title: Inclusion of non-viable neonates in the birth record and its impact on infant mortality rates in Shelby County, Tennessee, USA.
abstract: Rates of infant death are one of the most common indicators of a population's overall health status. Infant mortality rates (IMRs) are used to make broad inferences about the quality of health care, effects of health policies and even environmental quality. The purpose of our study was threefold: i) to examine the characteristics of births in the area in relation to gestational age and birthweight; ii) to estimate infant mortality using variable gestational age and/or birthweight criteria for live birth, and iii) to calculate proportional mortality ratios for each cause of death using variable gestational age and/or birthweight criteria for live birth. We conducted a retrospective analysis of all Shelby County resident-linked birth and infant death certificates during the years 1999 to 2004. Descriptive test statistics were used to examine infant mortality rates in relation to specific maternal and infant risk factors. Through careful examination of 1999-2004 resident-linked birth and infant death data sets, we observed a disproportionate number of non-viable live births (≤20 weeks gestation or ≤350 grams) in Shelby County. Issuance of birth certificates to these non-viable neonates is a factor that contributes to an inflated IMR. Our study demonstrates the complexity and the appropriateness of comparing infant mortality rates in smaller geographic units, given the unique characteristics of live births in Shelby County. The disproportionate number of pre-viable infants born in Shelby County greatly obfuscates neonatal mortality and de-emphasizes the importance of post-neonatal mortality.
authors: Children's Foundation Research Center at Le Bonheur Children's Medical Center, Department of Pediatrics, University of Tennessee Health Sciences Center, USA.
authors: Bryan L
authors: BL
authors: Williams
authors: Melina S
authors: MS
authors: Magsumbol
references: Public Health Rep. 2001 Jan-Feb;116(1):15-21
references: 11571404
references: Am J Obstet Gynecol. 2007 May;196(5):433-44
references: 17466694
references: Am J Epidemiol. 1998 Dec 1;148(11):1048-54
references: 9850126
references: Pediatrics. 2007 Jul;120(1):e1-9
references: 17606536
references: Ann Epidemiol. 2007 Jun;17(6):425-30
references: 17395481
references: Am J Obstet Gynecol. 2004 Oct;191(4):1398-402
references: 15507972
references: Birth Defects Res A Clin Mol Teratol. 2006 Nov;76(11):772-7
references: 17044070
references: J Obstet Gynecol Neonatal Nurs. 2006 Jan-Feb;35(1):3-12
references: 16466348
references: Am J Perinatol. 1992 May;9(3):219-22
references: 1575847
references: Arch Gynecol Obstet. 2006 Aug;274(5):257-60
references: 16715287
references: Am J Epidemiol. 2001 Jan 15;153(2):110-3
references: 11159154
references: J Law Med Ethics. 2006 Fall;34(3):600-10, 481
references: 17144184
references: Am J Epidemiol. 2001 Nov 15;154(10):889-90
references: 11700241
references: J Epidemiol Community Health. 2003 May;57(5):319
references: 12700211
references: Am J Epidemiol. 2001 Nov 15;154(10):883-8
references: 11700240
references: J Gynecol Obstet Biol Reprod (Paris). 2007 May;36(3):245-52
references: 17383115
references: Paediatr Perinat Epidemiol. 2007 Sep;21 Suppl 2:62-71
references: 17803619
references: Pediatrics. 2007 Sep;120(3):519-26
references: 17766524
references: Eur J Obstet Gynecol Reprod Biol. 2003 Nov 28;111 Suppl 1:S33-44
references: 14642318
references: Paediatr Perinat Epidemiol. 2007 Sep;21 Suppl 2:50-61
references: 17803618
references: Statistica. 1984 Oct-Dec;44(4):675-86
references: 12267011
references: Natl Vital Stat Rep. 2005 Jan 24;53(12):1-22
references: 15712582
references: Paediatr Perinat Epidemiol. 2007 Jul;21 Suppl 1:58-62
references: 17593198
references: J Gynecol Obstet Biol Reprod (Paris). 1998 Jun;27(4):384-8
references: 9690156
references: Demography. 1969 Nov;6(4):425-33
references: 21279796
references: Paediatr Perinat Epidemiol. 2002 Jan;16(1):16-22
references: 11862950
references: Obstet Gynecol. 2007 Aug;110(2 Pt 1):318-24
references: 17666606
references: Paediatr Perinat Epidemiol. 1997 Jan;11(1):105-21
references: 9018732
references: Paediatr Perinat Epidemiol. 1997 Jan;11(1):122-8
references: 9018733
references: Am J Obstet Gynecol. 2002 Dec;187(6):1660-6
references: 12501080
references: MMWR Morb Mortal Wkly Rep. 2002 Apr 19;51(15):329-32, 343
references: 11990238
references: Pediatrics. 2003 Mar;111(3):680-1
references: 12612257
references: Natl Vital Stat Rep. 2007 May 2;55(14):1-32
references: 17569269
references: J Health Care Poor Underserved. 1995;6(1):60-75
references: 7734636
references: Am J Public Health. 1999 Aug;89(8):1238-40
references: 10432914
references: J Perinatol. 2007 Dec;27(12):754-60
references: 17762845
references: Am J Epidemiol. 1990 Jun;131(6):1072-9
references: 2188499
references: Am J Obstet Gynecol. 2007 Feb;196(2):147.e1-8
references: 17306659
references: Public Health Nurs. 2003 Jul-Aug;20(4):318-27
references: 12823792
references: Wiad Stat (Warsaw). 1984 Aug;29(8):5-6
references: 12266471
references: BJOG. 2004 Feb;111(2):160-3
references: 14723754
references: Teratology. 1991 Aug;44(2):177-80
references: 1925976
references: Int J Circumpolar Health. 2007 Feb;66(1):4; author reply 5-6
references: 17451129
references: Acta Obstet Gynecol Scand. 2004 Nov;83(11):1039-43
references: 15488118
references: Birth Defects Res A Clin Mol Teratol. 2003 Sep;67(9):610-6
references: 14703782
references: Bol Asoc Demogr Hist. 1984 Mar;2(1):6-19
references: 12265955