Feto-infant mortality in Southern Nevada: A Perinatal Periods of Risk (PPOR) assessment

Objective This report presents recent trends relating to perinatal mortality in Southern Nevada for available data years from 2000 through 2012. Data and methods Data from the live birth/fetal death (preliminary from 2011 onwards) and death (preliminary from 2012 onwards) registries were used to develop rate estimates. The Perinatal Periods of Risk approach was adopted to provide an actionoriented perspective on the relative contributions of Maternal Health/Prematurity, Maternal Care, Newborn Care and Infant Health to the perinatal mortality burden, and to identify areas with the highest potential for mortality reduction. Main results The feto-infant death (FID) rate showed a slight uptick between 2009-10 and 2011-12, despite a long-term decreasing pattern. The vast majority of FIDs occurred in the Maternal Health/Prematurity and Maternal Care periods. NHB had FID rates well in excess of the NHW reference for all risk periods. Importantly, the birthweight pathway (high rates of VLBW), rather than that of mortality (poor survival rates), was the predominant cause of excess Maternal Health/Prematurity deaths among NHBs, underscoring the need to address preconception health gaps. Abbreviations NHB: non-Hispanic black NHW: non-Hispanic white LBW: low birth weight VLBW: very low birth weight LBFD: live births and fetal deaths CI: Confidence interval Infant mortality is generally considered one of the best barometers of a community’s socio-economic wellbeing, as well as its perinatal health. It is related to a range of factors including socio-economic and behavioral characteristics, environmental and biomedical factors, genetics, as well as the quality and accessibility of health care services. Many of these risk or protective factors also impact fetal mortality (stillbirths and miscarriages), a reproductive loss which is less understood in comparison with infant deaths. This report examines both fetal and infant mortality in order to provide a more complete picture of perinatal death in Clark County, and to help focus action where it is most needed. There were 8.3 feto-infant deaths (FID) per 1,000 live births or fetal deaths ( ≥24 weeks of gestation) weighing 500 grams or greater, corresponding to 435 perinatal deaths in 2011-12. This was an upturn from the rate in 2009-10 (7.8 per 1,000; 427 deaths), albeit a slight decrease from that in 200304 (8.4 per 1,000; 430 deaths). Over the period 2003-04 to 2011-12, the proportion of perinatal deaths that were fetal deaths rose from 40% to 51.5%, and the number of fetal deaths from 172 to 224. To help identify vulnerable neighborhoods or subpopulations with regard to perinatal mortality, spatial variations in FIDs were depicted using zip code as the enumeration area for the 2010-12 period