The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61950

Capri-Mara Fillmore, MD, MPH, MSc¹, Kathleen A. Blair, BSN, MS¹, Karen Michalski, MSW², Susan Shepeard, RN, MNS¹, and Seth Foldy, MD³. (1) City of Milwaukee Health Department, 841 N. Broadway, 3rd Fl, Milwaukee, WI 53202-3653, 414 286 3521, cfillm@ci.mil.wi.us, (2) City of Milwuakee Department of Health, 841 N. Broadway, 3rd Fl, Milwaukee, WI 53202-3653, (3) Milwaukee Health Department, 841 N. broadway, Milwaukee, WI 53202-333653

The 2002 Big Cities Health Inventory reported that Milwaukee had the greatest disparity between black and white infant mortality of the 50 largest US cities, hence a primary goal of the Milwaukee Health Department is to decrease African American infant mortality. One strategy was to target home visiting of public health nurses by analyzing 1998-2000 birth and death certificate data to predict from birth certificate factors which African American babies were of highest risk of dying. A relative risk (RR) of 3 or greater was considered “high-risk”. Among the birth certificates risk factors which met this criteria for all infants were: congenital anomalies (RR=12.0; 95% C.I.:6.5-22.6), birth weight <2500g (RR=3.0; 95% C.I.: 1.8-3.8), infants transferred to NICU (RR=4.5; 95% C.I.: 3.1-6.6), reported alcohol use during pregnancy (RR=3.4; 95% C.I.: 1.6-7.3), birth weight<2000g and cigarette use during pregnancy (RR=3.3; 95% C.I.: 1.5-7.2), and five-minute APGAR of 8 or less (RR=3.7; 95% C.I.: 2.6-5.4). However, for discharged African American infants, a five-minute APGAR of 8 is not high-risk (but rather, APGARS of 7 or less), birth weight of 2000g is not a significant risk (but birth weight <1500g is a high risk), and simply transferring to the NICU does not significantly increase risk of mortality of these discharged babies. Other factors noted on birth certificates, which seem to represent an “overwhelmed” factor, add significant risk to mortality among African American babies: teen mothers with 2 or more children already (RR=6.9; 95% C.I.: 1.7-27.6) and mothers of any age with 4 or more children at home (RR=3.3; 95% C.I.: 1.6-7.3). The Milwaukee Fetal and Infant Mortality Review suggests important messages for public health nurses in their home visits where poor sleep environments, prone sleeping positions, co-sleeping (especially on couches), and inability of recognizing a dangerous infection (or not knowing all infant “colds” at less than 3 months old are an emergency) are disproportionately high in cause of death among African American infants of Milwaukee.

Learning Objectives:

• ·Learn about differences in infant mortality risk factors which may add to racial disparity in mortality.
• ·Understand how to analyze a birth certificate data to determine the relative risk of mortality factors.
• ·Learn about using information gleaned the FIMR to let public health nurses know which educational messages may decrease mortality risk.

Keywords: Infant Mortality, African American

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.