(SDAR) Health Equity and Perinatal Periods of Risk: Considering A Changing Landscape

The overarching goal of this project is to improve the Perinatal Periods of Risk such that all valid and reliable data is used biased estimates are avoided and communities are empowered to address infant mortality rates and disparities. Primary goals are: 1. Assess differential reporting and update PPOR cutoffs if warranted: We hypothesize that due to changes in survival of small infants increased use of electronic reporting systems increased data use and national efforts to improve data quality the original cutoffs are too conservative. The impact of this adjustment will be to ensure utilization of valid cases in PPOR analyses and increase community confidence that they are making use of all possible valid information. 2. Create updated unbiased reference populations for community use: We hypothesize that due to improved survival the overall reference population mortality will decrease but that due to changes in survival patterns this decrease will not be uniform across the periods of risk. The impact of the new reference populations will be (1) to allow communities do use PPOR even if they cannot produce internal reference populations and (2) to allow comparison of excess mortality across communities. 3. Help communities interpret their findings in light of general patterns and the association of PPOR outcomes with income inequality at the county level: We hypothesize that within the major US racial/ethnic groups we will find significant and important variation in PPOR outcomes across counties and that income inequality as measured by the Gini Coefficient will account for a portion of this variation. The six outcomes that will serve as dependent variables include four PPOR Excess Period Specific Mortality Rates the percent of excess Maternal Health/Prematurity deaths due to birthweight distribution and the proportion of Excess Infant Health deaths due to Sudden Unexplained Infant Death. Because infant mortality rates increase with increasing inequality (i.e. Gini Coefficient) we predict a positive and significant coefficient of the Gini Coefficient in the model. The analyses will be performed for all race/ethnic groups combined repeated for the non-Hispanic Black non-Hispanic white and Hispanic sub populations. Database we will be analyzing: Vital Records: Natality All County Fetal Death-All County and Linked Birth/Infant Deaths - All County through NAPHSIS. This project is directly related to (1) MCH Strategic Research Issue I: Public health service systems and infrastructures at the community state and national levels as they apply to different MCH populations based on demographic and epidemiological factors; and (2) MCHB Strategic Research Issue II: MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations.