TY - JOUR
T1 - County Poverty, Urban–Rural Classification, and the Causes of Term Infant Death
T2 - United States, 2012-2015
AU - Mohamoud, Yousra A.
AU - Kirby, Russell S.
AU - Ehrenthal, Deborah B.
N1 - Publisher Copyright:
© 2021, Association of Schools and Programs of Public Health.
PY - 2021/9
Y1 - 2021/9
N2 - Objective: Higher mortality among full-term infants (term infant deaths) contributes to disparities in infant mortality between the United States and other developed countries. We examined differences in the causes of term infant deaths across county poverty levels and urban–rural classification to understand underlying mechanisms through which these factors may act. Methods: We linked period birth/infant death files for 2012-2015 with US Census poverty estimates and county urban–rural classifications. We grouped the causes of term infant deaths as sudden unexpected death in infancy (SUDI), congenital malformations, perinatal conditions, and all other causes. We computed the distribution and relative risk of overall and cause-specific term infant mortality rates (term IMRs) per 1000 live births and 95% CIs for county-level factors. Results: The increase in term IMR across county poverty and urban–rural classification was mostly driven by an increase in the rate of SUDI. The relative risk of term infant deaths as a result of SUDI was 1.6 (95% CI, 1.5-1.8) times higher in medium-poverty counties and 2.3 (95% CI, 1.2-2.5) times higher in high-poverty counties than in low-poverty counties. Cause-specific IMRs of congenital malformations, perinatal conditions, and death from other causes did not differ by county poverty level. We found similar trends across county urban–rural classification. Sudden infant death syndrome was the main cause of SUDI across both county poverty levels and urban–rural classifications, followed by unknown causes and accidental suffocation and strangulation in bed. Conclusions: Interventions aimed at reducing SUDI, particularly in high-poverty and rural areas, could have a major effect on reducing term IMR disparities between the United States and other developed countries.
AB - Objective: Higher mortality among full-term infants (term infant deaths) contributes to disparities in infant mortality between the United States and other developed countries. We examined differences in the causes of term infant deaths across county poverty levels and urban–rural classification to understand underlying mechanisms through which these factors may act. Methods: We linked period birth/infant death files for 2012-2015 with US Census poverty estimates and county urban–rural classifications. We grouped the causes of term infant deaths as sudden unexpected death in infancy (SUDI), congenital malformations, perinatal conditions, and all other causes. We computed the distribution and relative risk of overall and cause-specific term infant mortality rates (term IMRs) per 1000 live births and 95% CIs for county-level factors. Results: The increase in term IMR across county poverty and urban–rural classification was mostly driven by an increase in the rate of SUDI. The relative risk of term infant deaths as a result of SUDI was 1.6 (95% CI, 1.5-1.8) times higher in medium-poverty counties and 2.3 (95% CI, 1.2-2.5) times higher in high-poverty counties than in low-poverty counties. Cause-specific IMRs of congenital malformations, perinatal conditions, and death from other causes did not differ by county poverty level. We found similar trends across county urban–rural classification. Sudden infant death syndrome was the main cause of SUDI across both county poverty levels and urban–rural classifications, followed by unknown causes and accidental suffocation and strangulation in bed. Conclusions: Interventions aimed at reducing SUDI, particularly in high-poverty and rural areas, could have a major effect on reducing term IMR disparities between the United States and other developed countries.
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U2 - 10.1177/0033354921999169
DO - 10.1177/0033354921999169
M3 - Article
C2 - 33730532
AN - SCOPUS:85102778601
SN - 0033-3549
VL - 136
SP - 584
EP - 594
JO - Public Health Reports
JF - Public Health Reports
IS - 5
ER -