Advanced Education BSN Required for RN Degree Term Paper

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Infant Mortality

Health Care Disparities in Infant Mortality

Numerous empirical studies have demonstrated a significant discrepancy in survival rates of newborns of different race. It has been shown that black infants are two times more likely to die within the first month of life than their white counterparts. Identification of these disparaged findings has prompted analysis of health care offered from a demographic perspective, considering racial treatment and socioeconomic conditions. The Center for Disease Control (CDC) has examined race-specific mortality information on newborns, and reported a series of noted and persistent trends coinciding with the data differences. It is necessary to address this inconsistency in survival rates between the black and white races to identify potential changes in health care delivery systems and eliminate racial factors in infant mortality.

The U.S. government has identified six classes of racial and ethnic minority discrepancies in health care access, experience, and outcomes. In addition to infant mortality issues, the areas also include cancer screening and management, cardiovascular disease, diabetes, HIV infection and AIDS, and immunizations. In 1998 the presidential goal was established committing governmental resources to eliminating these health care differences and improving the overall health of all Americans. This involved contributions by the Health and Human Services (HHS) department. The strategies for administering these goals were written up in the Healthy People 2010, a revision of Healthy People 2000, specifically addressing the greater degree of illness and death experienced by minorities. Through this agenda, targeted disparities were identified, reliable national data was accumulated, near-term goals outlined, and Department leadership and resources put forth to accomplishing improvements in the health care provided to affected groups.

The HHS has an outline of their plan to combat health care discrepancies (HHS, 2000). Their goals are directed at providing leadership through research, and expanding and improving programs aimed at the delivery of health care services, poverty reduction, safe and healthy environments, and trauma and disease prevention. The committee providing these tasks is headed by the Assistant Secretary for Planning and Evaluation of the Department and the Surgeon General. They partnership with state and local governments, and national and regional minority health organizations, to gain better access to affected communities. The charge of the HHS involves the directed review of disparity reduction goals and currently developed applicable programs. They also determine consultation programs for the minority communities, as well as the health services groups, and review scientific data, demographics, and health care services for their potential areas of improvement in order to satisfy the goal of eliminating racial and ethnic factors in the outlined six groups.

Specifically considering the research aspect of the HHS minority outreach programs, the Department has required changes to be made to local and national data collection formats. For instance, they have adopted a policy requiring all HHS-sponsored data reporting programs to itemize racial and ethnic categories. The goal of this addition to the data reports allows the HHS to better monitor the distribution of federal funds for the guarantee that monies, services, and health care access are being equally applied in a nondiscriminatory manner. Also, improved interactions, interventions, and partnerships can be provided to minority communities to stimulate research involvement for disparaged groups, and determine and implement better strategies for health care access and delivery.

The persistence of infant mortality rate disparities among black and white babies, as addressed by Healthy People 2010, also involves the intervention by the CDC. The CDC has analyzed data from birth and death certificates obtained from the National Center for Health Statistics (Iyasu et al., 2002). Through this examination certain trends in infant mortality rates related to low birth weight (LBW) at less than 2500 grams and very low birth weight (VLBW) at less than 1500 grams were identified for the years 1980 to 2000. A subcategory of data analysis included birth weight-specific mortality rates (BWSMRs), calculated from data collected for 1983 to 1991 and 1995 to 1999. Race-specific data for these three categories used the mother's race. Statistics showed that 3,612,258 live births occurred in 1980 (almost 3 million born to white women and over 560,000 to black women), with an average of 12.6 deaths per 1,000 live births. These statistics significantly improved for all races, with infant mortality decreasing 45.2% in the year 2000, with 6.9 deaths in 1,000 live births, and 4,064,948 total births reported (3.2 million to white women and almost 620,00 to black women).

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Although the decline in infant mortality was noted, the decrease was greater for babies born to white mothers than to black mothers, with the white decline determined to be 47.7%, and 36.9% for blacks. During the time span analyzed, the ratio of black-white infant deaths actually increased 25% for a constant ratio of 2.4 for the years 1990 to 1998. This compelling information regarding the preponderance of black infant deaths to white is the basis of the health issue review in the Healthy People 2010, and of importance to racial health care disparities.

A prime determinant in the identification of causes of infant mortality discrepancies is birth weight, which involves several racial and ethnic factors. In the CDC's investigation of statistical data, it was found that the gap in low to very low birth weight risk increased significantly between black and white babies, with smaller declines in BWSMR over the two decades noted for blacks than whites. Thus, birth weight-specific influence on mortality rates among infants persisted as a persuading effector (Iyasu et al., 2002).

In recent years, improvements in medical technology, the introduction of neonatology, and the regionalization of perinatal care have accounted for increases in infant survival when birth weight is a factor. While this has overall benefited the odds of all races of infants surviving the conditions and causes related to low birth weight, the etiology of the disparities must still be accounted for. It should be first noted that some increases in low to very low birth weight infants has resulted from changes in obstetrical practices, such as assisted reproductive technology, induction of labor, and preterm delivery, which is most significantly reported in whites which have shown increases from 1986 to 1996, as compared to a decrease of 10% in blacks. Also, twin births increased at twice the rate for whites than blacks, lending to affected low birth weight ratios (Iyasu et al., 2002). In review of this information, mortality discrepancies are still presented. This infers evidence of race-related factors involved in the distortion of mortality rates.

Identified factors that may be potentially involved in the mortality rate for black infants includes demographic risk factors such as maternal age, income, education, lack of social support, use of drugs, alcohol, or tobacco during pregnancy, pregnancy spacing, maternal medical conditions (i.e. bacterial vaginosis, HIV), maternal health experiences that might be exclusive to black women, access to quality medical care (obstetric and neonatal), and medical expense coverage. However, in a joint study done by the New Jersey Department of Health and Senior Services and the Northern New Jersey Maternal/Child Health Consortium, when these race-related variables are not relevant, black infants continue to demonstrate mortality rates at twice those of white babies under one year of age (Marshall et al., n.d.).

Upon noting this discrepancy, a Blue Ribbon Panel was devised to further investigate this problem. It was determined that several other factors may play a role in black infant mortality rates, primarily of social consideration. One area found to impact these rates was the community's lack of awareness of the black infant mortality health concern, and the effect of social racism on adding psycho-social stress to the mother. Also, a significant lack of quality pre- and postnatal services exists for black families, especially those mothers and infants at risk (Marshall et al., n.d.). Thus, the influence of demographic risk factors as well as the attitudes and influences of social racism have seemingly affected infant mortality rates, accounting for the described discrepancies, which see higher rates of black infant deaths than white.

The socio-economic condition of all women, white and black, has also been demonstrated to affect infant mortality. In the assessment by Malkin et al. (2000) of newborn deaths related to early discharge (less than thirty hours after birth), it was found that the death rate for infants less than 28 days old showed an odds ratio of 3.65 for early discharges as compared with those sent home after thirty hours. It was specifically cited that early discharge infants were also more likely to suffer from heart conditions and infections in the first year of life. With the average postpartum stay for vaginal deliveries in the hospital at two days in 1993, and down to one day in 1995, the rise of early discharges is relevant to the consideration of infant mortality rate effectors. The concern, then, are what factors.....

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