Low birthweight and infant mortality in Puerto Rico

Objectives. The purpose of this study was to quantify the relative contributions of maternal age, education, marital status, hospital of birth, and use of prenatal care to the high incidence of low birthweight and infant mortality in Puerto Rico. Methods. An analysis was conducted of 257 537 live births that occurred from 1986 through 1989 among Puerto Rico residents and the 3373 corresponding infant deaths. Binomial multiple regression models were used to calculate the adjusted population attributable risks for each variable. Results. Our estimates indicate that approximately 6 of every 10 infant deaths on the island are potentially preventable if low birthweight were eradicated, regardless of other associated factors. Eliminating risks associated with sociodemographic and socioeconomic factors (including hospital of birth) would potentially decrease the incidence of low birth- weight in Puerto Rico by one third. Specifically, the elimination of risks associated with the socioeconomic disadvantage of women delivering in public hospitals alone would potentially decrease Puerto Rico's low birthweight incidence by 28%, regardless of other factors considered in our study. Conclusions. Efforts to prevent low birthweight and infant mortality in Puerto Rico should focus on reducing the gap between the private and public sectors.