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Rojas-Botero ML, Borrero-Ramírez YE, Cáceres-Manrique FDM. [Social inequalities in under-five mortality: a systematic review]. Rev Salud Publica (Bogota) 2023; 22:220-237. [PMID: 36753114 DOI: 10.15446/rsap.v22n2.86964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify the characteristics of the published studies on social inequalities in under-five mortality, their theoretical perspectives, axes of inequality, methods and results. METHOD We carried out a systematic literature review. We consulted four electronic databases and Google Scholar, for studies published between 2010 and 2018. RESULTS We analyzed 126 articles. In 62.7%, territory was studied as the axis of inequality, followed by socioeconomic determinants (27.8%). Neonatal, infant and under-five mortality was analyzed as an output in health in 19.0%, 49.2% and 32.3%, respectively. It predominated ecological (62.7%) and longitudinal (50.0%) studies. Significant reductions in mortality rates were found, however, the decline was not homogeneous among subpopulations. CONCLUSIONS The literature reports a marked decrease in under-five mortality; however, the gaps between different axes of inequality continue and in some cases they have increased. Gaps varied according to time, place, axis of inequality and type of mortality analyzed.
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Affiliation(s)
- Maylen L Rojas-Botero
- MR: Profesional en Gerencia de Sistemas de Información en Salud, M.Sc. Epidemiología. Ph.D.(c) Epidemiología. Universidad de Antioquia, Facultad Nacional de Salud Pública. Medellín, Colombia.
| | - Yadira E Borrero-Ramírez
- YB: MD. Esp. Teoría Métodos de Investigación. M.Sc. Sociología. Ph.D. Salud Pública. Posdoctorado en Salud Colectiva. Universidad de Antioquia, Facultad Nacional de Salud Pública.
| | - Flor de María Cáceres-Manrique
- FC: Enfermera. Esp.; M.Sc. Epidemiología. Esp. Docencia Universitaria. Ph.D. Salud Pública. Universidad Industrial de Santander, Facultad de Salud, Escuela de Medicina, Departamento de Salud Pública. Bucaramanga, Colombia.
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NICU Parents of Black Preterm Infants: Application of the Kenner Transition Model. Adv Neonatal Care 2022; 22:550-559. [PMID: 35588065 DOI: 10.1097/anc.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Black infants in the United States have the highest incidence of both infant mortality (IM) and preterm birth among all racial/ethnic groups. The IM disparity for Black preterm infants often occurs after neonatal intensive care unit (NICU) discharge, when parents become the primary caregivers. The revised Kenner Transition Model (KTM) is situation specific and comprised 5 interrelated domains of parental need after NICU discharge that have not been previously applied to the transition from NICU to home of Black infants. PURPOSE This study's purpose was to explore the conceptual fit of parental readiness to care for their Black preterm infants after NICU discharge with the revised KTM. METHODS A qualitative descriptive research approach was used for this single-site study of NICU parents of Black preterm infants. Qualitative analysis of 10 parents' perceptions before NICU discharge was via semantic content analysis; data were organized into categories aligned with the KTM. The Transition Questionnaire (TQ), an adjunct to the KTM, provided self- report quantitative data. RESULTS All parents endorsed the "Information Needs," "Stress and Coping," and "Professional Support" domains of the KTM. Parent TQ responses indicated perceptions of moderate to high levels of home transition readiness after NICU discharge. IMPLICATIONS FOR PRACTICE AND RESEARCH The domains of the revised KTM were affirmed by parents of Black preterm infants in this study via coded interview and TQ responses. Additional study exploring the clinical assessment of transition readiness with theoretical grounding in diverse NICU families is warranted. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .
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Waldron MK. Parent Protector: Perceptions of NICU-to-Home Transition Readiness for NICU Parents of Black Preterm Infant. J Perinat Neonatal Nurs 2022; 36:173-185. [PMID: 35476771 DOI: 10.1097/jpn.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Black infants have twice the incidence of infant mortality (IM), death before the first birthday, and preterm birth in comparison to other US racial/ethnic groups; these factors make Black infants a high-risk group. The literature on the factors impacting caregivers and home environments for these infants is sparse. The purpose of this descriptive qualitative study was to explore perceived parental readiness to care for their Black preterm infants at home after discharge from a neonatal intensive care unit (NICU). Ten NICU parents of Black preterm infants completed a structured interview and self-report questionnaires before hospital discharge; data were analyzed using descriptive and semantic content methods. Coded parent responses were categorized as Parent Protector of Infants' Health (n = 94, 29.2%); Hindrances to Parental Readiness for Transition to Home (n = 97, 30.1%), and Parent as Partner in NICU to Home Transition (n = 131, 40.6%). All parents rated themselves "confident" (n = 6) or "very confident" (n = 4) in their ability to care for their infant after NICU discharge. Partnership with the healthcare team was described as involving health information resources, effective communication, and, most importantly, support for the parental role as infant protector for transition to home for their high-risk infant after NICU discharge.
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Affiliation(s)
- Mia K Waldron
- Department of Nursing Science Professional Practice & Quality, Children's National Hospital, Washington, District of Columbia; and School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
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Russell C. Meeting the Moment: Bioethics in the Time of Black Lives Matter. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:9-21. [PMID: 34854793 DOI: 10.1080/15265161.2021.2001093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article, I begin by describing what I call this Black Lives Matter moment in the US. I then offer three reasons for considering racism as a bioethical issue, the least discussed of which is the way in which racism acts as a barrier to the creation of better healthcare systems. Next, I argue that the concept of race itself constitutes a bioethical issue in a way that is not fully reducible to racism. Finally, I discuss how we, both bioethicists and health care professionals, might meet this moment by identifying individual points of responsibility (beyond liability) for structural injustice.
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Sosnaud B. Cross-State Differences in the Processes Generating Black-White Disparities in Neonatal Mortality. Demography 2021; 58:2089-2115. [PMID: 34568897 DOI: 10.1215/00703370-9510578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The U.S. Black neonatal mortality rate is more than twice the White rate. This dramatic disparity can be decomposed into two components: (1) disparities due to differences in the distribution of birth weights, and (2) disparities due to differences in birth weight-specific mortality. I utilize this distinction to explore how the social context into which infants are born contributes to gaps in mortality between Black and White neonates. I analyze variation in Black-White differences in neonatal mortality across 33 states using 1995-2010 data. For each state, I calculate the contribution of differences in birth weight distribution versus differences in birth weight-specific mortality to the total disparity in mortality between White and Black neonates. Disparities are largely a product of different birth weight distributions between Black and White newborns (mirroring the pattern for the United States as a whole). However, in at least nine states, differences in birth weight-specific mortality make a notable contribution. This pattern is observed even among those from advantaged sociodemographic backgrounds and is driven by differences in mortality among very low birth weight neonates. This calls attention to inequality in medical care at birth as an importantcontributor to racial disparities in neonatal mortality.
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Affiliation(s)
- Benjamin Sosnaud
- Department of Sociology and Anthropology, Trinity University, San Antonio, TX, USA
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Vilda D, Hardeman R, Dyer L, Theall KP, Wallace M. Structural racism, racial inequities and urban-rural differences in infant mortality in the US. J Epidemiol Community Health 2021; 75:788-793. [PMID: 33504545 PMCID: PMC8273079 DOI: 10.1136/jech-2020-214260] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/15/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022]
Abstract
Background While evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban–rural lines remains unexplored. The objective of this study was to examine the associations between county-level structural racism (racial inequity in educational attainment, median household income and jail incarceration) and infant mortality and heterogeneity between urban and rural areas. Methods Using linked live birth/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013–2017 5-year infant mortality rates (IMRs) per 1000 live births in every county. Racially stratified and area-stratified negative binomial regression models estimated IMR ratios and 95% CIs associated with structural racism indicators, adjusting for county-level confounders. Adjusted linear regression models estimated associations between structural racism indicators and the absolute and relative racial inequity in IMR. Results In urban counties, structural racism indicators were associated with 7%–8% higher black IMR, and an overall structural racism score was associated with 9% greater black IMR; however, these findings became insignificant when adjusting for the region. In white population, structural racism indicators and the overall structural racism score were associated with a 6% decrease in urban white IMR. Both absolute and relative racial inequity in IMR were exacerbated in urban counties with greater levels of structural racism. Conclusions Our findings highlight the complex relationship between structural racism and population health across urban–rural lines and suggest its contribution to the maintenance of health inequities in urban settings.
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Affiliation(s)
- Dovile Vilda
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Lauren Dyer
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Fan W, Luo L. Understanding Trends in the Concentration of Infant Mortality Among Disadvantaged White and Black Mothers in the United States, 1983-2013: A Decomposition Analysis. Demography 2020; 57:979-1005. [PMID: 32445172 DOI: 10.1007/s13524-020-00878-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The United States compares unfavorably with other high-income countries in infant mortality, which recent literature has attributed to the poor birth outcomes among disadvantaged (i.e., unmarried and less-educated) mothers. Describing and decomposing the trend of the concentration of infant mortality among disadvantaged mothers thus provides important clues for improving birth outcomes. We develop the infant mortality disadvantage index (IMDI) to measure such concentration. Using the 1983-2013 Birth Cohort Linked Birth and Infant Death data, we show that although the IMDI-as a measure of mortality inequality-was persistently higher for Blacks than Whites, the trends were different between the two groups. The IMDI declined for Black women; for White women, however, it increased in the 1980s, then plateaued until the early 2000s, and declined thereafter. We then use Das Gupta's decomposition method to assess the contribution of five demographic/social factors (age, education, marriage, fertility, and infant mortality) to the IMDI trend. Nonmarital fertility among women with less than 12 years of education contributed most to Whites' changing IMDI; for Blacks, a shrinking proportion of the less-educated group and declines in infant mortality among disadvantaged mothers contributed to their declining IMDI. These findings explicate links between population-level compositional changes and infant mortality inequality.
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Affiliation(s)
- Wen Fan
- Department of Sociology, Boston College, Chestnut Hill, MA, 02467, USA.
| | - Liying Luo
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, 16802, USA
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Fishman SH, Hummer RA, Sierra G, Hargrove T, Powers DA, Rogers RG. Race/ethnicity, maternal educational attainment, and infant mortality in the United States. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2020; 66:1-26. [PMID: 33682572 PMCID: PMC7951143 DOI: 10.1080/19485565.2020.1793659] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study examines patterns of and explanations for racial/ethnic-education disparities in infant mortality in the United States. Using linked birth and death data (2007-2010), we find that while education-specific infant mortality rates are similar for Mexican Americans and Whites, infants of college-educated African American women experience 3.1 more deaths per 1,000 live births (Rate Ratio = 1.46) than infants of White women with a high school degree or less. The high mortality rates among infants born to African American women of all educational attainment levels are fully accounted for by shorter gestational lengths. Supplementary analyses of data from the National Longitudinal Study of Adolescent to Adult Health show that college-educated African American women exhibit similar socioeconomic, contextual, psychosocial, and health disadvantages as White women with a high school degree or less. Together, these results demonstrate African American-White infant mortality and socioeconomic, health, and contextual disparities within education levels, suggesting the role of life course socioeconomic disadvantage and stress processes in the poorer infant health outcomes of African Americans relative to Whites.
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Affiliation(s)
- Samuel H. Fishman
- Department of Sociology, Duke University, 276 Soc/Psych Building, 417 Chapel Dr., Durham, North Carolina 27708, USA
| | - Robert A. Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gracia Sierra
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Taylor Hargrove
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel A. Powers
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Richard G. Rogers
- Department of Sociology and Population Program, IBS, University of Colorado Boulder, Boulder, Colorado, USA
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Zhang Q, Lamichhane R, Wright M, McLaughlin PW, Stacy B. Trends in Breastfeeding Disparities in US Infants by WIC Eligibility and Participation. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:182-189. [PMID: 30514654 PMCID: PMC6369002 DOI: 10.1016/j.jneb.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/03/2018] [Accepted: 10/13/2018] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine the trends in breastfeeding disparities across Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) eligibility and participation statuses in the last 2 decades. DESIGN Secondary analyses from multiple cross-sectional surveys. SETTING United States. PARTICIPANTS The National Health and Nutrition Examination Survey 1999-2014 included 10,696 children younger than 60 months. Birth cohorts in 4-year increments were created from 1994 to 2014. MAIN OUTCOME MEASURES Ever-breastfed status and breastfed-at-6-months status. ANALYSIS The prevalence rates of ever-breastfed and breastfed at 6 months were estimated between WIC-eligible vs non-eligible children and WIC-eligible participants vs eligible nonparticipants. Prevalence rates and their 95% confidence intervals were plotted across birth cohorts. Log-binomial regression was conducted to test the trends of breastfeeding in each subgroup. RESULTS Ever-breastfeeding rates increased from 52% (WIC participants) vs 57% (WIC-eligible nonparticipants) in the 1994-1997 birth cohort to 71% vs 77% in the 2010-2014 birth cohort-a 36% vs 34% relative increase for participants vs eligible nonparticipants, respectively (P < .001). Breastfeeding-at-6-month rates increased from 28% (participants) vs 30% (eligible nonparticipants) to 34% vs 49% in the same time period-a 21% vs 66% relative increase, respectively (P < .001). CONCLUSION AND IMPLICATIONS To meet the Healthy People 2020's goal for breastfeeding at 6 months, sustainable postpartum breastfeeding education and interventions may be needed among WIC participants. Future research focusing on identification of the causal relationship between WIC participation and breastfeeding outcomes is warranted.
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Affiliation(s)
- Qi Zhang
- Room 1016, 1014 W 46 St, School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA, , Phone: 757-683-6870, Fax: 757-683-6333
| | - Rajan Lamichhane
- Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia 23510, Phone: 757-446-0337,
| | - Mia Wright
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, Phone: 757-812-9989,
| | - Patrick W. McLaughlin
- US Department of Agriculture/Economic Research Service, 355 E Street SW, Washington, DC 20024, Phone: 202-694-5402,
| | - Brian Stacy
- US Department of Agriculture/Economic Research Service, 355 E Street SW, Washington, DC 20024, Phone: 202-694-5414,
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Quantifying the excess risk of infant mortality based on race/ethnicity at the county level to inform Michigan's home visiting outreach plans. PLoS One 2018; 13:e0203688. [PMID: 30208082 PMCID: PMC6135493 DOI: 10.1371/journal.pone.0203688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/24/2018] [Indexed: 11/22/2022] Open
Abstract
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.
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Bhatt CB, Beck-Sagué CM. Bhatt and Beck-Sagué Respond. Am J Public Health 2018; 108:e25. [PMID: 29874505 PMCID: PMC5993399 DOI: 10.2105/ajph.2018.304487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Chintan B Bhatt
- Both authors are with Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami
| | - Consuelo M Beck-Sagué
- Both authors are with Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami
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Kozhimannil KB, Muoto I, Darney BG, Caughey AB, Snowden JM. Early Elective Delivery Disparities between Non-Hispanic Black and White Women after Statewide Policy Implementation. Womens Health Issues 2018; 28:224-231. [PMID: 29273264 PMCID: PMC5959748 DOI: 10.1016/j.whi.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In 2011, Oregon implemented a policy that reduced the state's rate of early (before 39 weeks' gestation) elective (without medical need) births. OBJECTIVE This analysis measured differential policy effects by race, examining whether Oregon's policy was associated with changes in non-Hispanic Black-White disparities in early elective cesarean and labor induction. METHODS We used Oregon birth certificate data, defining prepolicy (2008-2010) and postpolicy (2012-2014) periods, including non-Hispanic Black and White women who gave birth during these periods (n = 121,272). We used longitudinal spline models to assess policy impacts by race and probability models to measure policy-associated changes in Black-White disparities. RESULTS We found that the prepolicy Black-White differences in early elective cesarean (6.1% vs. 4.3%) were eliminated after policy implementation (2.8% vs. 2.5%); adjusted models show decreases in the odds of elective early cesarean among Black women after the policy change (adjusted odds ratio, 0.47; 95% confidence interval, 0.22-1.00; p = .050) and among White women (adjusted odds ratio, 0.79; 95% confidence interval, 0.67-0.93; p = .006). Adjusted probability models indicated that policy implementation resulted in a 1.75-percentage point narrowing (p = .011) in the Black-White disparity in early elective cesarean. Early elective induction also decreased, from 4.9% and 4.7% for non-Hispanic Black and non-Hispanic White women to 3.8% and 2.5%, respectively; the policy was not associated with a statistically significant change in disparities. CONCLUSIONS A statewide policy reduced racial disparities in early elective cesarean, but not early elective induction. Attention to differential policy effects by race may reveal changes in disparities, even when that is not the intended focus of the policy.
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Affiliation(s)
- Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
| | - Ifeoma Muoto
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon; National Institute of Public Health, Cuernavaca, Mexico
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jonathan M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
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Kennedy HP, Myers-Ciecko JA, Carr KC, Breedlove G, Bailey T, Farrell MV, Lawlor M, Darragh I. United States Model Midwifery Legislation and Regulation: Development of a Consensus Document. J Midwifery Womens Health 2018; 63:652-659. [DOI: 10.1111/jmwh.12727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
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Brown Speights JS, Goldfarb SS, Wells BA, Beitsch L, Levine RS, Rust G. State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013. Am J Public Health 2017; 107:775-782. [PMID: 28323476 PMCID: PMC5388953 DOI: 10.2105/ajph.2017.303689] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess state-level progress on eliminating racial disparities in infant mortality. METHODS Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. RESULTS We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. CONCLUSIONS States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.
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Affiliation(s)
- Joedrecka S Brown Speights
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Samantha Sittig Goldfarb
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Brittny A Wells
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Leslie Beitsch
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Robert S Levine
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - George Rust
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
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El-Sayed AM, Finkton DW, Paczkowski M, Keyes KM, Galea S. Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA. Prev Med 2015; 76:8-13. [PMID: 25849882 PMCID: PMC4671200 DOI: 10.1016/j.ypmed.2015.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Studies about racial disparities in infant mortality suggest that racial differences in socioeconomic position (SEP) and maternal risk behaviors explain some, but not all, excess infant mortality among Blacks relative to non-Hispanic Whites. We examined the contribution of these to disparities in specific causes of infant mortality. METHODS We analyzed data about 2,087,191 mother-child dyads in Michigan between 1989 and 2005. First, we calculated crude Black-White infant mortality ratios independently and by specific cause of death. Second, we fit multivariable Poisson regression models of infant mortality, overall and by cause, adjusting for SEP and maternal risk behaviors. Third, Crude Black-White mortality ratios were compared to adjusted predicted probability ratios, overall and by specific cause. RESULTS SEP and maternal risk behaviors explained nearly a third of the disparity in infant mortality overall, and over 25% of disparities in several specific causes including homicide, accident, sudden infant death syndrome, and respiratory distress syndrome. However, SEP and maternal risk behaviors had little influence on disparities in other specific causes, such as septicemia and congenital anomalies. CONCLUSIONS These findings help focus policy attention toward disparities in those specific causes of infant mortality most amenable to social and behavioral intervention, as well as research attention to disparities in specific causes unexplained by SEP and behavioral differences.
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Affiliation(s)
| | - Darryl W Finkton
- University of Oxford, Nuffield Department of Obstetrics & Gynaecology, Oxford, UK
| | | | | | - Sandro Galea
- Columbia University, Mailman School of Public Health, New York, USA
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