The Perinatal Periods of Risk Phase 2 Analytic Methods—Case Study Exercise William M. Sappenfield, MD, MPH 2015 HRSA MCH EPI Course

Alaska Infant Mortality Rates,

Feto-Infant Mortality Rates Racial/Ethnic subgroups of Alaska, (external reference group) Racial Groups Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Overall Feto- Infant Mortality All Races White Alaska Native External Reference Group

Excess Excess Feto-Infant Mortality Rates Racial/Ethnic subgroups of Alaska, (external reference group) Racial /Ethnic Groups Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Feto-Infant Mortality All Races White Alaska Native

Racial /Ethnic Groups Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Feto-Infant Mortality White Alaska Native Other/ Missing All Excess Number Excess Number Feto-Infant Deaths Racial/Ethnic subgroups of Alaska, (external reference group)

Phase 2 Analysis—Infant health period Identify causal pathways or biologic mechanisms for excess mortality Infant Health SIDS Injury Infection Anomalies Each cause category has its own set of Risk Factors Perinatal

Example Total Excess Mortality in the Infant Health Period is Per 1000 live births over 1500 g

Passive smoke Sleep position Breast-feeding Bedding Co-sleep Maternal age Death scene investigation Folic acid intake Alpha-feto protein Alcohol Drug abuse Diabetes Ultrasound Delivery site Phase 2 Analysis—Infant health period Estimate prevalence of risk and preventive factors by type of mechanism SIDS/SUIDAnomalies

Medical home Immunizations Breast-feeding Passive smoke Prenatal care Maternal age Infection type Bedding Supervision Environment Injury type InjuryInfection Phase 2 Analysis—Infant health period Estimate prevalence of risk and preventive factors by type of mechanism

Feto-Infant Mortality Rates Racial/Ethnic subgroups of Alaska, Racial Groups Urban White Rural White Urban Alaska Native Rural Alaska Native