Excess infant mortality in an American Indian population, 1940 to 1990.
OBJECTIVE.--To describe the infant mortality experience of an American Indian community and to demonstrate the utility of examining community-level mortality data. DESIGN.--Descriptive, population-based historical review of infant death certificates. SETTING.--The Warm Springs Indian Reservation, Oregon. PATIENTS OR OTHER PARTICIPANTS.-Infant tribal members of the Confederated Tribes of Warm Springs, 1940 to 1990. INTERVENTIONS.--None. MAIN OUTCOME MEASURES.--Categorization of causes of infant deaths and calculations of mortality rates. RESULTS.-The infant mortality rate, while lower in each decade since the 1940s, was still 2.6 times the national (all races) rate in the 1980s. Neonatal deaths did not account for many of the excess deaths. The postneonatal mortality rate has consistently been much greater than the national rate and was five times greater in the 1980s. Almost all of the excess infant mortality since 1980 has been due to the sudden infant death syndrome. CONCLUSIONS.--While there has been a dramatic decrease in infant mortality for this American Indian population, it remains higher than the national rate. Examining the causes of infant death has enabled this population to develop focused strategies to reduce infant mortality.