title: Trends in perinatal and infant health disparities between rural American Indians and Alaska natives and rural Whites.
abstract: OBJECTIVE
  We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time.
  
  
  METHODS
  We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births.
  
  
  RESULTS
  Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985-1987, 36.3%; 1995-1997, 26.3%) and postneonatal death (1985-1987, 7.1 per 1000; 1995-1997, 4.8 per 1000) improved significantly. However, disparities between American Indians and Alaska Natives and Whites in adjusted odds ratios (AORs) of postneonatal death (1985-1987, AOR = 1.55; 95% confidence interval [CI] = 1.41, 1.71; 1995-1997, AOR = 1.46; 95% CI = 1.31, 1.64) and adjusted risk ratios (ARRs) of inadequate prenatal care (1985-1987, ARR = 1.67; 95% CI = 1.65, 1.69; 1995-1997, ARR = 1.84; 95% CI = 1.81, 1.87) persisted.
  
  
  CONCLUSIONS
  Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close persistent health gaps for this group.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, WA 98195-4982, USA. lmb@u.washington.edu
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.forename: Elise
authors.initials: E
authors.lastname: Murowchick
authors.forename: Eric H
authors.initials: EH
authors.lastname: Larson
authors.forename: Walter B
authors.initials: WB
authors.lastname: Hollow
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Sugarman
authors.forename: William L
authors.initials: WL
authors.lastname: Freeman
authors.forename: L Gary
authors.initials: LG
authors.lastname: Hart
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007226:Infant Mortality / Q000208:ethnology* / Q000639:trends; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D004930:Inuit / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009309:National Center for Health Statistics, U.S.; D011295:Prenatal Care / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data / Q000639:trends; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult