Date of Graduation

2020

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Thomas Hulsey

Committee Member

Ian Rockett

Committee Member

Christa Lilly

Committee Member

Sijin Wen

Abstract

Background and objective

Infant mortality in United States is high relative to other more developed nations. Therefore, there is a need to curb this trend, especially in states with high infant mortality rates. Hence, this research investigated and examined characteristics associated with injury-related infant death in West Virginia. The objective of this retrospective study was to 1) investigate maternal and infant characteristics associated with injury-related infant deaths in West Virginia, 2) examine the relationship between unintentional-injury-related infant death and rurality in West Virginia, holding other variables in the model constant, and 3) compare differences in the unintentional-injury related infant mortality rate between West Virginia and the United States as a whole, stratified by race/ethnicity.

Methods

De-identified linked birth-infant death data for the period 2010-2014 were sourced from the West Virginia Bureau for Public Health, Charleston WV and the United States linked birth-death vital records from the Centers for Disease Control website. Additionally, 2013 Urban Influence Codes used for urban/rural classification were sourced from the United States Department of Agriculture Economic Research Service.

A generalized linear model with binomial distribution was used to determine characteristics associated with injury-related infant death, and a generalized linear mixed model with binomial distribution was used to determine the relationship between unintentional injury-injury related infant death and rurality, holding other variables in the model constant. A non-model-based method, which follows a simple Poisson distribution, was used to calculate the infant mortality rate in West Virginia and the United States, stratified by race.

Results

Maternal characteristics associated with injury-related infant mortality in West Virginia were race/ethnicity ( = 7.48, p = .03) and smoking during pregnancy ( , p < .00). Risk of a Non-Hispanic Black infant for an injury-related death was 4.0 (95% CI: 1.7 - 9.3) times that of infants of other race/ethnicities. Unintentional injury-relate infant death was significantly associated with rurality, race/ethnicity and a rurality-smoking during pregnancy interaction (p=0.02, p=0.3, and p=0.05 respectively). The relative risk for unintentional injury-related infant death in rural versus urban counties was 1.7 (95% CI: 0.7- 3.8), whereas the unintentional injury-related infant mortality rate for West Virginia and the United States Non-Hispanic Black population was 83.2 (95% CI: 26.8 - 258.0) deaths per 100,000 live births and 57.5 (95% CI: 54.8 - 60.3) deaths per 100,000 live births, respectively.

Conclusion

Injury-related infant mortality is associated with race/ethnicity and smoking during pregnancy. Smoking during pregnancy and living in rural counties was related to higher risk of unintentional injury-related infant death than living in urban counties, whether or not the mother smoked during pregnancy. In general, the unintentional injury-related infant mortality rate in West Virginia and the nation are similar.

Findings should be interpreted with caution due to the small number of cases. Nevertheless, this study provides important information to public health stakeholders, at both the state and local levels, for designing interventions for reduction or prevention of injury-related infant mortality in West Virginia.

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