.4‰ to 10.2‰ in all areas between 2010 and 2016, from 20.1‰ to 12.4 ‰ in rural areas and from 7.3‰ to 5.2‰ in urban areas, respectively, with a greater average annual decreasing rate in rural areas than urban area. During these years, in addition to traffic accidents and sepsis, other 8 cause-specific mortality rates showed a downward trend. There were substantial decreases of mortality rates of premature birth or low birth weight, birth asphyxia and neural tube defects. In urban areas, the mortality rate of premature birth or low birth weight, birth asphyxia decreased, and the mortality rate of congenital heart disease and diarrhea substantially decreased. However, there was a substantial increase of mortality rate of septicemia in urban areas. In rural areas, the change of major cause-specific mortality rates were consistent with the national trend.


Assuntos
Mortalidade da Criança , Mortalidade Infantil , Asfixia , Asfixia Neonatal , Causas de Morte , Criança , Mortalidade da Criança/etnologia , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , População Rural , População Urbana
10.
Rev Bras Enferm ; 72(1): 57-63, 2019.
Artigo em Português | MEDLINE | ID: mdl-30916268

RESUMO

OBJECTIVE: To compare infant mortality rates of indigenous and non-indigenous children according to microregions in Brazil. METHOD: The study was based on data from the 2010 Population Census and from the Mortality Information System. Rates and proportions were calculated using data from 558 microregions. RESULTS: Indigenous children presented a higher risk of dying before completing one year of age (60% higher compared to non-indigenous), and rates were higher in microregions with < 1%  of indigenous population. Seven out of 10 deaths were in children over one month of age and were mostly caused by infectious diseases. CONCLUSION: In general, indigenous children die mostly due to preventable causes. The study shows that there are important differences in the levels of infant mortality between indigenous and non-indigenous children in Brazil, even in geographical areas with increased presence of indigenous population.


Assuntos
Índios Sul-Americanos/estatística & dados numéricos , Mortalidade Infantil/etnologia , Brasil/etnologia , Humanos , Índios Sul-Americanos/etnologia , Lactente , Mortalidade Infantil/tendências , Recém-Nascido
11.
S D Med ; 72(1): 6-11, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30849221

RESUMO

In 2017, similar to 2016, there was a decrease in total live resident births in South Dakota. Racial minorities comprised 25 percent of these newborns, demonstrating a similar pattern of diversity among births observed nationwide. Unlike 2016, when the state recorded its lowest ever rate of infant mortality (4.8 per 1,000 live births), in 2017 it spiked to 7.8. This increase was primarily observed in the neonatal deaths in both the white and minority population. An increase in births of very low birth weight newborns and deaths due to congenital anomalies partially contributed to this increase. Compared to the nation, a higher percent of the state's infant deaths occur among those with birthweights above 2499 grams. A positive finding apparent in the 2017 mortality data was the decrease in the rate of sudden unexpected infant deaths from what has been observed in recent years. The small number of births in the state requires caution in interpreting findings that show year to year variability. Nonetheless, while the trend in infant mortality in the state is declining, it remains higher than the 2016 rate 5.9 for the nation.


Assuntos
Coeficiente de Natalidade , Mortalidade Infantil , Nascimento Vivo , Coeficiente de Natalidade/etnologia , Coeficiente de Natalidade/tendências , Peso ao Nascer , Causas de Morte , Humanos , Lactente , Mortalidade Infantil/etnologia , Mortalidade Infantil/tendências , Recém-Nascido , Nascimento Vivo/epidemiologia , South Dakota
12.
Reprod Health ; 16(1): 3, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626421

RESUMO

BACKGROUND: Around 5.4 million under-five deaths occur globally annually. Over 2.5 million neonatal deaths and an equivalent stillbirths also occur annually worldwide. India is largest contributor to these under-five deaths and stillbirths. To meet the National Health Policy goals aligned with sustainable development targets, adoption of specific strategy and interventions based on exact causes of death and stillbirths are essential. The current cause of death (CoD) labelling process is verbal autopsy based and subject to related limitations. In view of rare diagnostic autopsies, the minimally invasive tissue sampling (MITS) has emerged as a suitable alternate with comparable efficiency to determine CoD. But there is no experience on perception and acceptance for MITS in north Indian context. This formative research is exploring the perceptions and view of families, communities and healthcare providers regarding MITS to determine the acceptability and feasibility. METHODS: The cross-sectional study adopts exploratory qualitative research design. The study will be conducted in New Delhi linked to deaths and stillbirths occurring at a tertiary care hospital. The data from multiple stakeholders will be collected through 53-60 key-informant in-depth interviews (IDIs), 8 focus group discussions (FGDs) and 8-10 death or stillbirth event observations. The IDIs will be done with the parents, family members, community representatives, religious priests, burial site representatives and different health care providers. The FGDs will be conducted with the fathers, mothers, and elderly family members in the community. The data collection will focus on death, post-death rituals, religious practices, willingness to know CoD, acceptability of MITS and decision making dynamics. Data will be analysed following free listing, open coding, selective coding and theme identification. Subsequently 8-10 parents will be approached for consent to conduct MITS using the communication package to be developed using the findings. DISCUSSION: The study will provide in-depth understanding of the cultural, social, religious practices related to child death and stillbirth and factors that potentially determine acceptance of MITS. The findings will guide development of communication and counselling package and strategies for obtaining consent for MITS. The pilot experience on obtaining consent for MITS will inform suitable refinement and future practice.


Assuntos
Atitude Frente a Morte/etnologia , Autopsia , Mortalidade da Criança/etnologia , Mortalidade Infantil/etnologia , Natimorto/etnologia , Adulto , Atitude do Pessoal de Saúde , Causas de Morte , Pré-Escolar , Estudos Transversais , Família , Feminino , Humanos , Índia , Lactente , Procedimentos Cirúrgicos Minimamente Invasivos , Gravidez , Projetos de Pesquisa
13.
Matern Child Health J ; 23(6): 787-801, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30569299

RESUMO

Objectives To describe the creation of a multigenerational linked dataset with social mobility measures for South Carolina (SC), as an example for states in the South and other areas of the country. Methods Using unique identifiers, we linked birth certificates along the maternal line using SC birth certificate data from 1989 to 2014, and compared the subset of records for which linking was possible with two comparison groups on sociodemographic and birth outcome measures. We created four multi-generational social mobility measures using maternal education, paternal education, presence of paternal information, and a summary score incorporating the prior three measures plus payment source for births after 2004. We compared social mobility measures by race/ethnicity. Results Of the 1,366,288 singleton birth certificates in SC from 1989 to 2014, we linked 103,194, resulting in 61,229 unique three-generation units. Mothers and fathers were younger and had lower education, and low birth weight was more common, in the multigenerational linked dataset than in the two comparison groups. Based on the social mobility summary score, only 6.3% of White families were always disadvantaged, compared to 30.4% of Black families and 13.2% of Hispanic families. Moreover, 32.8% of White families were upwardly mobile and 39.1% of Black families were upwardly mobile, but only 29.9% of Hispanic families were upwardly mobile. Conclusions for Practice When states are able to link individuals, birth certificate data may be an excellent source for examining population-level relationships between social mobility and adverse birth outcomes. Due to its location in the Deep South, the multigenerational SC dataset may be particularly useful for understanding racial/ethnic difference in social mobility and birth outcomes.


Assuntos
Declaração de Nascimento , Grupos de Populações Continentais/etnologia , Pai/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Registro Médico Coordenado , Mães/estatística & dados numéricos , Mobilidade Social , Grupos de Populações Continentais/educação , Grupos de Populações Continentais/estatística & dados numéricos , Bases de Dados Factuais , Pai/educação , Feminino , Humanos , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido , Masculino , Mães/educação , Vigilância da População/métodos , Saúde Pública , Fatores Socioeconômicos , South Carolina
14.
Sci Rep ; 8(1): 17930, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30560946

RESUMO

Under-five mortality (U5M) is an important indicator of the overall health and development of society. There is a wide gap in U5M among different countries and also within the countries. This study was carried out to assess the prevalence, as well as the socio-demographic, and health-related causes of U5M in the region of study. A cross-sectional study was conducted among all registered cases of U5M in rural areas of Khuzestan province, Iran, during the years 2011 to 2015. To assess the socio-demographic determinants of U5M, the sample surveyed consists of 320 families with at least one under-five death using a multistage random sampling method. Also, this study evaluated the number of variables, which may increase the chance of families to have more than one U5M. U5M was 26 per 1000 live births in 2011, but decreased to 22 per 1000 live births in 2015. With the highest cumulative incidence of 43 in Masjed Soleyman and the lowest of 15 in Dehdez, infant mortality constitutes 76% of all U5M. Prematurity and congenital anomalies were responsible for 46% of all causes of mortality (that is, U5). Maternal age at delivery <18 years or >35 years (OR = 3.5; 95% CI, 1.29-6.22), marriage duration >9 years (1.85, 1.06-3.21), spouse age gap >5 years (2.32, 1.20-4.50), cesarean section (3.85, 1.19-5.74), delivery interval <3 years (2.83, 1.22-5.58), non-Arab ethnicity (2.58, 1.50-4.44), and mother working in agriculture or animal husbandry (3.93, 1.41-6.94) were the most important determinants associated with more than one child death per family. Spatially, there was a great disparity in U5M with different reduction rate during the 5 years of the study. Marriage age, cesarean delivery, delivery interval, and mother field activity were associated with U5M. This may have implications for the preventive health program.


Assuntos
Mortalidade da Criança/tendências , Mortalidade Infantil/tendências , População Rural , Mortalidade da Criança/etnologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil/etnologia , Irã (Geográfico)/epidemiologia , Masculino , Prevalência , Fatores de Risco , Análise Espaço-Temporal
15.
J Health Care Poor Underserved ; 29(4): 1188-1208, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30449742

RESUMO

The objectives of this study were to identify social determinants of health as risk factors for infant mortality, particularly among African Americans, and to determine the extent to which research has demonstrated an association between each social determinant of health and infant mortality. A systematic scoping review was conducted following PRISMA guidelines. Databases searched include: EBSCOhost, CINAHL Plus, PsycINFO, SocINDEX, Social Work Abstracts, and Sociological Collection. Following a three-step selection process conducted by two reviewers, 89 studies were included. The social ecological model was used to categorize both the search terms and the findings. Findings revealed that the majority of studies focused on the individual and public policy levels, and most failed to account for the complexity of the issue. Additional research is needed to explore the social determinants of health that are hypothesized to affect infant mortality across all levels, applying more complex, system-level approaches.


Assuntos
Afro-Americanos/estatística & dados numéricos , Mortalidade Infantil/etnologia , Determinantes Sociais da Saúde/etnologia , Aleitamento Materno/estatística & dados numéricos , Maus-Tratos Infantis/etnologia , Maus-Tratos Infantis/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil/tendências , Saúde Materna/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Política Pública , Características de Residência , Fatores de Risco , Fumar/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Morte Súbita do Lactente/epidemiologia
18.
PLoS One ; 13(9): e0203688, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30208082

RESUMO

OBJECTIVE: Michigan's infant mortality rate is consistently higher than the national rate, with persistent and significant racial/ethnic disparities. In Michigan, nine counties account for more than 80% of all infant deaths. A home visiting program serving low-income, first-time mothers in high-risk communities is one strategy to reduce infant mortality. The objective of this study was to quantify the risk of infant mortality based on race/ethnicity within Michigan's highest-risk counties to guide outreach for home visiting services in these counties. METHODS: To maximize the efficiency of limited resources and to identify women at highest risk, we used decomposition to develop risk-based, county-specific estimates of excess infant deaths in nine Michigan counties using data from the 2007 to 2009 Michigan resident infant death file linked to the live birth/file. RESULTS: The sample size for these counties was 200,610 live births and 1,836 infant deaths and for the reference population it was 195,180 live births and 1,133 infant deaths The study found that excess mortality varies among populations at the county level when compared to the reference population of infants born to Michigan mothers who attained more than a high school education and were at least 20 years of age at the infant's birth. The excess risk of mortality was highest for African American infants in seven of the nine counties (56.5% to 132.8%) and for Hispanic infants (86.6%) and white infants (48.2%) in one county each. CONCLUSION: Even with a longstanding commitment and legal mandate to reduce disparities and with efforts to improve outreach into high-risk areas, disparities persist. An improved understanding of the racial/ethnic disparities within communities was useful to focus outreach efforts on reaching women at highest risk as part of subsequent program enrollment.


Assuntos
Mortalidade Infantil/etnologia , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Nascimento Vivo , Michigan , Saúde Pública , Risco
20.
Can J Public Health ; 109(5-6): 692-699, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30242635

RESUMO

OBJECTIVE: Studies of perinatal health outcomes in Canadian First Nations populations have largely focused on limited geographical areas and have been unable to examine outcomes by registered status and community residence. In this study, we compare rates of adverse birth outcomes among First Nations individuals living within vs. outside of First Nations communities and those with vs. without registered status. METHODS: Data included 13,506 singleton pregnancies from the 2006 Canadian Birth-Census Cohort. Outcomes examined included preterm birth (PTB), small- and large-for-gestational-age birth (SGA, LGA), stillbirth, overall infant mortality, and neonatal and postneonatal mortality. Risk ratios (RRs) were estimated with adjustment for maternal age, education, parity, and paternal education. RESULTS: Mothers living in First Nations communities and those with status had elevated adjusted risks of LGA (RR for First Nations community residence = 1.22, 95% CI = 1.09-1.35; RR for status = 1.50, 95% CI = 1.16-1.93). Rates of SGA were significantly lower among mothers with status (adjusted RR = 0.62, 95% CI = 0.44-0.86). Rates of PTB did not vary substantially by residence or by status. Adjusted differences in fatal outcomes could not be estimated, owing to small cell sizes. However, mothers living in First Nations communities had higher crude rates of infant mortality (10.9 vs. 7.7 per 1000), particularly for neonatal mortality (6.1 vs. 2.9). CONCLUSION: Future investigations should explore risk factors, including food security and access to health care services, that may explain disparities in SGA and LGA by status and residence within First Nations populations.


Assuntos
Disparidades nos Níveis de Saúde , Índios Norte-Americanos/estatística & dados numéricos , Mortalidade Infantil/etnologia , Resultado da Gravidez/etnologia , Características de Residência/estatística & dados numéricos , Adulto , Canadá/epidemiologia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Sistema de Registros , Fatores de Risco , Adulto Jovem
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