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in the overall nonwhite neonatal mortality rate was due substantially to increases in weight-specific death rates. These increases in the weight-specific death rates were not associated with a decreasing percent of births in these weight categories occurring in Level III hospitals. Considering also that there were increases in certain race-weight-specific death rates from 1980 to 1981, it appears that the consistent decline of weight-specific neonatal mortality rates that has occurred since at least 1976 has temporarily abated. Discussion This study demonstrates that examination of "crude" neonatal or infant mortality rates is not sufficient. Birth-weight-specific mortality rates must be examined in relation to the distribution of births by weight. In order to undertake such analysis, matched birth and infant death flies are required. Given that the relatively poor ranking of the United States among industrialized nations with regard to neonatal mortality is due largely to low birth weight,"^ it is difficult to justify the unavailability of such data for the entire United States for the direction of national policy. The results of this analysis have some important implications for North Carolina policies designed to further reduce the neonatal mortality rate. Almost none of the reduction in neonatal mortality since 1976 has been due to increased birth weights. The major improvements in neonatal mortality have resulted from better medical care of small babies in neonatal intensive care units,'' which has served to reduce the weight-specific neonatal death rates particularly in the 1001 to 2500 grams categories. Williams and Chen'^ suggested that the increased rate of cesarean section for low-weight infants also contributed to the decline of neonatal death rates in California. They found that decreases in birth-weight-specific mortality accounted for 85 percent of the decline of the neonatal mortality rate in the 1970s, with only 15 percent due to improvements in birth weight, and no improvement was observed in the birth-weight distribution for blacks. Goldenberg et found that only 5 percent of the nearly 50 percent reduction in neonatal mortality in Alabama from 1970 to 1980 could be attributed to changes in birth-weight distributions, and birth-weight changes accounted for 12 percent of the decrease in the white neonatal mortality rate but none of the decrease in the nonwhite rate. David and Siegel'^ found for North Carolina that ''better babies," as reflected primarily in increased birth weights but also considering gestational age, accounted for 85 percent of the decline in neonatal mortality from 1968 to 1972, but accounted for only 16 percent of the decline from 1972 to 1977, with the rest of the decline attributable to better weight-specific survival rates or "better care.'' They also found that improved birth weights and gestational ages were a much less important factor in the decline of neonatal mortality for nonwhites as compared with whites. It is likely that, in the near future, further major reductions in neonatal mortality will require more than efforts to increase weight-specific neonatal survival after birth, though some improvement may occur by extending neonatal intensive care services to persons who have not had access to them. The birth-weight standardization carried out above suggests that North Carolina weight-specific neonatal death rates are probably already below the United Stales rates. Goldenberg et al''^ have presented the lowest average weight-specific neonatal mortality rates reported in the medical literature for the 1976-1980 period, and the average 1976-1980 rates for North Carolina were 20 to 65 percent higher than these lowest "literature" rates. By 1981, however, the North Carolina annual rates were below these lowest average 1976-1980 rates for all weight categories except 2001-2500 grams, where they were equal. The trend in weight-specific rates from 1981 to 1982 (table 2) indicates that future large increases in neonatal survival rates will be difficult to attain. If we apply the 1979 Swedish birth-weight distribution to 1979 North Carolina births and assume that 1979 North Carolina weight-specific neonatal death rates would be in operation, the expected rate is 5.6 compared with 5.0 in Sweden and compared with an actual North Carolina 1979 rate of 10.4. North Carolina weight-specific neonatal death rates therefore appear to be very close to those in Sweden, which has one of the lowest crude neonatal death rates in the world. Thus, further large reductions in neonatal mortality in North Carolina are not likely to result from neonatal intensive care and other methods that increase the rate of survival after birth, though certainly some improvements can be made in this area by extending these services to groups that have not had access to them in the past. If North Carolina is to reduce neonatal mortality to the United States average or lower, we must adopt policies that will lead to a substantial reduction in low-weight births. The results above also show that the North Carolina racial gap in neonatal mortality could be eliminated and in fact reversed if North Carolina nonwhites achieved the birth-weight distribution of whites, with no change in neonatal survival rates. Several of the studies cited above indicate that improved birth weights have been a much less important factor in the decline of nonwhite neonatal mortality compared with whites, including the study by David and Siegel' ^ for North Carolina during the 1968 to 1977 period. Goldenberg et found for Alabama that shifts in birth-weight distributions for nonwhites from 1970 to 1980 would have increased the neonatal mortality rate if weight-specific death rates had not been declining at the same time. The data in the present study show a widening racial gap in neonatal mortality: the nonwhite crude neonatal mortality rate was 35 percent higher than the white rate in 1976, 67 percent higher in 1980, 77 percent higher in 1981, and 113 percent higher in 1982. The percent of nonwhite births under 2501 grams remained almost exactly twice the white percent during this 1976-1982 period (12.1 versus 6.1 in 1982), but the percent of births under 1001 grams for nonwhites changed from 2.3 to 2.9 times the white percent. Death rates in this very low weight category have not declined as rapidly as those in the 1001-2500 grams categories. The ratio of nonwhite to white neonatal death rates at each weight category did not change substantially from 1976 to 1980. From 1981 to 1982, the weight-specific death rales for nonwhites worsened considerably in comparison with the white rates, contributing to the widening racial gap (table 2). In fact, the nonwhite neonatal death rate was higher than the while rate in 1982 for three of the 440 Vol. 45, No. 7
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1984 |
Identifier | NCHH-17-045 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 45 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-045.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-045 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 440 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1984 |
Identifier | NCHH-17-045-0024 |
Form General | Periodicals |
Page Type | all; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed45v21984medi_0024.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 45 |
Issue Number | 7 |
Page Number | 440 |
Health Discipline | Medicine |
Full Text | in the overall nonwhite neonatal mortality rate was due substantially to increases in weight-specific death rates. These increases in the weight-specific death rates were not associated with a decreasing percent of births in these weight categories occurring in Level III hospitals. Considering also that there were increases in certain race-weight-specific death rates from 1980 to 1981, it appears that the consistent decline of weight-specific neonatal mortality rates that has occurred since at least 1976 has temporarily abated. Discussion This study demonstrates that examination of "crude" neonatal or infant mortality rates is not sufficient. Birth-weight-specific mortality rates must be examined in relation to the distribution of births by weight. In order to undertake such analysis, matched birth and infant death flies are required. Given that the relatively poor ranking of the United States among industrialized nations with regard to neonatal mortality is due largely to low birth weight"^ it is difficult to justify the unavailability of such data for the entire United States for the direction of national policy. The results of this analysis have some important implications for North Carolina policies designed to further reduce the neonatal mortality rate. Almost none of the reduction in neonatal mortality since 1976 has been due to increased birth weights. The major improvements in neonatal mortality have resulted from better medical care of small babies in neonatal intensive care units,'' which has served to reduce the weight-specific neonatal death rates particularly in the 1001 to 2500 grams categories. Williams and Chen'^ suggested that the increased rate of cesarean section for low-weight infants also contributed to the decline of neonatal death rates in California. They found that decreases in birth-weight-specific mortality accounted for 85 percent of the decline of the neonatal mortality rate in the 1970s, with only 15 percent due to improvements in birth weight, and no improvement was observed in the birth-weight distribution for blacks. Goldenberg et found that only 5 percent of the nearly 50 percent reduction in neonatal mortality in Alabama from 1970 to 1980 could be attributed to changes in birth-weight distributions, and birth-weight changes accounted for 12 percent of the decrease in the white neonatal mortality rate but none of the decrease in the nonwhite rate. David and Siegel'^ found for North Carolina that ''better babies" as reflected primarily in increased birth weights but also considering gestational age, accounted for 85 percent of the decline in neonatal mortality from 1968 to 1972, but accounted for only 16 percent of the decline from 1972 to 1977, with the rest of the decline attributable to better weight-specific survival rates or "better care.'' They also found that improved birth weights and gestational ages were a much less important factor in the decline of neonatal mortality for nonwhites as compared with whites. It is likely that, in the near future, further major reductions in neonatal mortality will require more than efforts to increase weight-specific neonatal survival after birth, though some improvement may occur by extending neonatal intensive care services to persons who have not had access to them. The birth-weight standardization carried out above suggests that North Carolina weight-specific neonatal death rates are probably already below the United Stales rates. Goldenberg et al''^ have presented the lowest average weight-specific neonatal mortality rates reported in the medical literature for the 1976-1980 period, and the average 1976-1980 rates for North Carolina were 20 to 65 percent higher than these lowest "literature" rates. By 1981, however, the North Carolina annual rates were below these lowest average 1976-1980 rates for all weight categories except 2001-2500 grams, where they were equal. The trend in weight-specific rates from 1981 to 1982 (table 2) indicates that future large increases in neonatal survival rates will be difficult to attain. If we apply the 1979 Swedish birth-weight distribution to 1979 North Carolina births and assume that 1979 North Carolina weight-specific neonatal death rates would be in operation, the expected rate is 5.6 compared with 5.0 in Sweden and compared with an actual North Carolina 1979 rate of 10.4. North Carolina weight-specific neonatal death rates therefore appear to be very close to those in Sweden, which has one of the lowest crude neonatal death rates in the world. Thus, further large reductions in neonatal mortality in North Carolina are not likely to result from neonatal intensive care and other methods that increase the rate of survival after birth, though certainly some improvements can be made in this area by extending these services to groups that have not had access to them in the past. If North Carolina is to reduce neonatal mortality to the United States average or lower, we must adopt policies that will lead to a substantial reduction in low-weight births. The results above also show that the North Carolina racial gap in neonatal mortality could be eliminated and in fact reversed if North Carolina nonwhites achieved the birth-weight distribution of whites, with no change in neonatal survival rates. Several of the studies cited above indicate that improved birth weights have been a much less important factor in the decline of nonwhite neonatal mortality compared with whites, including the study by David and Siegel' ^ for North Carolina during the 1968 to 1977 period. Goldenberg et found for Alabama that shifts in birth-weight distributions for nonwhites from 1970 to 1980 would have increased the neonatal mortality rate if weight-specific death rates had not been declining at the same time. The data in the present study show a widening racial gap in neonatal mortality: the nonwhite crude neonatal mortality rate was 35 percent higher than the white rate in 1976, 67 percent higher in 1980, 77 percent higher in 1981, and 113 percent higher in 1982. The percent of nonwhite births under 2501 grams remained almost exactly twice the white percent during this 1976-1982 period (12.1 versus 6.1 in 1982), but the percent of births under 1001 grams for nonwhites changed from 2.3 to 2.9 times the white percent. Death rates in this very low weight category have not declined as rapidly as those in the 1001-2500 grams categories. The ratio of nonwhite to white neonatal death rates at each weight category did not change substantially from 1976 to 1980. From 1981 to 1982, the weight-specific death rales for nonwhites worsened considerably in comparison with the white rates, contributing to the widening racial gap (table 2). In fact, the nonwhite neonatal death rate was higher than the while rate in 1982 for three of the 440 Vol. 45, No. 7 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-045.pdf |
Document Sort | all; nchh-17 |
Article Title | The Impact Of Low Birth Weight On North Carolina Neonatal Mortality 1976-1982 |
Article Author | Paul A. Buescher; Richard R. Nugent; Ronald H. Levine |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-045 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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