July 23, 2006
Sunday

ANCHORAGE, Alaska - Despite decades' worth of efforts, Alaska Natives continue to have some of the highest rates of infant death in the nation, according to a 10-year review recently released by the state Division of Public Health.

The rates have steadily fallen over the years, but for every 1,000 Alaska Natives born between 1992 and 2001, 11.4 died before their first birthday, said review co-author Brad Gessner.

That's almost double the rate of non-Native infant deaths in Alaska - about six for every 1,000 live births during that period, he said.

Alaska health care providers have battled high infant-mortality rates for decades, especially in the Bush. The review, conducted by a panel made up mostly of doctors and health officials, attempts to analyze every infant death in Alaska as part of that effort, Gessner said.

The panel, created in 1991 with Gessner's help, analyzed 755 of 759 known infant deaths during the 10 years, he said.

Efforts have lowered Alaska's total infant mortality to almost the national average, to 7.3 deaths per 1,000 during the review period. The U.S. infant mortality rate was 6.8 in 2001, the review reported.

Despite that improvement, Alaska consistently ranks among the worst 10 states for mortality of infants in the post-neonatal period, between 4 weeks and 1 year old, he said.

A key cause is Alaska's high rates of sudden infant death syndrome, usually caused by accidental suffocation, which have been the highest in the nation in the last 10 years, he said.

SIDS is especially prevalent in the Native population, more than double the non-Native population's rate.

No one knows exactly why infant mortality is high among Alaska Natives, Gessner said. The review panel will conduct a detailed study of infant mortality in the Native population in the next six months, he said.

The lack of medical services in the Bush - most villagers visit health aides and must fly to hospitals in larger cities to see a pediatrician or other specialists - doesn't seem to be as large a factor as people think, he said.

That's because rural and urban Natives have equally high infant-death rates. Also, the disparity between Natives and non-Natives is the same in urban or rural Alaska. It can be argued, he said, that Natives, who receive free medical care, have greater access to medical services.

"It's not a rural issue and it's not an access-to-care issue," he said. "There are other things going on."

There are some important clues, he said.

Every year, the state, working with the federal Centers for Disease Control and Prevention, asks 20 percent of new mothers in Alaska to fill out a questionnaire, he said.

The latest available responses, collected in 2001 and broken down by racial categories, showed:

- Native mothers are more than twice as likely as white mothers to report smoking during pregnancy. Smoking during and after pregnancy is linked to SIDS for unknown reasons.

- Native infants are more than twice likely as white infants to suffer physical abuse, such as shaken baby syndrome, which causes bleeding in the brain that results in death or brain damage.

- Mothers who chew tobacco, which may cause infections leading to such illnesses as pneumonia or meningitis, are almost exclusively Natives living in Western Alaska.

Also, Native mothers are generally less educated, which may decrease their willingness and ability to seek out and interpret parenting information, Gessner said.

But all the clues don't add up, he said. Alaska Natives report drinking half as much alcohol - linked to higher rates of infant mortality - as whites during pregnancy, Gessner said.

Native mothers, 70 percent, are also just as likely to put infants to sleep on their backs instead of their stomachs, he said. Doing so has helped cut SIDS cases in half nationally, he said.

Despite the mystery, the good news is that infant mortality among Alaska Natives has fallen significantly since 1974, said Jim Berner, a pediatrician and senior director for community health services with the Alaska Native Tribal Health Consortium in Anchorage.

That was the year he got involved with Alaska Native health care. About 24 of every 1,000 Alaska Natives died before their first birthday then, he said. And incidents of SIDS among Natives were at least three times as high.

Progress continues, he said. The state Bureau of Vital Statistics, which tallies infant deaths but doesn't review them, recently reported that from 2001 through 2003, total infant mortality for Alaska Natives fell to 10.5 per every 1,000 births.

A big factor, he said, has been widespread efforts to advise parents on how their infant should sleep as part of the national Back to Sleep campaign. Health care providers around the state have also instructed families to smoke outdoors if they're going to smoke, even in winter, he said.

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