Secular trends in excess fetal and infant mortality using perinatal periods of risk analysis

Perinatal periods of risk (PPOR) provide an alternative analytical approach to studying infant mortality. Results can be used to focus community activities to improve infant and maternal health. This article demonstrates the use of PPOR to monitor trends in excess fetal and infant mortality related to disparities associated with race and ethnicity in Kansas City, MO (KC). Based on a comparison of PPOR analyses for 1996-2000 and 2001-2005, there was a 30% reduction in excess fetal and infant mortality in Kansas City and reductions for both non-Hispanic blacks (17%) and non-Hispanic whites (66.7%). However, the disparity ratio for excess mortality rates between non-Hispanic blacks and non-Hispanic whites nearly doubled. Prematurity, the most frequent cause of infant mortality in Kansas City during 2001-2005 accounted for 42.5% of the infant deaths. Being a teenage mother; having less than a high-school education; being unmarried; having an unintended pregnancy; being obese preconceptually; being diabetic; using substances such as tobacco or drugs during pregnancy; receiving late, inadequate or intermediate amounts of prenatal care; having a multifetal pregnancy; having a primary elective cesarean section; delivering a preterm infant or having a male infant; and being enrolled in Medicaid all increased the risk of infant death.