Decreased Infant Mortality Rates in a Low Income Population Served by a Comprehensive Community Health Program

MARK RICHMAN (Shaker Heights, Ohio): What statistical evidence do you have that the populations with which your study dealt (in the two different periods compared) were at all similar, in terms of some of the things you mentioned: socioeconomic status, mean maternal age, and so on? Dr. CHABOT: We do not have age breakdowns, but we know that the incidence of welfare recipients during the years is about the same. FRANK ZECHSNER (Germany): As your first example you showed an infant mortality rate for West Germany of about 22%. That is about the mortality rate of Central Africa. We are not that bad, you know; probably your data are derived from statistical publications of our government, and these are usually 100 years behind the present time. Dr. CHABOT: Thank you. Those were 1967 data, and are presented in the World Health Organization book. FRED SELIGMAN (University of Miami, Miami, Fla.): Dr. CHABOT, do you have any data on the socioeconomic parameters of the low socioeconomic and more affluent census tracts in 1964 and 1968? In other words, can the changes you ascribe to health care, possibly be ascribed to the fact that the socioeconomic parameters have changed, and that perhaps the narrowing gap in terms of health indices is a reflection of a narrowing gap socioeconomically ? Also, do you have any data on population characteristics, especially, birth rates ? Dr. CHABOT : I do not have those data. Hopefully, we will when we get the 1970 census data. As far as the number of children born, our birth rate decreased somewhat in the poverty areas, but not significantly. JOEL J.ALPERT (Children's Hospital Medical Center, Harvard Medical School, Boston, Mass.): I would like very much to be convinced that the health program was responsible for the changes you have described, but there are many questions one can ask about other possible factors. The infant mortality rate is observed to be falling in other communities as well. I agree with your final statement, when you say that the infant mortality rate in the low socioeconomic census tracts is approaching that of the more affluent census tract. I was curious as to how you calculated your statistical differences. Dr. CHABOT: A biostatistician did it on the basis of the sample size and the number of deaths. He has been calculating this on the number of live births and on the number of actual deaths that occurred. It was a chi-square test. Lois LYON NEUMANN (New York University School of Medicine): Was there a significant difference in the incidence of low birth weight deliveries between the periods being compared? Dr. CHABOT : No, there was no decrease.