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Sunday, October 14, 2001

By Byron Spice, Science Editor, Post-Gazette

One of the paradoxes of health care in Pittsburgh has been the persistently high death rate of African-American infants in a community that boasts a highly sophisticated medical establishment.

In the very first PG Benchmarks in 1996, Pittsburgh ranked last on this measure.

The latest figures, for 1997-99, from the National Center for Health Statistics reflect an encouraging trend, however. Pittsburgh's black infant death rate averaged 17.23 per 1,000 live births over those three years, compared with the 23.8 deaths per 1,000 in 1991-93 that was reported in the first PG Benchmarks.

	PG Benchmarks: Infant mortality Infant death rates among African Amercans, 1997-99. Below are the number of deaths per 1,000 live births. Metro area 1. Portland-Salem 8.58 2. Minneapolis-St. Paul 12.57 3. Tampa 12.90 4. Atlanta 13.31 5. San Diego 13.78 6. Kansas City 14.01 7. Cleveland-Akron 15.37 8. Milwaukee-Racine 15.68 9. Cincinnati-Hamilton 17.21 10. Pittsburgh 17.23 11. Seattle-Tacoma- Bremerton 18.17 12. Denver-Boulder- Greeley 18.84 13. Phoenix-Mesa 19.01 14. St. Louis 19.02 15. Miami-Ft. Lauderdale 5.96* * The death rate for Miami is thought to substantially understate the true rate because of discrepancies in stating place of residence on birth certificates. Source: National Center for Health Statistics

That's good enough to rank Pittsburgh 10th on the list of PG Benchmark cities. Some cities in the survey, including Denver, St. Louis and Seattle, recently saw their death rates worsen, but Pittsburgh's has only gotten better.

"We've made significant progress," said Carol Synkewecz, director of Allegheny County's Healthy Start program, a federally funded effort that focuses on improving infant death rates in six areas of the county where death rates are particularly high.

Infant mortality is a widely used measure of health care quality because so many factors can affect the health of a newborn -- quality of care, access to care, socioeconomic status, mother's age and lifestyle factors such as smoking, drug use and diet. African Americans nationwide are particularly vulnerable, with an infant death rate last year that was more than twice as high as the U.S. rate for all infants. The African-American infant mortality rate is thus a particularly sensitive measure of a community's health.

Unfortunately, it can't pinpoint whatever problem or problems might be plaguing a community, and that also means that improving the death rates requires a wide range of actions -- improving access to care, counseling, parent education, transportation, nutrition and more.

That's been the case for Allegheny County's Healthy Start program, which was one of the first 15 such programs to be funded by the U.S. Department of Health and Human Services a decade ago. The local program's intensive, home-based services became a model for the national program, and the county program achieved its goal last year of halving the infant death rate in its six target areas.

Synkewecz said it was impossible to name just a handful of factors that were most responsible for the decrease

And it can be doubly hard to identify blame when the rates suddenly jump. In St. Louis, for instance, the three-year average for black infant deaths increased from 16.39 per 1,000 last year to 19.02 this year, ranking it last among the PG Benchmarks cities.

Louise Quesada, head of planning for that city's health department, said she was not sure what occurred to cause that change. Most of it is attributable to an astounding jump in neonatal deaths -- deaths in the first month of life -- from 36 in 1998 to 59 in 1999. That could suggest some sort of epidemic, or it could simply signal a problem in tabulating the statistics, she added.

Despite the encouraging news in Pittsburgh, the city remains in the lower half of the PG Benchmarks cities. And there remains a considerable disparity between the rates for whites and blacks, Synkewecz noted. In 1999, for instance, the infant death rate for whites in Pittsburgh was 7.2 per 1,000 live births, compared with 17.3 for African Americans. Nationwide, that gap was a little narrower -- 7.1 for whites and 14.6 for blacks.

And there's room for improving the survival of all infants in Allegheny County. The rate for all infant deaths in the city, 11.4 per 1,000, and in the county, 8.1 per 1,000, both exceeded the overall rate of 7.1 deaths per 1,000 found in the state and the nation as a whole.

One factor that can't be helping the Pittsburgh area is the high rate of smoking among pregnant women, an activity that increases the risk of premature births and low birth weight. A survey of 41 cities last year by the Ann E. Casey Foundation found that one in four Pittsburgh women smoked during pregnancy, the worst of all the cities surveyed. In top-ranked Miami, by contrast, just 2 percent of pregnant women smoked; in midranked Denver, 11 percent.