Disparities in fetal death and first day death: the influence of risk factors in 2 time periods.
OBJECTIVE
We examined how changes in risk factors over time influence fetal, first day, and combined fetal-first day mortality and subsequent racial/ethnic disparities.


METHODS
We selected deliveries to US resident non-Hispanic White and Black mothers from the linked live birth-infant death cohort and fetal deaths files (1995-1996; 2001-2002) and calculated changes over time of mortality rates, odds, and relative odds ratios (RORs) overall and among mothers with modifiable risk factors (smoking, diabetes, or hypertensive disorders).


RESULTS
Adjusted odds ratios (AORs) for fetal mortality overall (AOR=0.99; 95% confidence interval [CI]=0.96, 1.01) and among Blacks (AOR=0.98; 95% CI=0.93, 1.03) indicated no change over time. Among women with modifiable risk factors, the RORs indicated no change in disparities. The ROR was not significant for fetal mortality (ROR=0.96; 95% CI=0.83, 1.01) among smokers, but there was evidence of some decline. There was evidence of increase in RORs in fetal death among mothers with diabetes and hypertensive disorders, but differences were not significant.


CONCLUSIONS
Disparities in fetal, first day, and combined fetal-first day mortality have persisted and reflect discrepancies in care provision or other factors more challenging to measure.
Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. mslay@uab.edu
Martha S
MS
Wingate
Wanda D
WD
Barfield
Joann
J
Petrini
Ruben
R
Smith
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000208:ethnology*; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult