title: Disparities in infant health among American Indians and Alaska natives in US metropolitan areas.
abstract: OBJECTIVE
  To determine geographic variation in urban American Indian and Alaska Native (AI/AN) rates of infant mortality, low birth weight, prenatal care use, and maternal-child health care service availability.
  
  
  METHODS
  This was a retrospective cohort study using data from the 1989 to 1991 birth-death linked database from the National Center for Health Statistics. We examined births from metropolitan areas with a minimum of 300 AI/AN births during the study period. Key outcomes of interest included rates of low birth weight, neonatal mortality, postneonatal mortality, and women receiving inadequate prenatal care using the modified Kessner index. To determine the type of health services tailored to AI/AN mothers residing in these urban areas, we conducted a telephone survey of the 36 urban Indian health programs operating in 1997 using a semistructured survey. Items in the survey included questions about the availability of prenatal and infant health care.
  
  
  RESULTS
  During the 1989 to 1991 study period, there were 72 730 singleton births to AI/AN mothers and/or fathers residing in urban areas, representing 49% of all AI/AN births in the United States. Overall 14.4% of urban AI/AN births were to women who received inadequate care during pregnancy, 5.7% of pregnancies resulted in low birth weight infants, and 11.0 infants died per 1000 live births. Death rates for the neonatal period (5.5 per 1000 births) and postneonatal period (5.4 per 1000 births) were similar. Marked disparity in these indicators exist between pregnancies to AI/AN and white women. Among the 54 metropolitan areas, 46 had a rate ratio (AI/AN: white) for inadequate care of > or =1.5 (range: 0.9-8.5). The mean rate ratios for neonatal and postneonatal mortality were 1.6 (range: 0.3-4.0) and 2.0 (range: 0.5-5.5). There was also considerable geographic variation of AI/AN mortality rates between metropolitan areas in all of the outcomes studied. All of the 20 metropolitan areas with the highest birth counts had some type of direct medical care or outreach services available from an urban clinic targeted toward AI/AN patients.
  
  
  CONCLUSIONS
  Considerable variation also exists among rates of AI/ANs between metropolitan areas. Disparity exists in rates of perinatal outcomes between AI/ANs and whites living in the same metropolitan areas Although AI/AN urban health programs exist in most cities with large birth counts, it seems that many have inadequate resources to meet existing needs to improve perinatal outcomes and infant health.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA. navajo@u.washington.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: Susan
authors.initials: S
authors.lastname: Casey
authors.forename: Brigitte
authors.initials: B
authors.lastname: Nixon
authors.forename: Walter
authors.initials: W
authors.lastname: Hollow
authors.forename: L Gary
authors.initials: LG
authors.lastname: Hart
mesh_terms: D000413:Alaska / Q000453:epidemiology; D002662:Child Health Services / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007229:Infant Welfare / Q000208:ethnology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data; D011159:Population Surveillance; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service / Q000458:organization & administration; D014504:Urban Health / Q000706:statistics & numerical data; D044465:White People