Perinatal Periods of Risk (PPOR): Analysis of Feto-Infant Mortality in Louisville Metro During 2001–2003

Purpose The objective of the present study was to analyze feto-infant mortality rates in Louisville Metro during 2001–2003 to understand specific causes and to interpret disparities using the Perinatal Periods of Risk (PPOR) as a surveillance tool. The study question was: which areas in perinatal health have the highest feto-infant mortality rates in Louisville Metro during the period 2001–2003? Methods The PPOR approach divides feto-infant mortality into four strategic prevention areas: Maternal Health / Prematurity (MHP), Maternal Care (MC), Neonatal care (NC) and Infant Health (IH) based on birth weight and age at death. Category specific infant mortality rates were calculated using linked birth-death files and fetal death records. Excess mortality in Louisville was determined with respect to a national reference population. Kitagawa analysis was used to differentiate between excess mortality due to birthweight distribution and birth weight specific mortality. Determinants for very low birthweight (VLBW) were further analyzed using logistic regression. Results In 2001–2003, feto-infant mortality rate in Louisville Metro was 10.6 per 1000 live births: 9.3 among whites and 14.8 among African Americans. Mortality rates (per 1000) among PPOR categories were: MHP (4.7) > MC (2.4) > IH (2.3) > NC (1.2). Two categories, MHP and IH, accounted for 78 % of excess deaths. Birthweight distribution accounted for 39% of excess mortality in the MHP category; however, there was a 10 % survival advantage due to birthweight specific mortality in MHP category. A two fold excess mortality among African Americans versus whites in the MHP category was due to birthweight distribution. Multiple births followed by medical risk, alcohol consumption and late onset prenatal care were found to be significant risk factors for VLBW. Conclusion More efforts should be targeted to reduce the prevalence of VLBW and to prevent post-neonatal mortality in the Louisville Metro.