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
