Using the perinatal periods of risk and life course theory to address health disparities

Background: Maternal and infant health outcome disparities continue to exist globally despite advancements in technology and increased spending in healthcare. Despite increased efforts and research, few population-level successes have been reported. Methods: Fetal and infant death data in Kansas from 2005-2009 was analyzed to describe the Perinatal Periods of Risk (PPOR). PPOR data is used for analyzing trends to inform community-based prevention strategies to address health disparities. Four prevention areas using fetal and infant mortality birth weight and time of death data were identified: 1) Maternal Health/Prematurity (MH/P), 2) Maternal Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). Linked birth-death cohort data was combined from birth/death certificate data. The reference group included 2000-2002 data from the US with the following characteristics: 20 or more years of age, 13 or more years of education, non-Hispanic Caucasian women, and residents of the US at time of birth. Results: The excess fetal-infant mortality rates were 10.7 for African Americans compared to 2.3 for Caucasians and 3.8 for Hispanics. Excess fetal-infant mortality rates for African Americans were 4.8 for MH/P, 2.3 for MC, and 3.0 for IH. Caucasians rates were 0.5, 0.3, and 1.1; Hispanic rates were 1.0, 0.9, and 1.7 respectively. Conclusions: Excess mortality in the MH/P risk period was due primarily to high rates of very low birth weight babies for non-Hispanic African Americans. Interventions based on the Life Course Theory are needed to improve the preconception health of African American women to reduce health disparities globally.