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BACKGROUND: Although Wisconsin’s overall infant mortality rate is lower than the national rate, Wisconsin’s black population experiences one of the worst infant mortality rates in the United States. During 2006-2010, a baby born to a non-Hispanic black woman in Wisconsin was 2.8 times as likely to die before his or her first birthday as a baby born to a non-Hispanic white woman. Eliminating this disparity is a public health priority in Wisconsin. In order to inform state efforts and identify opportunities to close the gap in birth outcomes, we performed a Perinatal Periods of Risk Analysis (PPOR) using 2006-2010 Wisconsin vital records data.
METHODS: PPOR is an analytic framework for identifying opportunities for reducing fetal and infant death by mapping these deaths into four periods of risk according to age at death [fetal (≥24 weeks gestation), neonatal (≤28 days old), post-neonatal (>28 days old)] and birth weight (500-1499g, 1500+ grams). PPOR requires three vital records files: fetal death, live birth, and linked birth and infant death. Fetal deaths and live births occurring between 2006-2010 to Wisconsin resident mothers were included in the PPOR birth cohort. Counts and rates of feto-infant mortality were calculated for each period of risk for the overall population, racial/ethnic subpopulations, and an internal Wisconsin reference group (non-Hispanic white mothers, >19 years of age, >12 years education). Populations of interest were compared to the reference group in order to calculate excess feto-infant mortality rates for each period of risk.
RESULTS: The overall feto-infant mortality rate for Wisconsin during 2006-2010 was 7.8 per 1000 live births and fetal deaths. The non-Hispanic black feto-infant mortality rate was substantially higher than all other racial/ethnic groups at 15.1 deaths per 1000 live births and fetal deaths, representing an excess rate of 9.9 when compared to the reference population. The majority of the excess death occurred in the maternal health/prematurity (42.6%) and infant health (29.6%) periods. Despite constituting only 9% of live births during the study period, the black population contributed nearly 40% (351/912) of the overall excess fetal and infant deaths in Wisconsin.
CONCLUSIONS: To effectively address the racial disparity in feto-infant mortality that exists in Wisconsin between the non-Hispanic black population and the reference group, we need to further explore the root causes of the excess rate of fetal and infant deaths in the black population, particularly those attributed to maternal health and prematurity factors, through Phase II PPOR analysis.