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Postneonatal mortality among normal birth weight infants in Alabama, 1980 to 1983
1School of Public Health, University of Alabama, Birmingham 35294.
Insights
Black infants experienced significantly higher postneonatal mortality rates than white infants, particularly from infections. Rural living worsened these disparities, highlighting preventable causes like infections and injuries.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Postneonatal mortality rates show significant racial disparities.
- Understanding the causes of these differences is crucial for targeted interventions.
Purpose of the Study:
- To investigate the reasons behind racial differences in postneonatal deaths.
- To identify potential intervention strategies to reduce these disparities.
Main Methods:
- Utilized Alabama's linked birth-death file for infants born between 1980-1983.
- Analyzed causes of postneonatal mortality, comparing rates by race and urban-rural residence.
Main Results:
- Black infants had mortality rates at least double that of white infants, excluding congenital anomalies.
- Infection-related deaths showed the largest racial disparity.
- Rural residence amplified postneonatal death risk and racial differentials, especially for infection and systemic causes.
Conclusions:
- A substantial proportion of postneonatal deaths are preventable.
- Interventions focusing on injury control, infectious disease prevention, and timely treatment are recommended.
- Addressing racial and rural disparities in postneonatal mortality is a public health priority.
Abstract:
To identify reasons for the racial differential in postneonatal deaths and possible intervention strategies, Alabama's linked birth-death file was used to evaluate causes of postneonatal mortality for the 1980 to 1983 cohorts of normal birth weight infants. Causes were aggregated into six categories, and cause-specific rates were compared by race and by urban-rural residence. Both total and cause-specific postneonatal mortality rates among black infants were two or more times higher than for white infants, except for congenital anomalies. The greatest differential was for infection-related deaths. Rural residence increased both the risk of postneonatal death and the magnitude of the racial differential. The risks were especially elevated for deaths due to infection and "systemic causes" (including those in the perinatal category). Only 26% of postneonatal deaths were probably not preventable, and nearly one third were clearly preventable. Potential prevention strategies include injury control, prevention of infectious diseases, and prompt treatment of infectious diseases.