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Refreshing the Perinatal Periods of Risk: A New Reference Group and Nationwide Large-County-Level Analyses.

Carol S Gilbert1, Pamela K Xaverius2,3, Melissa K Tibbits4

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Summary

New national reference groups for the Perinatal Periods of Risk (PPOR) approach are now available, using 2014-2016 vital records data. These updated benchmarks aid communities in addressing fetal-infant mortality and understanding disparities.

Keywords:
Community planningFeto-infant mortalityHealth disparities methodologyInfant mortality preventionPerinatal Periods of Risk

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Area of Science:

  • Public Health
  • Biostatistics
  • Maternal and Child Health

Background:

  • The Perinatal Periods of Risk (PPOR) approach uses vital records to identify causes of fetal-infant mortality.
  • PPOR is utilized by health departments and partners to drive systems changes.
  • Previous national reference groups were outdated due to data quality issues.

Purpose of the Study:

  • To assess fetal death data quality and create updated, unbiased national reference groups.
  • To provide current benchmarks for communities using the PPOR approach.

Main Methods:

  • Utilized 2014-2016 national vital records data.
  • Assessed data quality and created national reference groups.
  • Employed Phase 1 and Phase 2 analytic methods to divide excess mortality into six components.
  • Generated percentile plots for 100 large US counties.

Main Results:

  • Eight states with poor fetal death data quality were excluded to minimize bias.
  • Significant Black-White disparities were observed in reference groups, varying by component.
  • PPOR results demonstrated variability based on region, maternal demographics, and county.
  • The magnitude of excess mortality components differed substantially across US counties.

Conclusions:

  • Updated national reference groups enhance the usability of the PPOR approach for more communities.
  • Percentile plots serve as valuable benchmarks for PPOR implementation, highlighting problem areas and potential solutions.