Division of Family Health Services, MCH Practice and Analysis Unit, Florida Department of Health, 4052 Bald Cypress Way Bin A13, Tallahassee, FL 32399-1721, USA.
Matern Child Health J. 2012 Aug;16(6):1188-96. doi: 10.1007/s10995-011-0891-9.
Assess whether the 55% increase in Florida's Hispanic infant mortality rate (HIMR) during 2004-2007 was real or artifactual. Using linked data from Florida resident live births and infant deaths for 2004-2007, we calculated traditional (infant Hispanic ethnicity from death certificates and maternal Hispanic ethnicity from birth certificates) and nontraditional (infant and maternal Hispanic ethnicity from birth certificate maternal ethnicity) HIMRs. We assessed trends in HIMRs (per 1,000 live births) using Chi-square statistics. We tested agreement in Hispanic ethnicity after implementation of a revised 2005 death certificate by using kappa statistics and used logistic regression to test the associations of infant mortality risk factors. Hispanic was defined as being of Mexican, Puerto Rican, Cuban, Central/South American, or other/unknown Hispanic origin. During 2004-2007 traditional HIMR increased 55%, from 4.0 to 6.2 (Chi-square, P < 0.001) and nontraditional HIMR increased 20%, from 4.5 to 5.4 (Chi-square, P = 0.03). During 2004-2005, agreement in Hispanic ethnicity did not change with use of the revised certificate (kappa = 0.70 in 2004; kappa = 0.76 in 2005). Birth weight was the most significant risk factor for trends in Hispanic infant mortality (OR = 1.33, 95% CI = 1.10-1.61). Differences in Hispanic reporting on revised death certificates likely accounted for the majority of traditional HIMR increase, indicating a primarily artifactual increase. Reasons for the 20% increase in nontraditional HIMR during 2004-2007 should be further explored through other individual and community factors. Use of nontraditional HIMRs, which use a consistent source of Hispanic classification, should be considered.
评估 2004-2007 年期间佛罗里达州西班牙裔婴儿死亡率（HIMR）增加 55% 是否真实存在或属于人为因素。我们利用佛罗里达州 2004-2007 年居民活产和婴儿死亡的关联数据，计算了传统（死亡证明中婴儿的西班牙裔种族和出生证明中母亲的西班牙裔种族）和非传统（出生证明中婴儿和母亲的西班牙裔种族，母亲的种族来自出生证明）HIMR。我们使用卡方检验评估 HIMR（每千例活产）的趋势。我们使用 Kappa 检验评估 2005 年修订死亡证明实施后西班牙裔种族的一致性，并使用逻辑回归检验婴儿死亡率危险因素的关联。西班牙裔定义为墨西哥、波多黎各、古巴、中/南美洲或其他/未知的西班牙裔血统。2004-2007 年期间，传统 HIMR 增加 55%，从 4.0 增至 6.2（卡方，P<0.001），非传统 HIMR 增加 20%，从 4.5 增至 5.4（卡方，P=0.03）。2004-2005 年期间，使用修订证书后西班牙裔种族的一致性没有变化（2004 年 Kappa=0.70；2005 年 Kappa=0.76）。出生体重是西班牙裔婴儿死亡率趋势的最重要危险因素（比值比=1.33，95%置信区间=1.10-1.61）。修订死亡证明中西班牙裔报告的差异可能导致传统 HIMR 增加的主要原因，表明这主要是人为因素导致的增加。应该通过其他个人和社区因素进一步探讨 2004-2007 年非传统 HIMR 增加 20%的原因。应考虑使用非传统 HIMR，其使用一致的西班牙裔分类来源。
