State of the State: Infant Mortality in Indiana. Jerome Adams, MD, MPH State Health Commissioner Indiana State Department of Health

State of the State: Infant Mortality in Indiana Jerome Adams, MD, MPH State Health Commissioner Indiana State Department of Health International Inf...
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State of the State: Infant Mortality in Indiana Jerome Adams, MD, MPH State Health Commissioner Indiana State Department of Health

International Infant Mortality Rates 2010 Japan

2.3

Finland

2.3

Sweden

2.5

Portugal

2.5

Czech Republic

2.7

Norway

2.8

Spain

3.2

Korea

3.2

Italy

3.4

Germany

3.4

Denmark

3.4

France

3.6

Belgium

3.6

Israel

3.7

Switzerland

3.8

Netherlands

3.8

Ireland

3.8

Greece

3.8

Austria

3.9

Australia

4.1

United Kingdom

4.2

Poland

5.0

Hungary

5.3

New Zealand

5.5

Slovakia

5.7

United States

0.0

6.1

1.0

2.0

3.0 4.0 Rate per 1,000 live births

5.0

6.0

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Original Source: CDC/NCHS, linked birth/infant death data set (U.S. data); and OECD 2014 (all other data). Data are available from http://www.oecd.org

7.0

0.00 Iowa Massachusetts Vermont New Jersey Washington Wyoming Conneticut California New York Oregon Minnesota Colorado Utah Arizona Nebraska Nevada New Mexico Alaska Idaho New Hampshire Montana Texas Illinois North Dakota Florida Virgina Wisconsin Delaware Kentucky Kansas Rhode Island Missouri Hawaii South Dakota Maryland Pennsylvania District of Columbia Tennessee Oklahoma South Carolina Georgia North Carolina Maine Michigan Indiana Ohio West Virginia Arkansas Alabama Louisiana Mississippi

4.14

Rate per 1,000 live births 10.00 9.65

12.00

Infant Mortality Rates United States, 2013

8.00

6.00

4.00

2.00

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Original Source: CDC/NCHS, National Vital Statistics Report “Deaths: Final Data for 2013”, Volume 64, Number 2

Infant Mortality Rates Indiana, U.S. and Healthy People 2020 Goal 2007 - 2013 Rate per 1,000 live births

10.0

8.0

6.0

4.0

2.0

0.0 Indiana U.S. HP 2020 Goal

2007 7.5 6.8 6.0

2008 6.9 6.6 6.0

2009 7.8 6.4 6.0

2010 7.5 6.1 6.0

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] United States Original: Centers for Disease Control and Prevention National Center for Health Statistics Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

2011 7.7 6.05 6.0

2012 6.7 5.98 6.0

2013 7.15 5.96 6.0

Infant Mortality Rates County Level, All Races 2009 - 2013 HIGHEST Infant Mortality Rates in State • Adams, 9.9 • Henry, 9.8

• Montgomery, 9.7 • Grant, 9.5 • Marion, 9.5 • Daviess,9.5

• Cass, 9.2 • Bartholomew, 9.1 • LaPorte, 8.6 • Lake, 8.5

• St. Joseph, 8.2 Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Infant Mortality Rates by Zip Code 2009 – 2013 Combined, All Races *Zip codes with the highest Infant Mortality Rate for the 5 years among zip codes that had at least 20 infant deaths.

Zip Code

County

# Total Infant Deaths

Infant Mortality Rate

46806

Allen

37

15.3

46312

Lake

39

15.1

46218

Marion

36

14.7

46201

Marion

44

14.6

46208

Marion

22

14.5

46226

Marion

50

14.4

46953

Grant

20

13.7

46203

Marion

42

12.2

46222

Marion

38

11.6

46205

Marion

28

11.6

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Infant Mortality Rates by Race Indiana 2002 - 2013 Indiana

20.0

Rate per 1,000 live births

Blacks

Healthy People 2020

18.1

18.0 16.0

Whites

15.6

15.9

17.1 16.9

15.7

14.9

16.1

15.3

14.7

14.5

14.0 12.3 12.0 10.0 8.0 6.0

4.0

7.6 6.5

7.4 6.4

8.1 6.9

8.0 6.9

7.9

6.4

7.5

6.9

6.5

7.8 6.4

5.5

7.5

6.0

7.7 6.7

7.1

6.9 5.5

5.8

2.0 0.0

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Infant Mortality Rates by Ethnicity Indiana 2002 - 2013 10.0 Rate per 1,000 live births

9.0 8.0

7.0 6.0 5.0 4.0 3.0 2.0

1.0 0.0

2002 Indiana 7.6 Non-Hispanic 7.6 Hispanic 8.0 Healthy People 2020 Goal 6.0

2003 7.4 7.6 5.6 6.0

2004 8.1 8.0 9.0 6.0

2005 8.0 8.0 8.1 6.0

2006 7.9 8.1 5.2 6.0

Note: Hispanic ethnicity can be of any race. Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

2007 7.5 7.6 6.8 6.0

2008 6.9 6.8 7.8 6.0

2009 7.8 7.8 7.4 6.0

2010 7.5 7.4 8.6 6.0

2011 7.7 7.8 7.4 6.0

2012 6.7 6.6 8.1 6.0

2013 7.15 7.2 7.3 6.0

Infant Mortality Rates County Level, by Race 2009 - 2013 Black Infant Mortality •

Worst counties for combined years: –

Allen County • (Black IMR = 19.9)



St. Joseph County • (Black IMR = 16.5)



Marion County • (Black IMR = 14.4)



Lake County • (Black IMR = 12.8)



These 4 counties account for nearly 80% of all the black infant deaths in Indiana between 2009 and 2013

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Infant Mortality Rates by Zip Code 2009 – 2013 Combined, by Race *Zip codes with the highest Infant Mortality Rate for the 5 years among zip codes that had at least 20 infant deaths for each race.

Zip Codes with Worst White Infant Mortality Zip Code

County

# Total White Infant Deaths

46112

Hendricks

21

Zip Codes with Worst Black Infant Mortality

White Infant Mortality Rate

Zip Code

10.7

County

# Total Black Infant Deaths

Black Infant Mortality Rate

46312

Lake

33

26.6

46201

Marion

22

26.1

46203

Marion

28

10.3

46806

Allen

29

25.6

46368

Porter

20

10.1

46226

Marion

40

18.9

46222

Marion

22

17.7

46205

Marion

22

16.7

46218

Marion

30

16.2

46235

Marion

22

11.3

46350

LaPorte

21

8.7

46227

Marion

28

8.1

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

CAUSES OF INFANT MORTALITY IN INDIANA

Infant Mortality Distribution by Cause Indiana Indiana, Whites 2013 N = 393 Indiana, All Races N = 594

1.8% Assaults/ Accidents

14.8% Other 44.5% Perinatal Risks

14.5% SUIDs

1.3%

24.4%

Assaults / Accidents

Congenital Malformations

15.3% Other 47.6% Perinatal Risks

14.0% SUIDs 21.7%

Indiana, Blacks N = 153 1.3% Assaults/ Accidents

Congenital Malformations

15.7% Other

13.1% SUIDs 16.3% Congenital Malformations

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

53.6% Perinatal Risks

Factors Contributing to Infant Mortality in Indiana • Obesity (ISDH #2 Priority) –

If woman is obese = 25% chance of delivering premature infant



If woman is morbidly obese = 33% chance of delivering premature infant



Indiana is 9th most obese state in U.S.

• Smoking (ISDH #3 Priority) –

15.7% of mothers smoke during pregnancy (TWICE the U.S. average)



25.9% of mothers on Medicaid smoke



Indiana has 7th worst smoking rate among pregnant women in U.S.



Indiana has 12th highest smoking rate overall in U.S.

• Limited Prenatal Care –

Only 67.4% of mothers receive prenatal care during the 1st trimester

• Unsafe Sleep Practices –

14.0% of infant deaths in 2013 can be attributed to SUIDs

Percent of Women Ages 18-44 Who are Obese (BMI >= 30) Indiana, 2014 IN

Non-Hispanic Whites

40.0 35.0

Non-Hispanic Blacks 37.9%

31.5%

31.2%

Percent

30.0 25.0 20.0 15.0 10.0 5.0 0.0 Obese Source: Indiana State Department of Health, Division of Nutrition and Physical Activity , BRFSS 2014 [October 26, 2015]

HP2020 = 30.5%

Percent of Mother’s Who Smoked Anytime During Pregnancy 2013 20.0

IN

Percent of all Live Births

Blacks

17.4%

18.0 16.0

Whites

15.7%

14.0

11.8%

12.0 10.0 8.0 6.0

4.0

HP2020 = 1.4%

2.0 0.0

Smoking During Pregnancy Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Percent of Mother’s Who Smoked Anytime During Pregnancy, by Race 3 Worst Counties 2013 35.0

Whites 33.0%

32.9%

32.3%

30.0 Percent of all Live Births

Percent of all Live Births

30.0 25.0 20.0

Blacks

35.0

Indiana = 17.4%

15.0 10.0

22.6%

Vanderburgh

Madison

Indiana = 11.8%

15.0 10.0 5.0

0.0

0.0 Scott

22.9%

20.0

5.0

Crawford

25.0%

25.0

Owen

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Grant

Percent of Mother’s Who Received Prenatal Care in the 1st Trimester 2013

Percent of all Live Births

80.0 70.0

IN 67.4%

Whites

Blacks

69.9% 56.8%

60.0 50.0 40.0 30.0 20.0 10.0 0.0

Early Prenatal Care Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

HP2020 = 77.9%

% Women Receiving PNC 1st Trimester Indiana, by Race 2009 - 2013 Indiana

80.0 70.0 60.0 50.0

68.5 66.1

53.1

Whites

Blacks

70.7

70.3

70.7

68.5

68.1

68.4

67.4

56.0

56.1

57.4

56.8

2010

2011

2012

2013

69.9

Percent of all 40.0 live births 30.0 20.0

10.0 0.0

2009

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Percent of Mother’s Who Received Prenatal Care in the 1st Trimester, by Race Worst Counties 2013 Whites

70.0

Blacks

70.0 Indiana = 69.9%

60.0

50.0 44.4% 40.0

39.2%

36.2%

30.0

20.0

Percent of all Live Births

Percent of all Live Births

60.0

50.0

Floyd

Allen

20.0

0.0

0.0 Kosciusko

40.8%

30.0

10.0

Adams

42.0% 40.0

10.0

LaGrange

48.8%

Indiana = 56.8%

48.8%

St. Joseph

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team

Grant

Closing the Disparity Gap • If Indiana brought it’s Black infant mortality rate (15.3 in 2013) down to the State’s infant mortality rate of 7.15, 82 additional black infants would have lived to see their first birthday. • If Indiana’s Black infant mortality rate were the same as the white infant mortality rate (5.8), 96 additional black infants would have lived to see their first birthday.

Closing the Disparity Gap • If the counties with the worst infant mortality rates lowered their combined infant mortality rate to Indiana’s rate, 253 babies in those 11 counties would have lived to see their first birthday. • If the 10 zip codes with the worst infant mortality rates would lower the rate to Indiana’s, 165 additional babies born in those areas would have survived.

Infant Mortality