Abstract
Objectives The goal of this study is to use Perinatal Periods of Risk (PPOR) analysis to differentiate broad areas of risk (Maternal-Health/Prematurity, Maternal Care, Newborn Care, and Infant Health) associated with being Black from those associated with being poor. Methods Phase I PPOR compared two target populations (Black women/infants and poor women/infants) against a gold standard reference group (White, non-Hispanic women, aged 20+ years with 13+ years of education), then against each other. Phase II PPOR further partitioned excess risk into (1) Very-low-birthweight-risk and (2) Birthweight-specific-mortality-risk and identified individual-level risk factors. Results Phase I PPOR revealed Black excess mortality within the Maternal-Health/Prematurity category (67% of total excess mortality). Phase II PPOR revealed that Black excess mortality within this category was primarily due to premature deliveries of very-low-birthweight infants. In a unique extension of the PPOR methodology, a poverty-excess-PPOR was subtracted from the Black-excess-PPOR, and showed that Black women have substantial excess mortality above and beyond that associated with poverty. Subsequent analyses to identify Black-specific risks, controlling for poverty, found that vaginal bleeding, premature rupture of membranes, history of preterm delivery, and having no prenatal care significantly predicted preterm delivery. Conclusions This study demonstrated the utility of PPOR, a standardized risk assessment approach for focusing health promotion efforts. In the study community, PPOR identified that maternal preconception and prenatal factors contributed the greatest risk for Black infants due to prematurity and low birthweight. Higher socioeconomic status did little to mitigate this risk. These findings informed a community-wide plan that integrated evidence-based strategies for addressing systematic racial inequity with strategies for addressing systematic socioeconomic disadvantage.
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Acknowledgements
This study was funded by the Kalamazoo County Healthy Babies Health Start program. We would like to thank Yasi Back of Kalamazoo County Health and Community Services for her assistance securing the data and assisting with the data preparation. We would like to further acknowledge Michael Beebe and Glenn Radford of the Division for Vital Records and Health Statistics, Michigan Department of Community Health for their invaluable assistance, and the Cradle Kalamazoo (formerly named the Kalamazoo Infant Mortality Community Action) initiative for providing the community-based structure for local dissemination of study findings and for translating these findings into action.
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The funding was provided by Maternal and Child Health Bureau.
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This study was sponsored by the Kalamazoo Healthy Babies Healthy Start program, but the program itself has no financial interest regarding the direction of study findings.
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Kothari, C.L., Romph, C., Bautista, T. et al. Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative. Matern Child Health J 21 (Suppl 1), 49–58 (2017). https://doi.org/10.1007/s10995-017-2383-z
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DOI: https://doi.org/10.1007/s10995-017-2383-z