摘要：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. Previous studies and reports published by the Indian Health Service have demonstrated dramatic improvements in perinatal and infant health among American Indian and Alaska Native (AIAN) populations over the past 50 years. Infant mortality rates declined substantially from 62.7 per 1000 live births in 1955 to 9.3 per 1000 live births in the years 1994 to 1996. 1 Yet disparities between American Indians and Alaska Natives and Whites have persisted. In 1989–1991, American Indians and Alaska Natives overall had 2.4 times the rate of postneonatal death compared with the White population 1 ; rural American Indians and Alaska Natives had a postneonatal death rate 2.6 times that of Whites. 2 Since the mid-1980s, considerable attention has been paid to improving access to health care services, changing risk behaviors among pregnant women, and modifying provider practices, with the intention of improving birth outcomes and lowering infant mortality rates. 3 – 5 Among the general population, some of these efforts have been associated with higher rates of early and adequate prenatal care, as well as declining postneonatal mortality rates, especially from sudden infant death syndrome (SIDS). 6 – 8 However, it is not known how these efforts have influenced the perinatal health status of American Indians and Alaska Natives specifically, especially among rural American Indians and Alaska Natives, many of whom live in remote settings that may be more distant from health services. Our goal was to determine whether the disparities in perinatal care, birth outcomes, and infant health among rural American Indians and Alaska Natives and rural Whites diminished, remained stable, or increased during a period of policy, funding, and practice changes in maternal and child health care from the mid-1980s through the 1990s. We addressed these questions by examining trends in prenatal care receipt, low-birthweight rates, neonatal and postneonatal death rates, and causes of death among rural American Indians and Alaska Natives and Whites between 1985 and 1997.
