Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative.

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  • Additional Information
    • Subject Terms:
    • Author-Supplied Keywords:
      Kitagawa analysis
      Perinatal Periods of Risk
      Racial disparities
      Socioeconomic disparities
    • Abstract:
      Objectives The goal of this study is to use Perinatal Periods of Risk (PPOR) analysis to differentiate broad areas of risk (Maternal-Health/Prematurity, Maternal Care, Newborn Care, and Infant Health) associated with being Black from those associated with being poor. Methods Phase I PPOR compared two target populations (Black women/infants and poor women/infants) against a gold standard reference group (White, non-Hispanic women, aged 20+ years with 13+ years of education), then against each other. Phase II PPOR further partitioned excess risk into (1) Very-low-birthweight-risk and (2) Birthweight-specific-mortality-risk and identified individual-level risk factors. Results Phase I PPOR revealed Black excess mortality within the Maternal-Health/Prematurity category (67% of total excess mortality). Phase II PPOR revealed that Black excess mortality within this category was primarily due to premature deliveries of very-low-birthweight infants. In a unique extension of the PPOR methodology, a poverty-excess-PPOR was subtracted from the Black-excess-PPOR, and showed that Black women have substantial excess mortality above and beyond that associated with poverty. Subsequent analyses to identify Black-specific risks, controlling for poverty, found that vaginal bleeding, premature rupture of membranes, history of preterm delivery, and having no prenatal care significantly predicted preterm delivery. Conclusions This study demonstrated the utility of PPOR, a standardized risk assessment approach for focusing health promotion efforts. In the study community, PPOR identified that maternal preconception and prenatal factors contributed the greatest risk for Black infants due to prematurity and low birthweight. Higher socioeconomic status did little to mitigate this risk. These findings informed a community-wide plan that integrated evidence-based strategies for addressing systematic racial inequity with strategies for addressing systematic socioeconomic disadvantage. [ABSTRACT FROM AUTHOR]
    • :
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    • Author Affiliations:
      1Western Michigan University Homer Stryker MD School of Medicine , 1000 Oakland Drive Kalamazoo 49008 USA
      2Kalamazoo County Health and Community Services , 3299 Gull Road Kalamazoo 49048 USA
    • ISSN:
      1092-7875
    • Accession Number:
      10.1007/s10995-017-2383-z
    • Accession Number:
      126875569
  • Citations
    • ABNT:
      KOTHARI, C. et al. Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative. Maternal & Child Health Journal, [s. l.], v. 21, p. 49–58, 2017. DOI 10.1007/s10995-017-2383-z. Disponível em: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=her&AN=126875569&authtype=sso&custid=s5834912. Acesso em: 27 jan. 2020.
    • AMA:
      Kothari C, Romph C, Bautista T, Lenz D. Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative. Maternal & Child Health Journal. 2017;21:49-58. doi:10.1007/s10995-017-2383-z.
    • APA:
      Kothari, C., Romph, C., Bautista, T., & Lenz, D. (2017). Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative. Maternal & Child Health Journal, 21, 49–58. https://doi.org/10.1007/s10995-017-2383-z
    • Chicago/Turabian: Author-Date:
      Kothari, Catherine, Camryn Romph, Terra Bautista, and Debra Lenz. 2017. “Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative.” Maternal & Child Health Journal 21 (December): 49–58. doi:10.1007/s10995-017-2383-z.
    • Harvard:
      Kothari, C. et al. (2017) ‘Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative’, Maternal & Child Health Journal, 21, pp. 49–58. doi: 10.1007/s10995-017-2383-z.
    • Harvard: Australian:
      Kothari, C, Romph, C, Bautista, T & Lenz, D 2017, ‘Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative’, Maternal & Child Health Journal, vol. 21, pp. 49–58, viewed 27 January 2020, .
    • MLA:
      Kothari, Catherine, et al. “Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative.” Maternal & Child Health Journal, vol. 21, Dec. 2017, pp. 49–58. EBSCOhost, doi:10.1007/s10995-017-2383-z.
    • Chicago/Turabian: Humanities:
      Kothari, Catherine, Camryn Romph, Terra Bautista, and Debra Lenz. “Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative.” Maternal & Child Health Journal 21 (December 2, 2017): 49–58. doi:10.1007/s10995-017-2383-z.
    • Vancouver/ICMJE:
      Kothari C, Romph C, Bautista T, Lenz D. Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative. Maternal & Child Health Journal [Internet]. 2017 Dec 2 [cited 2020 Jan 27];21:49–58. Available from: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=her&AN=126875569&authtype=sso&custid=s5834912