Which newborns in New York City are at risk for special education placement?
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In this study of 162 third graders in New York City public schools, we found that slightly over half of the children in special education were males who had Medicaid coverage at birth and mothers with medical conditions or adverse health habits noted on the birth certificate; two thirds of the children with this combination of characteristics actually were placed in special education. These findings suggest that newborns at risk for later learning disabilities can be targeted to receive preventive interventions. (+info)
The lowest birth-weight infants and the US infant mortality rate: NCHS 1983 linked birth/infant death data.
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The National Center for Health Statistics Linked Birth and Infant Death Data Set, 1983 birth cohort, shows that infants weighing less than 750 g, comprising only 0.3% of all births, account for 25% of deaths in the first year of life and for 41% of deaths in the first week. If interventions had prevented the death of these very small babies, the infant mortality rate would have been 8.3 per 1000 live births instead of 10.9, and the Black/White mortality differential would have been reduced by 25%. (+info)
Analyzing the effect of prenatal care on pregnancy outcome: a conditional approach.
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We used vital statistics data to examine the effect of the time of entry into prenatal care relative to the gestational age of delivery on pregnancy outcome. Early entry into prenatal care was associated with better outcomes only in women who delivered at 37 through 42 weeks of gestation. We are concerned that the evaluation of the effect of prenatal care using vital statistics data may be questionable because of the problems inherent in the data. (+info)
Reengineering vital registration and statistics systems for the United States.
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For more than a hundred years, the United States has operated a decentralized vital statistics system as an essential component of public health. Statistics based on births and deaths registered in the United States are a primary source of data used to track health status, to plan, implement, and evaluate health and social services, and to set health policy. The national vital statistics system provides nearly complete, continuous, and comparable federal, state, and local data. The system, however, is based on outmoded vital registration practices and structures, which raises concerns about data quality, timeliness, and the lack of real-time linkage capabilities. While many organizations are working together to address these issues and have made notable achievements, questions remain to be answered. Efforts to rejuvenate the nation's vital statistics system will need to expand dramatically to provide public health with a timely, high-quality, and flexible system to monitor vital health outcomes at the local, state, and national levels. (+info)
Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal.
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OBJECTIVES: To determine the prevalence of iron deficiency anemia among 1-year-old infants of disadvantaged families in Montreal as well as certain predictors of this condition. DESIGN: Cohort study. SETTING: Five poorest health districts in Montreal. PARTICIPANTS: Infants 10 to 14 months of age were identified from registration lists of births from May 1988 to August 1989. Those whose mother had less than 11 years of schooling and a family income below the government-defined low-income cutoff point were eligible. INTERVENTION: During a home visit capillary blood samples were obtained from the child, and the mother answered a questionnaire about infant-feeding practices. Infants with a serum ferritin level of 10 micrograms/L or less and either a hemoglobin level of 115 g/L or less or a mean corpuscular volume of 72 fL or less were considered as having iron deficiency anemia. RESULTS: Of the 299 mothers who were eligible and could be located 220 (74%) agreed to participate; 218 blood samples were available. Iron deficiency anemia was found in 25% of the infants (95% confidence interval [CI] 19% to 31%). The mean hemoglobin level was 115 (standard deviation 11) g/L. The serum ferritin level, assessed routinely in the last 62 infants, was 10 micrograms/L or less in 37% of the infants. The factors that were found to be predictors of iron deficiency anemia included the use of whole cow's milk before 6 months of age (odds ratio [OR] 3.56 [95% CI 1.07 to 11.26]) and the use of iron-fortified infant cereal for less than 6 months (OR 3.15 [95% CI 1.25 to 7.96]). A low birth weight and the use of iron-fortified formula for less than 6 months were associated with iron deficiency anemia. CONCLUSIONS: Despite a decrease in the prevalence of iron deficiency anemia among children of disadvantaged families in the United States socioeconomically disadvantaged infants in Montreal are at risk. Preventive measures must be taken to ensure adequate iron status in the first year of life. (+info)
Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999.
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OBJECTIVES: We identified risk factors for pregnancy-associated homicide (women who died as a result of homicide during or within 1 year of pregnancy) in the United States from 1991 to 1999. METHODS: Pregnancy-associated homicides were analyzed with data from the Pregnancy Mortality Surveillance System at the Centers for Disease Control and Prevention. RESULTS: Six hundred seventeen (8.4%) homicide deaths were reported to the Pregnancy Mortality Surveillance System. The pregnancy-associated homicide ratio was 1.7 per 100000 live births. Risk factors included age younger than 20 years, Black race, and late or no prenatal care. Firearms were the leading mechanism for homicide (56.6%). CONCLUSIONS: Homicide is a leading cause of pregnancy-associated injury deaths. (+info)
Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality.
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OBJECTIVES: I studied the extent to which maternal deaths are underreported on death certificates. METHODS: We collected data on maternal deaths from death certificates, linkage of death certificates with birth and fetal death records, and review of medical examiner records. RESULTS: Thirty-eight percent of maternal deaths were unreported on death certificates. Half or more deaths were unreported for women who were undelivered at the time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder. CONCLUSIONS: The number of maternal deaths is substantially underestimated when death certificates alone are used to identify deaths, and it is unlikely that the Healthy People 2010 objective of reducing the maternal mortality rate to no more than 3.3 deaths per 100000 live births by 2010 can be achieved. Increasing numbers of births to older women and multiple-gestation pregnancies are likely to complicate efforts to reduce maternal mortality. (+info)
A further examination of the "epidemiologic paradox": birth outcomes among Latinas.
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PURPOSE: Low rates of low birthweight (LBW) among foreign-born Latinas of low socioeconomic status have been called the "epidemiologic paradox." This study examined the extent to which the paradox can be explained by differential distribution of risk factors. PROCEDURES: The data source was the 1996-1997 New York City Birth File with 78,364 singleton births to Latinas. Ancestries included Colombians, Dominicans, Ecuadorians, Mexicans, Puerto Ricans and other Hispanics. First, a logistic regression was used to predict a LBW birth with ancestry and birthplace as the only independent variables. Demographic, medical and behavioral risks were added in subsequent regression models. FINDINGS: The LBW rate for the sample was 6.8%, with significant differences between birthplace subgroups and among ancestries. Puerto Ricans had the highest LBW rates, 9.1% for the mainland-born and 9.2% for the island-born. In separate regressions for six ancestry groups, birthplace was a significant predictor of LBW only among Mexicans and other Hispanics. CONCLUSION: In this population-based study of Latina women in New York City, the positive birth outcomes of foreign-born women are largely due to their more favorable distribution of behavioral risk factors. The "epidemiologic paradox" does not account for the LBW rates among Puerto Ricans in New York City, a high percentage of whom are mainland-born (73.4%). Compared to other Latinas, Puerto Rican women are likely to have experienced far more years of acculturation, which can result in negative health behaviors. (+info)