American Indian and Alaska Native infant deaths in the Pacific Northwest: Identifying prevention areas using the Perinatal Periods of Risk Method (2000-2004)

Overall Aim: To examine excess fetal-infant deaths among American Indian and Alaska Natives (AI/AN) in the Pacific Northwest using the Perinatal Periods of Risk (PPOR) method.

Background: Although infant mortality in the United States has declined over the past decades, rates among AI/AN populations remain significantly higher than Whites. Metropolitan areas within the Pacific Northwest region report some of the highest infant mortality rates for AI/AN in the country, falling considerably below Healthy People 2010 goals. PPOR mapping can identify perinatal periods of mortality, thus suggesting areas for prevention.

Methods: Oregon, Idaho and Washington State vital statistic records from 2000-2004 were examined in aggregate form. Infant deaths were mapped by birth weight and age at death into four PPOR prevention areas: 1) Maternal Health/Prematurity, 2) Maternal Care, 3) Newborn Care, and 4) Infant Health. Mortality rates were compared to an internal reference group to identify excess fetal-infant mortality rates.

Results: Among AI/AN, excess mortality rates and thus preventable deaths were found. 6029 fetal-infant deaths occurred within the region and 179 AI/AN deaths. Results showed an overall excess fetal-infant mortality rate of 7.3 per 1,000 births for AI/AN. The highest contributors to excess AI/AN fetal-infant deaths were infant health (excess rate of 4.64 deaths per 1,000) and maternal health/prematurity (excess rate of 0.96 per 1,000).

Conclusions: Study findings indicate a need for preventative interventions during the Maternal Health/Prematurity and Infant Health periods among AI/AN. Focusing on risk time points can direct policy and program development for a regional and population specificity.