[Slide 1]{.underline}

**Disparities in Perinatal and Birth Outcomes: National Trends and
Contributing Factors**

Paul Wise, MD, MPH

Richard E Behrman Professor of Child Health and Society

[Slide 2]{.underline}

**Infant Mortality Rates: US**

On a line graph, the x-axis shows years from 1975 to 2002 and the y-axis
represents infant deaths per 1,000 live births. There are lines labeled
Total, White, Black, and Hispanic, the last of which is only for
[1997]{.mark} to 2001. All lines have a general downward trend. The
Black line is consistently far above the others, starting from a
mortality rate of 26.2 and declining to 13.3. The Total line, which is
the only one that extends to 2002 instead of 2001, drops from 16.1 to 7.
The White line is consistently a little below the Total line, dropping
from 14.2 to 5.7. The Hispanic line shows nearly the same values as the
White line where it appears.

[Slide 3]{.underline}

**Example of Differential Mortality**

  ----------------- ----------------- ----------------- -----------------
  Group             Number Exposed    Number of Deaths  Percent Mortality

  One               144               4                 3

  Two               93                13                14

  Three             165               89                54
  ----------------- ----------------- ----------------- -----------------

[Slide 4]{.underline}

At the top of the slide is a box labeled Efficacy. Two-way arrows
connect it to a box labeled Differential Risk at the lower left and a
box labeled Differential Access at the lower right.

[Slide 5]{.underline}

**Examples**

Neonatal intensive care

SIDS and the Back to Sleep Campaign

Surfactant therapy

Immunizations

Congenital anomalies and prenatal diagnosis

[Slide 6]{.underline}

**Cumulative Percent of Racial Disparity in Neonatal Mortality Rates by
Birth Weight: US: 1997 to 98**

On a line graph, the x-axis lists number ranges: less than 500, 500 to
749, 750 to 999, 1,000 to 1,249, 1,250 to 1,499, 1,500 to 1,749, 1,750
to 1,999, 2,000 to 2,499, 2,500 to 2,999, 3,000 to 3,499, 3,500 to
3,999, and 4,000 and up. An arrow indicates the change of scale from
groups of 250 to groups of 500. The y-axis shows percentages. The line
starts at 35, promptly rises to 70 and then to 80, and rises more
gradually thereafter to 99 with a slightly greater spike at the scale
change.

Modified from Wise et al, Jama 2001

[Slide 7]{.underline}

**Infant Mortality Rates by Year: US**

On a line graph, the x-axis shows years from 1990 to 2002 and the y-axis
shows deaths under 1 year per 1,000 live births. The line starts from
about 9.2 and gradually descends to about 6.9 in 2001. After that, there
is an increase marked Plus 3 Percent.

Source: MacDoman et al, National Vital Statistics Report 2005, 53

[Slide 8]{.underline}

At the left side of the slide is a box labeled Neonatal Mortality Rate.
An arrow points from it to a box at the upper right labeled Birth
Weight-Specific Mortality. Another arrow points from the left box to a
box at the lower right labeled Birth Weight Distribution.

[Slide 9]{.underline}

**Very Low Birth Weight Birth Rates and Neonatal Mortality Rates: US**

On a line graph, the x-axis shows years from 1985 to 2002. The y-axis
shows both birth rates and neonatal mortality rates per 1,000 live
births, the exact measures given at the left and right sides of the
graph, respectively. A line marked Less than 500 Grams remains nearly
steady, with a slight overall increase from 1.29 to 1.79. A less steady
line marked 500 to 999 Grams has an overall increase from 4.72 to 5.74,
with a low point of 4.67 in 1986 and a high point of 5.83 in 1999. A
line marked 1,000 to 1,499 Grams has an overall increase from 6.15 to
7.33, with a high point of 7.35 in 2000. The NMR line, for national
mortality rates, has an overall decrease from about 6.52 to about 4.58,
with a low of about 4.45 in 2001.

[Slide 10]{.underline}

**Annual Change in Neonatal Mortality Rate for Very Low Birth Weight:
US**

On a line graph, the x-axis shows years from 1986 to 2002 and the y-axis
shows annual percent changes in national mortality rates. A line marked
Less than 500 Grams, which starts in 1990 instead of 1986, zigzags
greatly with a high point of 9.8 in 2001 and a low point of negative
18.2 in 1998. A line marked 500 to 999 Grams also zigzags but has a
clear upward trend from negative 36.6 in 1990 to 8.5 in 2002. A line
marked 1,000 to 1,499 Grams has substantial valleys at 1987 and 1990,
the latter of which sees a low point of negative 14.5, but there is
relative steadiness from 1991 onward, with an overall increase to a high
of 0.3 in 2000.

[Slide 11]{.underline}

**Conclusions**

The epidemiology of perinatal disparities is intensely dynamic

Disparities are sensitive to all forms of efficacious interventions

Recent trends enhance the importance of regionalized specialty care
services and women's health