Child Health

Background of Community Child Health Research

Last Updated Oct 6, 2008 04:03 AM

Racial and ethnic disparities in maternal and child health are widespread.
Disparities appear to be closely related to the social conditions associated with poor communities and fragmented families. For example, infant deaths are highest among many of our nation's urban and rural minorities. Sudden Infant Death Syndrome (SIDS) is the leading cause of post-neonatal mortality, accounting for approximately 28 percent of such deaths. SIDS rates vary
widely by race and ethnicity. According to 1999 period linked files, the rate of SIDS was 1.3/1000 live births among blacks, 0.56/1000 among whites, 0.37/1000 among Hispanics, and 0.31/1000 among Asian/Pacific Islanders.
Among American Indians and Alaskan Natives, SIDS is the leading cause of overall infant mortality, with a rate of 1.47/1000 live births, which is almost three times that of whites. The basis for the racial disparity is not fully determined. Gains in reducing the disparity will come from continued efforts in the implementation and evaluation of the "Back to Sleep" campaign, expanded research into the etiology and pathogenesis of SIDS, and the development of new prognostic, therapeutic, and preventive strategies.

Although many of the remaining deaths in the post-neonatal period are due to a range of diagnoses such as infections, accidents, neglect, and abuse, the diagnosis of a large proportion of the deaths is still undetermined. It is important to understand the contributions of biological, medical, behavioral, and social factors in all causes of unexpected early childhood deaths in high-risk communities. In this way, complete diagnosis and effective interventions can be chieved.

In addition, fetal death rates are higher among blacks compared with whites.
The rate of fetal deaths 20 weeks or greater in 1998 was 12.3/1000 live births plus fetal deaths among black mothers and 6.7/1000 live births plus fetal deaths among white mothers. The late fetal mortality rate (28 weeks gestation or greater) is also higher among blacks (5.3/1000 compared with 3.4/1000). Some studies show that unexplained antenatal stillbirths, which represent about half of late fetal deaths, share characteristics with SIDS.

Preterm birth affects 11.6 percent of all births in the United States and is a major contributor to infant morbidity and mortality. Within preterm birth, there is a significant health disparity, with preterm births at less than 32 weeks occurring almost 2.5 times more often to African American mothers than whites. Prematurity, intrauterine growth retardation, and their complications supercede all other conditions (including congenital anomalies)
as the primary cause of infant morbidity and mortality in the African
American population, with deaths attributed to short gestation and low birthweight almost four times that of white infants. While technology has contributed significantly to improving neonatal survival over the past several decades, especially in relation to those diseases and disorders that are specific sequelae of preterm birth and low birthweight, a disproportionate contribution to the overall post-neonatal deaths and infant morbidity from infection, respiratory problems, child abuse, etc. occurs in survivors of prematurity and low birth weight. Additionally, these infants
are also at higher risk for SIDS in the post-neonatal period. Despite improvements in the cause-specific rates of fetal, infant, and early childhood mortality and morbidity in recent years, the health disparities remain.

Scientific Knowledge to be Achieved Through Research Supported by the RFA

The family and community are important influences on child health. The family and community also frame the context through which private and public resources are mobilized to address child health problems. Research on community and family effects on child health has demonstrated that these influences are real and the next logical step for such research to take is to ask how they work to produce child health outcomes. Traditional research on
infant mortality and morbidity has focused on either the environmental factors, i.e. individual, family or community influences, or on the biologic etiologies and mechanisms. Such approaches have failed to acknowledge the important synergism of these different sources of vulnerability.

This deficiency is most apparent in health disparities where traditional approaches have failed to explain adequately the causes of these disparities.

The next logical step for research to take is to specify social and
behavioral processes that combine to produce biological pathways by which disparities in health arise at birth and through early childhood. The work supported by this RFA will create a foundation that will support such a study
in the future.

See also Child Health 674 1 - 4