Perinatal Periods of Risk: Phase 2 Analytic Methods for Further Investigating Feto-Infant Mortality

Sappenfield, William M.; Peck, Magda G.; Gilbert, Carol; Haynatzka, Vera; Bryant, Thomas

doi:10.1007/s10995-010-0624-5

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…14 Any rate or ratio, including MMR, can be considered the product of the percentage distribution of a factor (ie, maternal age) and factor-specific ratios (ie, maternal age-specific MMRs). By use of the formula developed by Kitagawa and commonly used in perinatal epidemiology, 15,16 a difference in 2 rates or MMRs, where R 1 is the MMR in 1998–2002 and R 2 is the MMR in 2008–2012, can be reexpressed and partitioned into differences in the distribution of maternal age and maternal age-specific MMRs.…”

Section: Methodsmentioning

confidence: 99%

Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978–2012

Davis

Hoyert

Goodman

et al. 2017

American Journal of Obstetrics and Gynecology

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BACKGROUND Maternal mortality ratios (MMR) appear to have increased in the United States over the last decade. Three potential contributing factors are (1) a shifting maternal age distribution, (2) changes in age-specific MMR, and (3) the addition of a checkbox indicating recent pregnancy on the death certificate. OBJECTIVE To determine the contribution of increasing maternal age on changes in MMR from 1978 to 2012 and estimate the contribution of the pregnancy checkbox on increases in MMR over the last decade. STUDY DESIGN Kitagawa decomposition analyses were conducted to partition the maternal age contribution to the MMR increase into 2 components: changes due to a shifting maternal age distribution and changes due to greater age-specific mortality ratios. We used National Vital Statistics System natality and mortality data. The following 5-year groupings were used: 1978–1982, 1988–1992, 1998–2002, and 2008–2012. Changes in age-specific MMRs among states that adopted the standard pregnancy checkbox onto their death certificate before 2008 (n = 23) were compared with states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (n = 11) to estimate the percentage increase in the MMR due to the pregnancy checkbox. RESULTS Overall US MMRs for 1978–1982, 1988–1992, and 1998–2002 were 9.0, 8.1, and 9.1 deaths per 100,000 live births, respectively. There was a modest increase in the MMR between 1998–2002 and 2008–2012 in the 11 states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (8.6 and 9.9 deaths per 100,000, respectively). However, the MMR more than doubled between 1998–2002 and 2008–2012 in the 23 states that adopted the standard pregnancy checkbox (9.0–22.4); this dramatic increase was almost entirely attributable to increases in age-specific MMRs (94.9%) as opposed to increases in maternal age (5.1%), with an estimated 90% of the observed change reflecting the change in maternal death identification rather than a real change in age-specific rates alone. Of all age categories, women ages 40 and older in states that adopted the standard pregnancy checkbox had the largest increase in MMR—from 31.9 to 200.5—a relative increase of 528%, which accounted for nearly one third of the overall increase. An estimated 28.8% of the observed change was potentially due to maternal death misclassification among women ≥ 40 years. CONCLUSION Increasing age-specific maternal mortality seems to be contributing more heavily than a changing maternal age distribution to recent increases in MMR. In states with the standard pregnancy checkbox, the vast majority of the observed change in MMR over the last decade was estimated to be due to the pregnancy checkbox, with the greatest change in MMR occurring in women ages ≥ 40 years. The addition of a pregnancy checkbox on state death certificates appears to be increasing case identification but also may be leading to maternal death misclassification, particularly for women ages ≥ 40 ye...

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Section: Methodsmentioning

confidence: 99%

Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978–2012

Davis

Hoyert

Goodman

et al. 2017

American Journal of Obstetrics and Gynecology

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“…Babies weighing less than 500 g and delivered prior to 24 weeks gestation are excluded from PPOR analyses. The second analytic phase (phase 2) is performed to determine the risk factors that are contributing to the excess mortality (Sappenfield, Peck, Gilbert, Haynatzka, & Bryant, 2010b).…”

Section: Introductionmentioning

confidence: 99%

Risk of Very Low Birth Weight Based on Perinatal Periods of Risk

Demont-Heinrich

Hawkes

Ghosh

et al. 2013

Public Health Nursing

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“…Third, the action statements can be used to further the work of the Perinatal Periods of Risk (PPOR) approach [53][54][55][56]. PPOR, a comprehensive approach to help communities use data to reduce infant mortality, was designed for use in urban areas with high infant mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality

Kasehagen¹,

Brandert²,

Nickol³

et al. 2014

J. Racial and Ethnic Health Disparities

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Objectives This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM). Design Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process. Results Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services -014-0008-4 for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61. Conclusion Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or systemwide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community's control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.. Racial and Ethnic Health Disparities (2014) 1:69-84 DOI 10.1007/s40615

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Perinatal Periods of Risk: Phase 2 Analytic Methods for Further Investigating Feto-Infant Mortality

Cited by 14 publications

References 25 publications

Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978–2012

Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978–2012

Risk of Very Low Birth Weight Based on Perinatal Periods of Risk

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality

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