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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.119735v1 99/4/638    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baldwin, L.-M. Articles by Hart, L. G. Search for Related Content PubMed PubMed Citation Articles by Baldwin, L.-M. Articles by Hart, L. G. Related Collections Health Policy Access to Care Birth Outcomes Pregnancy Native Americans Rural Health Mortality Women's Health Minority Children

Laura-Mae Baldwin, MD, MPH, David C. Grossman, MD, MPH, Elise Murowchick, PhD, Eric H. Larson, PhD, Walter B. Hollow, MD, Jonathan R. Sugarman, MD, MPH, William L. Freeman, MD, MPH and L. Gary Hart, PhD

At the time of the study, Laura-Mae Baldwin, Elise Murowchick, Eric H. Larson, and L. Gary Hart were with the Department of Family Medicine, University of Washington School of Medicine, Seattle. David Grossman was with the Department of Pediatrics, University of Washington School of Medicine, Seattle. Walter B. Hollow was with the Native American Center of Excellence, University of Washington School of Medicine, Seattle. Jonathan R. Sugarman was with Qualis Health, Seattle. William L. Freeman was with the Northwest Indian College, Bellingham, WA.

Correspondence: Requests for reprints should be sent to Laura-Mae Baldwin, MD, MPH, University of Washington, Department of Family Medicine, Box 354982, Seattle, WA 98195-4982 (e-mail: lmb{at}u.washington.edu).

Objectives. We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time.

Methods. We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births.

Results. Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985–1987, 36.3%; 1995–1997, 26.3%) and postneonatal death (1985–1987, 7.1 per 1000; 1995–1997, 4.8 per 1000) improved significantly. However, disparities between American Indians and Alaska Natives and Whites in adjusted odds ratios (AORs) of postneonatal death (1985–1987, AOR = 1.55; 95% confidence interval [CI] = 1.41, 1.71; 1995–1997, AOR = 1.46; 95% CI = 1.31, 1.64) and adjusted risk ratios (ARRs) of inadequate prenatal care (1985–1987, ARR = 1.67; 95% CI = 1.65, 1.69; 1995–1997, ARR = 1.84; 95% CI = 1.81, 1.87) persisted.

Conclusions. Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close persistent health gaps for this group.