International Journal of Epidemiology, Vol 28, 1096-1101, Copyright © 1999 by International Epidemiological Association
KE Heck, KC Schoendorf and J Parker
BACKGROUND: International infant mortality rates vary widely. This
variation has been attributed to many factors, including differential
reporting. In the US, American Indians and Alaska Natives (AI/AN), who
generally have low socioeconomic status, have a low neonatal mortality
rate. One possible explanation is underregistration of very low birthweight
(VLBW, < 1,500 g) births. We hypothesized that underregistration may
occur disproportionately among AI/AN residing on or near reservations
(areas controlled by an American Indian group). We estimated infant
mortality in these areas. METHODS: Linked birth-infant death files for
1989-1991 were used to compare VLBW and neonatal mortality among AI/AN
infants in counties with reservations with those in non-reservation
counties. The VLBW rates for non-reservation counties were applied to the
reservation risk distribution to calculate directly adjusted VLBW and
neonatal mortality rates for reservation counties. This method assumes that
greater registration in non- reservation counties yields a more accurate
estimate of the relationship between risk factors and outcomes. RESULTS:
Despite a higher prevalence in reservation counties of risk factors, the
reported VLBW rate was 0.84% in reservation and 1.17% in non-reservation
counties. The neonatal mortality rate was 5.4 per 1,000 in reservation
counties and 6.0 in non-reservation counties. Direct adjustment yielded a
VLBW rate of 1.28% (95% CI: 1.14-1.39) and a neonatal mortality rate of
6.7-9.8 per 1,000 in reservation counties. CONCLUSIONS: Reported neonatal
mortality among AI/AN may understate the true rate due to underregistration
of VLBW births. Direct adjustment may be useful in estimating infant
mortality rates for populations with incomplete vital registration.
Are very low birthweight births among American Indians and Alaska Natives underregistered?
National Center for Health Statistics, Hyattsville, MD 20782, USA.
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