The 130th Annual Meeting of APHA

Abstract #50531

Jim Gaudino, MD, MS, MPH, The Epidemiology Center, Northwest Portland Area Indian Health Board, 527 SW Hall Street, Suite 300, Portland, OR 97201, 503-228-4185, jag8@cdc.gov

US AI/AN infant mortality rates, IMRs, have remained higher than white rates. Under federal self-determination law and serving 42 Pacific Northwest, NW, tribes, the Northwest Portland Area Indian Health Board, NPAIHB, recently began working with CDC and the Washington, Oregon, and Idaho health departments to investigate NW AI/AN infant survival and establish pregnancy outcome monitoring.

NPAIHB requested computerized birth certificate (BC), birth-death (BD) linked, and fetal death files for 1981-1999. BD records were linked to complete birth files. For IMR calculations, maternal residents of the 3 states, based on BCs, were included and death and birth cohort methods used. Infant race was based on mother's race on BCs, regardless of Hispanic origin. CDC's National Infant Mortality Surveillance ICD-9 categories were used for cause-specific rates.

Files include 2.6 million records. Form and file format changes created standardization challenges. From 1984-1990, AI/AN IMRs were 1.8-2.4 fold higher than white rates. AI/AN IMRs significantly dropped from 21.6 per 1000 births in 1990 to 6.0 in 1995, nearly crossing the 5.5 1995 white rate. AI/AN IMRs significantly increased to 10.3 in 1998. AI/AN SIDS rates significantly decreased from 8.1 in 1984-87 to 2.3 in 1994-96, but then leveled off. Although based on small numbers, other cause of death rates apparently dropped. 'Other perinatal conditions' and 'birth trauma, hypoxia and asphyxia' rates apparently increased since 1997.

Collaborations helped build epidemiologic capacity to support tribal prevention programs and policies. NPAIHB provides tribes these data and begins analyses examining which factors were associated with these IMR changes.

Learning Objectives:

• 1) Understand NPAIHB's new role as a tribal epidemiology center to address Native American health issues.
• 2) Discuss latest findings about Northwest Native American infant morality and tribal policy implications.
• 3) Formulate hypotheses and discuss needed areas for further epidemiologic investigations AI/AN IM.
• 4) Develop ideas for potential MCH epidemiologic and program collaborations with NPAIHB and other tribal organizations.

Keywords: Infant Mortality, American Indians

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.