Articles on PPOR
These articles were identified in PubMed by searching on the term “PPOR”
1: Public Health Nurs. 2005 Jan-Feb;22(1):2-7.
Reducing infant mortality rates using the perinatal periods of risk model.
Burns PG.
Texas Christian University, Fort Worth, Texas 76129, USA. p.burns@tcu.edu
Despite decreases in the last 50 years, infant mortality rates in the United
States remain higher than in other industrialized countries. Using overall infant
mortality rates to determine the effectiveness of interventions does not help
communities focus on particular underlying factors contributing to static, and
sometimes increasing, community rates. This study was designed to determine and
rank contributing factors to fetal-infant mortality in a specific community using
the Perinatal Periods of Risk (PPOR) model. The PPOR model was used to map
fetal-infant mortality for 1995 to 1998 in the Tulsa, Oklahoma, Healthy Start
Program as compared to traditional calculation methods. The overall fetal-infant
mortality rate using the PPOR model was 12.7 compared to 7.11 calculated using
the traditional method. The maternal health cell rate was 5.4, maternal care cell
rate was 2.9, newborn care cell was 1.9 compared to a 4.1 neonatal death rate
calculated using the traditional method, and the infant health cell was 2.4
compared to a 2.9 postneonatal rate calculated using the traditional method.
Because the highest infant mortality was in the maternal health cell,
intervention strategies were designed to promote the health of women prior to and
between pregnancies. The PPOR model was helpful in targeting interventions to
reduce fetal-infant mortality based on the prioritization of contributing
factors.
Publication Types: Evaluation Studies
PMID: 15670319 [PubMed - indexed for MEDLINE]
2: Matern Child Health J. 2005 Jun;9(2):199-205.
Perinatal periods of risk: analysis of fetal-infant mortality rates in Kansas
City, Missouri.
Cai J, Hoff GL, Dew PC, Guillory VJ, Manning J.
Kansas City Health Department, Office of Epidemiology and Community Health
Monitoring, Kansas City, MS, USA. Jinwen_Cai@kcmo.org
OBJECTIVES: The Perinatal Periods of Risk (PPOR) technique was used to analyze
resident fetal and infant death data from Kansas City, Missouri, for the period
1998-2002. Results offer important information that can be used to develop
community-based prevention strategies related to racial/ethnic disparities in
infant mortality rates (IMR). METHODS: The PPOR approach for fetal and infant
mortality can be mapped by birthweight at delivery and time of death into four
strategic prevention areas: 1) Maternal Health/Prematurity (MHP), 2) Maternal
Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). For this analysis,
all fetal and infant death certificates from the metropolitan Kansas City area
were linked to their birth certificates and those associated with residents of
Kansas City, Missouri, proper were used to create the dataset used in this
analysis. Due to the small number of fetal and infant deaths among other ethnic
groups, the analysis was restricted to a comparison of the disparity of IMR
between Blacks, Whites, and a national non-Hispanic white reference group. The
Kitagawa formula was used to determine contribution to excess deaths from
birthweight-specific mortality and birthweight distribution rates. Logistic
regression techniques were used to identify risk factors for death among Black
fetuses and infants with very low birthweights and also deaths due to sudden
infant death syndrome (SIDS). RESULTS: The PPOR analysis showed that of the
excess deaths among black infants, when compared to a national reference group,
47% was attributable to MHP and another 29% was attributable to IH. Differences
in MC and NC only accounted for 27 and 8% of the total excess deaths. During the
study period, rates of sudden infant death syndrome (SIDS) were found to be
significantly higher among Blacks as compared to Whites (2.12 vs. 0.81 per
1,000). An analysis of maternal characteristics for SIDS deaths among blacks
using a step-wise logistic regression model, found that maternal age less than 20
years old, previous births, inadequate prenatal care, and being a Medicaid
recipient were significant-adjusted odds ratios of 23.7 (95% Cl 10.48, 53.67),
8.4 (95% Cl 3.64, 19.21), 2.9 (95% Cl 1.38, 6.05) and 2.5 (95% Cl 1.04, 5.84),
respectively. CONCLUSIONS: PPOR is an easy to use approach that helps focus
community initiatives for improving maternal and infant health. In Kansas City,
Missouri, efforts to further lower IMR in blacks can be achieved through the
reduction of risk factors affecting maternal health and through maternal
education to improve infant health.
Publication Types: Comparative Study
PMID: 15965626 [PubMed - indexed for MEDLINE]
3: J Natl Med Assoc. 2005 Aug;97(8):1128-32.
Racial and ethnic disparities in perinatal mortality: applying the perinatal
periods of risk model to identify areas for intervention.
Besculides M, Laraque F.
Mathematica Policy Research, Inc., USA.
OBJECTIVES: To determine the feto-infant mortality rate for New York City, assess
racial/ethnic variations and identify areas for intervention using the Perinatal
Periods of Risk (PPOR) approach. METHODS: The PPOR model examines fetal and
infant deaths by age at death (fetal, neonatal, postneonatal) and birthweight
(500-1499, > or =1500 g). It groups age at death and birthweight into four
categories to identify problems hypothesized to lead to the death: factors
related to Maternal Health and Prematurity, Maternal Care, Newborn Care and
Infant Health. The model was applied to fetal and infant deaths occurring in New
York City using Vital Records data from 1996-2000. Analysis was completed for the
entire city and by race/ethnicity (white non-Hispanic, black non-Hispanic,
Hispanic, Asians/Pacific Islander). RESULTS: The overall feto-infant mortality
rate was 11.5/1,000 live births plus fetal deaths. This rate varied by
race/ethnicity; black non-Hispanics had a higher rate than other racial/ethnic
groups. Conditions related to maternal health and prematurity were the largest
contributing factors to feto-infant mortality (5.9/1000) in New York City. Among
blacks and Hispanics, problems related to maternal health and prematurity
contributed a larger share than among whites and Asians/Pacific Islanders.
CONCLUSION: The use of the PPOR approach shows that the racial/ethnic disparities
in feto-infant mortality that exist in New York City are largely related to
maternal health and prematurity. Interventions to reduce the feto-infant
mortality rate should include preconception care and improvements in women's
health.
PMID: 16173328 [PubMed - indexed for MEDLINE]
4: J Public Health Manag Pract. 2007 May-Jun;13(3):270-7.
Perinatal periods of risk analysis of infant mortality in Jackson County,
Missouri.
Cai J, Hoff GL, Archer R, Jones LD, Livingston PS, Guillory VJ.
Office of Epidemiology and Community Health Monitoring, Kansas City Health
Department, Kansas City, Missouri 64108, USA.
The perinatal periods of risk (PPOR) methodology provides an easy-to-use
analytical approach to infant mortality that helps focus community initiatives
for improving maternal and infant health. Because few analyses have been
published, many public health practitioners may be unfamiliar with PPOR. This
article demonstrates the application of PPOR analysis using infant mortality in
Jackson County, Missouri. While the PPOR consists of two phases, this analysis
was restricted to the initial phase of the overall process. The second phase
builds on the initial findings and prioritizes the contributing factors of
fetal/infant mortality so that targeted interventions can be developed. For
Jackson County, the PPOR analysis found that racial and geographic disparities
existed and, for very low-birth-weight infants, different interventions
strategies may be needed on the basis of race. In addition, a mother who
experienced a fetal or infant death was more likely to have had a medical risk
factor, to have smoked cigarettes, to have started prenatal care after the first
trimester or received no prenatal care, and to have been nulliparous.
PMID: 17435494 [PubMed - indexed for MEDLINE]
5: J Natl Med Assoc. 2008 Dec;100(12):1450-6.
Secular trends in excess fetal and infant mortality using perinatal periods of
risk analysis.
Guillory VJ, Cai J, Hoff GL.
Kansas City Missouri Health Department, kansas City, MO, USA.
Perinatal periods of risk (PPOR) provide an alternative analytical approach to
studying infant mortality. Results can be used to focus community activities to
improve infant and maternal health. This article demonstrates the use of PPOR to
monitor trends in excess fetal and infant mortality related to disparities
associated with race and ethnicity in Kansas City, MO (KC). Based on a comparison
of PPOR analyses for 1996-2000 and 2001-2005, there was a 30% reduction in excess
fetal and infant mortality in Kansas City and reductions for both non-Hispanic
blacks (17%) and non-Hispanic whites (66.7%). However, the disparity ratio for
excess mortality rates between non-Hispanic blacks and non-Hispanic whites nearly
doubled. Prematurity, the most frequent cause of infant mortality in Kansas City
during 2001-2005 accounted for 42.5% of the infant deaths. Being a teenage
mother; having less than a high-school education; being unmarried; having an
unintended pregnancy; being obese preconceptually; being diabetic; using
substances such as tobacco or drugs during pregnancy; receiving late, inadequate
or intermediate amounts of prenatal care; having a multifetal pregnancy; having a
primary elective cesarean section; delivering a preterm infant or having a male
infant; and being enrolled in Medicaid all increased the risk of infant death.
PMID: 19110914 [PubMed - in process]