Disparities in Perinatal and Birth Outcomes: National Trends and Contributing Factors

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Disparities in Perinatal and Birth Outcomes
National Trends and Contributing Factors

• Paul Wise, M.D., M.P.H
• Richard E. Behrman Professor of Child Health and
  Society

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Infant Mortality Rates US
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Example of Differential Mortality
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Efficacy
Differential Risk
Differential Access
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Examples

• Neonatal intensive care
• SIDS and the Back to Sleep Campaign
• Surfactant therapy
• Immunizations
• Congenital anomalies and prenatal diagnosis

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Modified from Wise et al. JAMA. 2001
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Infant Mortality Rate by Year US
Source MacDoman et al. Nat Vit Stat Rep. 200553
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Birth Weight-Specific Mortality
Neonatal Mortality Rate
Birth Weight Distribution
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1000-1499gm
NMR
500-999gm
lt500
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lt500gm
1000-1499gm
500-999gm
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Conclusions

• The epidemiology of perinatal disparities is
  intensely dynamic
• Disparities are sensitive to ALL forms of
  efficacious interventions
• Recent trends enhance the importance of
  regionalized specialty care services and womens
  health