Maternal mortality among black women in Brazil

Every minute a woman dies in the world due to labor or complications of pregnancy. Maternal mortality is a public health problem in Brazil and affects the country's various regions unequally. Researchers agree that maternal death occurs mainly in women with lower income and less schooling. The racial issue emerges in the midst of socioeconomic issues. The analysis is hampered by the difficulty in understanding Brazil's official classification of race/color, which often impedes recording this information. Various Maternal Mortality Committees are applying the color item and reviewing their data. The current article analyzes various Maternal Mortality Committee reports, showing that the risk of maternal mortality is greater among black women (which encompasses two census categories, negra, or black, and parda, or brown), thus representing a major expression of social inequality. The article concludes with a review of political and technical recommendations to decrease maternal mortality.     

Cardiovascular mortality of Chinese in New York City

To determine cardiovascular disease mortality among Chinese migrants in New York City and compare it to both that of residents in China and whites in New York City, mortality records for 1988 through 1992 for New York City and the 1990 US census data for New York City were linked. Age-specific death rates for urban China, reported by the World Health Organization, were used for comparison. The results show that male and female Chinese residents in New York City had lower mortality rates for all causes and total cardiovascular disease than did either New York City whites or Chinese in China. Coronary heart disease deaths among New York City Chinese were intermediate between Chinese in China (lowest) and New York City whites (highest). Stroke death rates for New York City Chinese were substantially lower than those in China and, in general, were similar to those for New York City whites. However, New York City Chinese had higher death rates for hemorrhagic stroke and lower for atherosclerotic stroke than did New York City whites. In conclusion, cardiovascular mortality rates among Chinese migrants in New York City fall below those of both Chinese in China and whites in New York City.     

Active surveillance of maternal mortality in New York City

OBJECTIVES: This study examined the usefulness of computer-assisted active surveillance in identifying maternal deaths in New York City. METHODS: Computerized searches of hospital discharge and autopsy record databases were conducted for maternal deaths occurring in 1997. RESULTS: Active surveillance revealed 14 new maternal deaths not previously reported, an 88% increase. Nine of these deaths were found through the hospital discharge database search, 1 was found through the autopsy record search, and 4 were found in both searches. Overall maternal mortality ratios associated with active surveillance and routine surveillance were 24.3 and 13.0 deaths per 100 000 live births, respectively. CONCLUSIONS: Active surveillance of maternal mortality is useful in identifying new maternal deaths. Existing databases can be used relatively easily to augment routine surveillance of maternal mortality.     

Income inequality and infant mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6–29.6/1,000 live births: range in income inequality: 12.7–27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P<.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions. Data collection and initial analyses for this project were supported in part by an Investigator Award in Health Policy Research from The Robert Wood Johnson Foundation. The views expressed are those of the authors and do not imply endorsement by The Robert Wood Johnson Foundation.     

Cancer mortality among Puerto Rican-born residents in New York City

More than half the 800,000 Puerto Rican migrants living in the United States resided in New York City in 1970. Mortality statistics from 1969-1971 indicate that Puerto Rican natives in the metropolis have a standardized mortality ratio for cancer which is 77% of that of non-Puerto Rican white males and 81% of that of non-Puerto Rican white females. The age-adjusted death rates of the Puerto Rican-born residing in New York City for cancers of the lung, prostate, bladder, ovary, and rectum are low, ranging from 43-70% of those of non-Puerto Rican whites; rates for breast cancer and colon cancer are somewhat lower relative to those for non-Puerto Rican whites. As is true for Puerto Ricans on the island, migrants to New York City have excessive levels of cancer of the cervix and esophagus (each roughly three times that of non-Puerto Rican whites) and cancer of the stomach (almost twice that of non-Puerto Rican whites).     

Decrease in infant mortality in New York City after 1989.

OBJECTIVES: This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. METHODS: Changes in birthweight distributions and in birthweight/age-, cause-, and birthweight/age/cause-specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. RESULTS: Infant, neonatal, and postneonatal mortality of very-low-birthweight (< 1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/age groups experiencing mortality declines. CONCLUSIONS: Widespread, multiple perinatal and postnatal factors contributed to the decline in infant mortality.     

Maternal ethnicity and pre-eclampsia in New York City, 1995-2003

Studies on ethnic differences in the risk of pre-eclampsia are limited. We linked birth records for 902,460 singleton births for the period 1995-2003 in New York City with hospital discharge data to evaluate the association between ethnicity and the risk of pre-eclampsia and compare risks between US-born and foreign-born women. Logistic regression models adjusted for maternal age, maternal education, parity, self-reported pre-pregnancy maternal weight, smoking during pregnancy and year of delivery were used to compare each ethnic group with non-Hispanic White women. The prevalence of pre-eclampsia in this study population was 3.2%. Among the major ethnic groups considered in our study, East Asian women had the lowest risk of pre-eclampsia (1.4%) and Mexican women had the highest risk (5.0%). Compared with non-Hispanic White women, there was a slightly decreased risk for East Asian women (adjusted OR = 0.8, [95% CI 0.7, 0.8]), similar risk for North African women (adjusted OR = 1.1, [95% CI 0.9, 1.3]), and increased risk for all other major ethnic groups (adjusted ORs: 1.3, 2.9), with the highest risk for Mexican women (adjusted OR = 2.9, [95% CI 2.7, 3.1]). No difference in risks was observed for US- vs. foreign-born women with the exception that foreign-born South-East Asian and Pacific Islanders had an increased risk of pre-eclampsia (adjusted OR = 1.8, [95% CI 1.0, 3.1]) relative to those born in the US. We concluded that there was ethnic heterogeneity in the development of pre-eclampsia among women in New York City and that Asian subgroups should be examined separately in future studies on ethnicity. Our results should contribute to screening for pre-eclampsia taking ethnic variation into account, and may help to suggest leads for the study of the aetiology of the condition.     

Therapeutic networks of pregnancy care: Bengali immigrant women in New York City

The aim of this paper is to elucidate the links between place and Bengali immigrant women’s use of social networks in their efforts to live a healthy pregnancy. The literature on therapeutic landscapes has mostly emphasized characteristics of local places. I argue that social networks constituted in and beyond the places where people live are equally important. I draw on findings of a qualitative study conducted with Bengali immigrant women in New York City between 2004 and 2006 to understand the place-creating characteristics of social therapeutic networks. In-depth interviews with 40 women in selected neighborhoods in New York City show that such networks operated at multiple scales, ranging from the local to the transnational. A mix of tangible and virtual care and support were received through face-to face interaction and phone conversations. Advice on how to live a healthy pregnancy, cooking and bringing or sending food and therapeutic conversations emerged as important kinds of care and support provided by therapeutic networks. These networks worked in complex ways, reflecting: 1) the situational context of women’s lives, shaped by the temporal (e.g. length of residence) and place-based (e.g. residential geographies) aspects of migration, 2) the importance of ‘imaginative aspects’ in shaping the meanings women formed of therapeutic networks and 3) the diverse ways in which women created and sustained these networks, based on class, country of origin, religion and culture.     

The urban built environment and overdose mortality in New York City neighborhoods

Accidental drug overdose continues to be a substantial cause of mortality for drug users. Characteristics of the neighborhood built environment may be important determinants of the likelihood of drug overdose mortality independent of individual-level factors. Using data from the New York City Office of the Chief Medical Examiner, we conducted a multilevel case control study using data on accidental overdose deaths as cases and non-overdose accidental deaths as controls. We used archival data from the New York City Housing and Vacancy Survey and the Mayor's Office of Operations to assess characteristics of neighborhood external (e.g. dilapidation of buildings) and internal (e.g. quality of utilities in houses) built environment. Multilevel analyses were used to assess the relations between the neighborhood built environment and the likelihood of overdose death. Six out of the eight characteristics of the external environment studied and three out of the six characteristics of the internal environment studied were significantly associated with the likelihood of fatal drug overdose in multilevel models after adjusting for individual-level (age, race, sex) and neighborhood-level (income, drug use) variables. Deterioration of the built environment, particularly the external environment, is associated with an increased likelihood of fatal accidental drug overdose. Disinvestment in social resources, psychosocial stressors, neighborhood differences in response to a witnessed overdose, and differences in vulnerability to the adverse consequences of drug use in different neighborhoods may explain the observed associations.     

Trends in cancer mortality among Puerto Rican-born migrants to New York City

Age-standardized cancer death rates in Puerto Rican-born males and females residing in New York City have been calculated for 1979-81, and compared with those for white non-Puerto Rican-born people. For all population groups the rates in 1979-81 have been compared with rates in 1969-71. For some cancer sites, in particular cancers of the lung, breast and ovary, the Puerto Rican migrant population exhibited rates well below those of other residents of New York at both time periods. For other sites, most notably colon cancer (and to a lesser extent, prostate and bladder cancer), the rates for Puerto Ricans were somewhat lower than those of other New Yorkers in 1979-81, but had very markedly increased from levels shown in the earlier period. The Puerto Rican-born population at each time period had considerably higher rates of stomach cancer and cervical cancer than did 'other' white New Yorkers. Although substantial reductions in risk for these sites occurred among Puerto Ricans during the intercensal period examined, these corresponded to the reductions among 'other' white New York residents. The trends are discussed with reference to differences in lifestyle patterns, especially diet.     

Barriers to prenatal care among low-income women in New York City

Postpartum in-hospital interviews with 496 low-income women in New York City revealed that attitudinal and motivational barriers as well as financial obstacles are significant impediments to timely initiation of prenatal care. The two most common reasons cited by these women in explaining why they had obtained prenatal care late or not at all were motivational items: "feeling depressed and not up to going for care" and "needing time and energy to deal with other problems." In logistic regression analyses, receipt of late or no prenatal care was significantly associated with the latter motivational barrier, along with the cost of care, having no health insurance, being Hispanic, being a substance abuser and holding negative attitudes toward the use of prenatal care.     

Organochlorine exposures and breast cancer risk in New York City women

A hospital-based case-control study of breast cancer risk related to organochlorine (OC) exposure was conducted in a multiethnic setting in New York City. We enrolled 175 breast cancer patients and 355 control patients. The overall racial/ethnic distribution was 57% Caucasian, 21% Hispanic, 22% African-American; cases and controls were frequency-matched by age and race/ethnicity. Tumor markers (estrogen and progesterone receptors, p53, erbB-2) were assessed and organochlorines (DDE, DDT, trans-nonachlor, and higher (HPCB) and lower (LPCB) chlorinated biphenyls) were measured in blood serum. Tumors among minority women were of slightly higher stage than among Caucasians, but tumor markers were similar across the racial/ethnic groups. DDE levels were highest among African-American and Hispanic women; DDT was highest among Hispanics; HPCBs were highest among African-Americans; LPCBs were lowest among Hispanics; and trans-nonachlor was highest among African-Americans. However, OC levels were not associated with risk for breast cancer, nor did OCs differ with respect to tumor stage or tumor markers. Higher DDE levels were associated with increasing body mass index (BMI), but with decreasing level of education, frequency of nulliparity, and frequency of family history of breast cancer. HPCB levels decreased with BMI and were not correlated with breast cancer risk factors. These relationships can be attributed to historical patterns of exposure and to metabolic differences in OCs related to BMI.     

Cancer mortality, ethnicity, and socioeconomic status: two New York City groups

Cancer mortality rates for 1979-81 among Puerto Ricans and non-Hispanic whites in New York City are analyzed for cancer in six sites. They include cancers of the lung, esophagus, breast, stomach, colon, ovary, and all cancers. New York City health areas were divided into four quartiles representing four levels of income. In general, Puerto Ricans in New York City have lower mortality rates from cancer than non-Hispanic white residents of the city. In comparing cancer mortality by quartile, Puerto Rican males show little variation. Puerto Rican females show their highest mortality rates from breast cancer in the wealthiest quartile, and non-Hispanic white women show highest mortality rates from breast cancer in the poorest quartile. Non-Hispanic white males show mortality rates from lung cancer in the poorest quartile that are distinctly higher than in the more affluent ones. For all groups, with the exception of Puerto Rican males, mortality rates from all cancers increased progressively with decreasing income. Factors influencing differential mortality rates by quartile appear to include tobacco use, alcohol consumption, occupational hazards, fertility, and differential use of health facilities.     

HIV and intimate partner violence among methadone-maintained women in New York City

Intimate partner violence (IPV) has been recognized as a risk factor for HIV and sexually transmitted infections (STIs) among women, particularly among those who are drug involved. This study examines the temporal relationships between sexual and/or physical partner violence (IPV) and sexual risk of HIV/STI transmission in a longitudinal study with a random sample of 416 women enrolled in methadone maintenance treatment programs in New York City. Two hypotheses are tested: whether sexual risk-related factors or risk reduction behavior leads to subsequent IPV (H1); and whether IPV decreases likelihood of subsequent risk reduction behavior (i.e., requesting to use condoms) or increases likelihood of certain sexual risk-related factors (i.e., inconsistent condom use, having unprotected anal sex, having more than one partner, exchanging sex for drugs or money, having had an STI, being HIV positive, having a partner who engaged in HIV risk) (H2). Participants were interviewed at three waves: baseline, six months and twelve months. Hypotheses were examined using propensity score matching and multiple logistic regression analyses. The prevalence rate of any physical or sexual IPV was 46% at baseline. Findings for H1 indicate that women who reported always using condoms at wave 2 were significantly less likely than women who reported inconsistent or no condom use to experience subsequent IPV at wave 3. Similarly, increased risk of IPV at wave 3 was associated with self-reported STIs (OR=2.0, p=.03), and unprotected anal sex (OR= 2.0, p<.01); always requesting that partners use condoms was associated with a significant decrease in subsequent IPV (OR=.18, p<.01). Findings for H2 suggest that IPV at wave 2 decreased the subsequent likelihood of always using condoms at wave 3 (OR=.41, p<.01) and always requesting that a partner use condoms (OR=.42, p=.02). The implications of the findings for HIV prevention interventions for women on methadone are discussed.