Perinatal Disparities Between American Indians and Alaska Natives and Other US Populations: Comparative Changes in Fetal and First Day Mortality, 1995–2008

Abstract

To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth-infant death cohort and fetal deaths files from 1995-1998 and 2005-2008. We examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day (<24 h), and cause-specific deaths. We calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods (4.6 and 6.5 %). Over time, late fetal death for AIANs decreased 17 % (aOR = 0.83, 95 % CI 0.72-0.97), but we noted a 47 % increased risk over time for Hispanics (aOR = 1.47, 95 % CI 1.40-1.55). Our data indicated no change over time among AIANs for first day death. For AIANs compared to whites, increased risks and disparities persisted for mortality due to congenital anomalies (ROR = 1.28, 95 % CI 1.03-1.60). For blacks compared to AIANs, the increased risks of fetal death (2005-2008: aOR = 0.60, 95 % CI 0.53-0.68) persisted. For Hispanics, lower risks compared to AIANs persisted, but protective effect declined over time. Disparities between AIAN and other groups persist, but there is variability by race/ethnicity in improvement of perinatal outcomes over time. Variability in access to care and pregnancy management should be considered in relation to health equity for fetal and early infant deaths.

Ethnic variation in causes of stillbirth in high‐income countries: A systematic review and meta‐analysis

“…In our review, we built upon this foundation by investigating ethnic variation of causes of stillbirth in high‐income countries. While perinatal outcomes in some ethnic minority groups appear to have improved over time, disparities in stillbirth rates based on ethnicity continue to persist in the majority of reported cases 7–9,34,36,39,40,49–59 . Ethnicities with the largest sample sizes (Caucasian, African and Hispanic) overall showed similar proportions in the causes of stillbirth.…”

“…While perinatal outcomes in some ethnic minority groups appear to have improved over time, disparities in stillbirth rates based on ethnicity continue to persist in the majority of reported cases. [7][8][9]34,36,39,40,[49][50][51][52][53][54][55][56][57][58][59] Ethnicities with the largest sample sizes (Caucasian, African and Hispanic) overall showed similar proportions in the causes of stillbirth. Compared to non-Indigenous Australians, Indigenous…”

Identifying County-Level All-Cause Mortality Rate Trajectories and Their Spatial Distribution Across the United States

“…Buffalo County, South Dakota, where the Cow Creek Sioux Tribe resides, had the highest 2016 all-cause mortality rate and the lowest per capita income in the United States. This may be because American Indians have higher rates of mortality across the lifespan than other racial/ethnic groups (22–24). Additionally, the economic and social conditions on reservations may contribute to a higher mortality rate and a less favorable temporal mortality rate trajectory for American Indians living on reservations compared with those living in other areas of the country.…”

Epidemiological investigation of perinatal deaths in Recife-Pernambuco: a quality assessment

“…The importance (or lack thereof) given to filling information on fetal mortality is one of the main factors associated with incompleteness of data (15) . In Brazil, despite the declining trend of the stillbirth rate, it is still almost twice as high the one found in developed countries (16) .…”