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Am J Public Health. 2013 Nov;103(11):e88-95. doi: 10.2105/AJPH.2013.301294. Epub 2013 Sep 12.

Excess infant mortality among Native Hawaiians: identifying determinants for preventive action.

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Ashley H. Hirai and Gopal K. Singh are with the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Donald K. Hayes and Loretta J. Fuddy are with the Hawai'i Department of Health, Honolulu. Maile M. Taualii is with the Office of Public Health Studies, Native Hawaiian and Indigenous Health, University of Hawai'i and Papa Ola Lokahi, Honolulu.



We identified potential determinants and cause-specific sources of excess infant mortality among Native Hawaiians.


We compared infant mortality rates among Native Hawaiians and Whites by using data from the 2002 to 2009 Hawai'i State Linked Birth/Infant Death Cohort File. We evaluated the components of excess infant mortality by age and underlying cause of death as well as maternal sociodemographic, behavioral, and chronic condition disparities.


The Native Hawaiian infant mortality rate was more than twice that for Whites (7.9 vs 3.5/1000 live births). Excess Native Hawaiian infant mortality was equally apportioned to neonatal and postneonatal deaths. Preterm-related causes of death accounted for 43.9% of the infant mortality disparity, followed by sudden unexpected infant death (21.6%) and injury (5.6%). In multivariable models, maternal educational inequality accounted for the largest portion of the neonatal mortality disparity (20.9%); younger maternal age (12.2%) and smoking (9.5%) were the only significant contributors to the postneonatal mortality disparity.


Addressing educational inequalities, promoting safe sleep practices, and reducing smoking among Native Hawaiian mothers would help to eliminate excess infant mortality.

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