Background After a nine-year decline, feto-infant mortality rates (FIMR) in New Orleans rose sharply in 2001 and 2002. We followed the Perinatal Periods of Risk (PPOR) approach to investigate mortality rates by birth weight and age at death to identify groups with the highest risk.
Methods We used Louisiana's linked birth-death and fetal death files to examine maternal characteristics and calculate FIMR, per 1,000 live births + fetal deaths, for residents of Orleans Parish, LA, from 1991 to 2002. Births weighing 500+ g and fetal deaths weighing 500+ g and of 24+ weeks of gestation were included. Rates were split into PPOR components as follows: (1) very low birth weight (VLBW, 500-1499 g) versus not VLBW and (2) fetal versus neonatal (1-28 days) versus post-neonatal (29-365 days) age at death. Kitagawa's rate standardization was used to identify excess deaths.
Results Orleans Parish births declined from about 9,000 to 7,000 per year from 1991 to 2002. Black women accounted for about 79% of all births, 90% of VLBW births, and 95% of births to teen moms. First trimester prenatal care (PNC) initiation rose from 62 to 75% for blacks and from 87 to 94% for whites from 1991-2002 (p < .0001 for both), but only 78% of blacks and 83% of whites received adequate PNC in 2002. The FIMR declined from 17.0 deaths per 1,000 in 1991 to 8.6 in 2000 but climbed to 11.6 and 14.3 in 2001 and 2002, respectively. PPOR results indicated that VLBW births had the largest impact on FIMR, irrespective of age at death. Specifically, births weighing under 1,500 g accounted for 40-50% of all fetal and infant deaths each year. Race standardized rates showed that excess mortality in blacks was primarily due to the occurrence of more VLBW births to blacks than whites.
Conclusions and Public Health Implications Reducing the number of VLBW births will help reduce the FIMR. Factors associated with VLBW may include preconceptional health, unintended pregnancies, and maternal risk factors such as STDs. Intervention programs for Orleans Parish should focus on black women, targeting improving maternal health and preventing prematurity.
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