Risk Factors for Infectious Disease Infant Mortality in the United States, 2008-2009 Pubblico

Abstract

PURPOSE: The objective of this study is to determine maternal and infant risk factors associated with infant deaths due to infectious diseases (IDs) in the United States and the role that birth weight and infant race have on infant ID mortality.

METHODS: A retrospective case-control study was conducted to determine infant and maternal risk factors for ID infant mortality occurring in 2008-2009 using the Period Linked Birth/Infant Death data among singleton infants born in the United States to U.S. residents. An ID death was defined when the underlying cause of death was an ID International Classification of Diseases, 10^th Revision code. A 1:1 ratio of cases to controls was selected with controls defined as infants surviving to the end of their birth year. Risk factors for infant ID deaths were determined with multivariable logistic regression models stratified by birth weight [low (LBW) and normal birth-weight (NBW)] and also with continuous birth weight in spline regression. A sub-analysis of births recorded with the 2003 birth certificate was conducted to determine the role of maternal education and prenatal care in infant mortality due to IDs.

RESULTS: There were 3,798 infant deaths (2,633 LBW and 1,158 NBW) due to IDs during 2008-2009 in the United States. Male sex, younger maternal age (<25 years), a live birth order of fourth or more and low 5-minute Apgar score were associated with ID death among LBW and NBW infants. Non-Hispanic ethnicity and having an unmarried mother were both associated with increased odds of ID death among NBW infants, while for LBW infants, black race was associated with increased odds of death. Among infants with a 2003 birth certificate, less than adequate prenatal care was a risk factor for NBW infant ID deaths. American Indian/Alaska Native (AI/AN) race was a risk factor for infant mortality due to ID in the spline regression analysis.

DISCUSSION: Awareness of ID mortality risk factors should lead to improved prevention of IDs for children with ID mortality risk factors in their first year of life. Future studies should focus on eliminating disparities in infant death due to IDs.

Table of Contents

TABLE OF CONTENTS

List of Tables...............................................................................i List of Figures..............................................................................ii

1. Introduction............................................................................1

1.1. Problem Statement...............................................................1 1.2. Purpose Statement...............................................................2 1.3. Significance Statement..........................................................2 1.4. Definition of Terms...............................................................3

2. Review of the Literature...........................................................4

2.1. Global Burden of Infectious Disease........................................4

2.2. Global Infant Mortality..........................................................6

2.3. Infectious Disease in the United States...................................7

2.4. Burden of Infectious Disease in Infants in the United States.....11

3. Methodology........................................................................18

3.1. 2008 and 2009 Period Linked Birth/Infant Death Data Set.......18

3.2. Study Design....................................................................19 3.3. Variables.........................................................................20 3.4. Analyses.........................................................................21

4. Results..............................................................................25

4.1. Overall Analysis...............................................................25 4.2. Stratification by Birth Weight.............................................26

4.2a. Low Birth Weight............................................................26

4.2b. Normal Birth Weight.......................................................26

4.2c. Multivariable Logistic Regression Models............................27

4.3. Continuous Birth Weight...................................................28

4.4. 2003 Birth Certificate Sub-Analysis....................................29

4.4a. Low Birth Weight...........................................................30

4.4b. Normal Birth Weight......................................................31

4.4c. Multivariable Logistic Regression Models...........................32

5. Discussion........................................................................34

References...........................................................................38 Appendix..............................................................................41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	Infectious Disease Risk Factors Infant
Committee Chair / Thesis Advisor	Hertzberg, Vicki S, Emory University
Committee Members	Holman, Robert, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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