Presentation: Infant Mortality in Minnesota: A Focus on ... · Infant Mortality in Minnesota: A...

Michelle Chiezah, MA, MPH Maternal and Child Health Section

Community and Family Health DivisionMinnesota Department of Health

November 16, 2016

Infant Mortality in Minnesota: A Focus on Black/African Americans

Maternal and Child Health Section, Minnesota Department of Health

Background

What is Infant Mortality?

Infant mortality is defined as the death of a live born infant during the first year of life.

Infant mortality is usually divided into two categories based on age:

(1) Neonatal mortality— death of infants aged 0-27 days

(2) Post-neonatal mortality— death of infants aged 28 days to 1 year old

What Does the Infant Mortality Rate Indicate or Suggest?

The infant mortality rate is the number of infant deaths per 1,000 live births.

It is an important indicator of the health status of a population. Factors affecting the health of populations can also affect infant mortality

The IMR reflects “…a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices.”1

1Source: MacDorman MF, Mathews TJ. Recent Trends in Infant Mortality in the United States. NCHS data brief, no 9. Hyattsville, MD: National Center for Health Statistics. 2008.

Source: Disparities in Infant Mortality, January 2009

http://www.health.state.mn.us/divs/chs/infantmortality/infantmortality09.pdf

A Complex Multi-Factorial Problem

http://www.health.state.mn.us/divs/chs/infantmortality/infantmortality09.pdf

Contributing Factors to Infant Health Outcomes

• Individual-Mother ( Health, Demographic, ...)-Infant ( Birth Health Status )

• Environment / Community-Physical (e.g., Housing, Safety, Environmental Hazards)-Economic (Income, Employment, Education, . . )-Social (Culture, Racism, Stress, . . .)

• Systems-Health Care Delivery-Public Health (National, State, Local)-Other (transportation, interpreters, cultural competence of services)

Infant Mortality Data Reporting

Data Source

Linked Infant Death/Birth Data Set

Match the death of the infant to its birth

Race reported as mother’s race

Reported by birth year

Births and Deaths

Percentage of Births by Maternal Nativity, Minnesota, 1990-2013

94.6

82.0

5.4

18.0

0

10

20

30

40

50

60

70

80

90

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Perc

en

t

Year

US-born

Foreign

Source: MDH, MCHS linked Infant Death/Birth File

Percentage of Black/African American Births by Maternal Nativity, Minnesota1990-2013

6.1

53.0

93.9

47.0

0

10

20

30

40

50

60

70

80

90

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pe

rce

nt

Year

Foreign-born

U.S. Born

Source: MDH, MCHS linked Infant Death/Birth File

Year

Source: Minnesota Department of Health, Center for Health Statistics

380

346353

324 325

370 375

404

429

315 313324

340349

5.65.0

0

50

100

150

200

250

300

350

400

450

0

1

2

3

4

5

6

7

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nu

mb

er o

f In

fan

t D

eat

hs

Infa

nt

Mo

rtal

ity

Rat

e

Number of Infant Deaths and Infant Mortality Rates, Minnesota 2000-2013

Number of Deaths

Infant Mortality Rates

11

Year


62

39

47

37

49

70

60

70

90

55

49

5856

75

14.2

9.9

0

10

20

30

40

50

60

70

80

90

100

0

2

4

6

8

10

12

14

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nu

mb

er

of

Infa

nt

Dea

ths

Infa

nt

Mo

rtal

ity

Rat

e

Number of Infant Deaths and Infant Mortality Rates for Black/African Americans, Minnesota, 2000-2013

Number of Deaths

Infant Mortality Rates

12

Percentage of Black/African American Infant Deaths by Maternal Nativity Minnesota, 2000-2013

U.S.-Born65.3%

Foreign-born34.7%


Percent Distribution of U.S.-Born Black/African American Infant Deaths by Minnesota County, 2010-2014

Hennepin46.5%

Ramsey25.7%

Anoka, Carver, Dakota, Scott, Washington

11.4%

All Other Counties

16.3%


Black/African American Infant Mortality Rates by County and City, Minnesota2010-2014

National and Regional Comparisons

Infant Mortality Rates by Year of Birth, Minnesota and U.S.3-Year Averages

7.2

5.95.9

4.9

0

1

2

3

4

5

6

7

8

Ra

te p

er

1,0

00

Liv

e B

irth

s

Year

US Minnesota Healthy People 2020 Target

Source: National Center for Health Statistics*HP 2020 Infant Mortality Target is 6.0 infant deaths per 1,000 live births

Black/African-American Infant Mortality Rates,1 Minnesota, 2000-2004 through 2009-2013

5.0 5.0 4.9 5.05.3 5.2 5.1 5.0 4.9 4.8

9.5 9.3 9.49.6

10.8 10.7

9.8 9.79.2

8.5

4.5 4.4 4.4 4.44.6 4.5 4.4 4.4 4.3

4.1

0

1

2

3

4

5

6

7

8

9

10

11

2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2009-2013

Rate

per

1,0

00 L

ive B

irth

s

MN Total African American White HP 2020 Target

Year

1Five-year averages *HP 2020 Infant Mortality Target is 6.0 infant deaths per 1,000 live birthsSource: Minnesota Department of Health, Center for Health Statistics

Infant Mortality Rates & Rank by Race/Ethnicity Among Region V States, 2011-2013

State Total Non-

Hispanic

Black

Non-Hispanic

American

Indian or

Alaska Native1

Asian or

Pacific

Islander

Hispanic Non-

Hispanic

White

Region V

Rank

Illinois 6.3 12.9 -- 4.6 5.2 4.8 3

Indiana 7.1 12.8 -- 5.1 6.0 6.4 5

Michigan 6.8 13.1 8.8 4.3 5.9 5.3 4

Minnesota 4.9 8.8 11.2 4.5 5.3 4.2 1

Ohio 7.6 13.5 -- 4.2 6.9 6.3 6

Wisconsin 6.0 14.0 8.0 6.7 5.2 5.0 2

U.S. 5.9 11.2 8.0 4.1 5.0 5.0 N/ASource: National Center for Health Statistics--Data not available.1 Includes Aleuts and Eskimos

Infant Mortality Rates1 by Race/Ethnicity of Mother, Minnesota, 2000-2004 through 2009-2013

0

1

2

3

4

5

6

7

8

9

10

11

2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2009-2013

Rate

per

1,0

00 L

ive B

irth

s

Total African AmericanAmerican Indian or Alaska Native AsianHispanic* WhiteHP 2020

Year

*Hispanic can be of any race1Five-year rolling averages Source: Minnesota Department of Health, Center for Health Statistics

Infant Mortality Rates1 and Rate Ratios2 among Infants born to Black/African American Mothers, Minnesota, 2000-2004 through 2009-

2013

2000-2004

2001-2005

2002-2006

2003-2007

2004-2008

2005-2009

2006-2010

2007-2011

2008-2012

2009-2013

African American 9.5 9.3 9.4 9.6 10.8 10.7 9.8 9.7 9.2 8.5

White 4.5 4.4 4.4 4.4 4.6 4.5 4.4 4.4 4.3 4.1

African American-White Ratio 2.1 2.1 2.1 2.2 2.4 2.4 2.2 2.2 2.1 2.1

White Comparison Group 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0

0.0

0.5

1.0

1.5

2.0

2.5

3.0

0

1

2

3

4

5

6

7

8

9

10

11

Afr

ican

Am

eric

an: W

hit

e R

ate

Rat

io

Rate

pe

r 1

,00

0 liv

e b

irth

s

*1Five-year rolling averages 2Rate Ratios are calculated by dividing a specific population’s IMR by the White rateSource: Minnesota Department of Health, Center for Health Statistics

Causes

Percent Distribution of the Leading Causes of Infant Deaths, Minnesota, 2009-2013

Congenital Anomalies

25.7

Prematurity19.6

SUID*11.9

11.7 Obstetric Conditions

Injury2.1

Birth Asphyxia0.9

Other28.3

*SUID includes SIDS and sleep-related infant deathsSource: Minnesota Department of Health, Center for Health Statistics

Top Five Leading Causes1 of Infant Mortality by Race/Ethnicity of Mother, Minnesota,2009-2013

Race/Ethnicity First Second Third Fourth Fifth

African American Prematurity

(23.2%)

Congenital Anomalies

(22.9%)

Obstetric Conditions

(11.9%)

SUID (includes SIDS

and Sleep-Related

Infant Deaths

(11.6%)

Birth Asphyxia

(1.0%)

American Indian SUID (includes SIDS and

Sleep-Related Infant

Deaths

(29.9%)

Congenital

Anomalies

(16.4%)

Prematurity

(11.9%)


(9.0%)

Injury

(3.0%)

Asian Congenital Anomalies

(30.4%)

Prematurity

(23.2%)


(14.3%)

SUID (include SIDS

and Sleep-Related

Infant Deaths

(5.4%)

Birth Asphyxia

(0.9%)

Hispanic* Congenital

Anomalies

(32.6%)

Prematurity

(20.5%)

SUID (includes SIDS

and Sleep-Related

Infant Deaths

(12.1%)


(8.3%)

Injury

(2.3%)

White Congenital Anomalies

(25.4%)

Prematurity

(18.3%)

SUID (includes SIDS

and Sleep-Related

Infant Deaths

(12.1%)


(11.7%)

Injury

(2.3%)

Total Congenital Anomalies

(25.7%)

Prematurity

(19.6%)

SUID (includes SIDS

and Sleep-Related

Infant Deaths

(11.9%)


(11.7%)

Injury

(2.1%)

24

1Excludes deaths classified as “other.”*Can be of any raceSource: Minnesota Department of Health, Center for Health Statistics

5.7

4.6

3.5 3.5

2.8

3.2

2.8

4.9

0.9

1.8

1.31.5

0

1

2

3

4

5

6

Black/AfricanAmerican

American Indian Asian Hispanic* White MN Total

Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Neonatal and Post-Neonatal Mortality Rates by Race/Ethnicity of Mother, Minnesota, 2009-2013

Neonatal Post-Neonatal

*Can be of any raceSource: Minnesota Department of Health, Center for Health Statistics

11.611.3

10.8 10.7

9.4 9.39.8

0

2

4

6

8

10

12

14


American Indian Asian Hispanic* White Other/Unknown MN Total

Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Percentage of Preterm* births by Race/Ethnicity, Minnesota, 2014

38.3

29.9

27.028.4

24.126.6

3.45.6

1.32.5 1.7 1.9

0

5

10

15

20

25

30

35

40

45



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by Gestational Age and Race/Ethnicity, Minnesota, 2009-2013

<37 Weeks >=37 Weeks


56.853.8

41.0

52.7

41.945.2

3.05.9

1.1 2.1 1.7 1.8

0

5

10

15

20

25

30

35

40

45

50

55

60

65



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by Birth Weight and Race/Ethnicity, Minnesota, 2009-2013

<2,500g >=2,500g


Maternal Characteristics

11.7

9.7

#

5.8

4.14.7

5.4

4.2

5.0

3.8

4.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by Maternal Nativity and Race/Ethnicity of Mother, Minnesota, 2009-2013

U.S.-Born Foreign-Born

*Can be of any race#Indicates unstable rates; fewer than 20 casesSource: Minnesota Department of Health, Center for Health Statistics

4.9

12.1

# #

6.5

8.4 8.57.9

9.1

4.2

5.6

3.94.5

9.5

#

6.0

#

4.04.7

0

2

4

6

8

10

12

14



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by Maternal Age and Race/Ethnicity of Mother, Minnesota, 2009-2013

<20 20-34 35+


9.5

# #

5.86.1

6.9

8.8

9.5

5.7

4.94.6

5.3

#

3.3

#

3.1 3.2

0

2

4

6

8

10

12



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by Maternal Education and Race/Ethnicity of Mother, Minnesota, 2009-2013

0 to 11 years 12 to 16 years 16+ years


10.6

16.1

12.5

# #

7.2

8.57.7 7.4

4.34.9

3.64.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by Maternal Smoking Status and Race/Ethnicity of Mother, Minnesota, 2009-2013

Yes No


3.8**

6.6

7.7 7.8

4.9**

7.1

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Non-HispanicBlack

American Indian Hispanic* Non-HispanicWhite

Other Minnesota Total

Pe

rcen

t

Race/Ethnicity

Percent of Women Who Consumed Alcohol During the Last 3 Months of Pregnancy by Race/Ethnicity, 2009-2013

*Can be of any race

**Significantly different from Non-Hispanic Whites (p<.05)Consumed any amount of alcohol during pregnancy among those who drank any alcoholic beverages in the previous two years.Other includes Asians, Foreign-born, Mixed Race, and data for which the race of the respondent is unknown.Source: Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS), Minnesota Department of Health, Division of Community and Family Health, Maternal and Child Health.

8.37.9

4.04.5

3.84.3

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0



Rat

e p

er 1

,00

0 L

ive

Bir

ths

Race/Ethnicity

Infant Mortality Rates by First Trimester Prenatal Care Initiation and Race/Ethnicity of Mother, Minnesota, 2009-2013


Plans To Reduce Infant Mortality in MN!

Examples of Past or Ongoing Evidence-Based Infant Mortality Activities/Programs in Minnesota

37

Healthy Babies are Worth the Wait Campaign

MN Prematurity Coalition

Minneapolis Healthy Start

Eliminating Health Disparities Community Grants

2015 Breastfeeding Summit

DHS Elective Induction Coverage Policy

MN Medicaid Family Planning Waiver

MDH Preconception Health Work Group

Infant Mortality Reduction Plan

Low Birth Weight Initiative

MDH Health Equity Efforts

Women’s Children and Infant’s Nutrition Program (WIC) Special

Supplementation Nutrition Program

MN SID Center Grant (SUID reduction)

Family Planning Special Projects Grants Programs

MCH Title V Black Grant

New Clinical/Hospital-based Efforts

Reduce the incidence of Sleep-Related Infant Deaths Modeling safe sleep in hospitals via the National Safe

Sleep Certification Program

Reduce Prematurity MN 17P clinical quality improvement initiative to reduce

subsequent preterm births in the African American and American Indian populations

Place-based

MDH State Partnership Initiative to Improve Minority Health Grant *

New Efforts and Partnerships

Next Steps

“Health equity means achieving the conditions in which all people have the opportunity to realize their health potential — the highest level of health possible for that person — without limits imposed by structural inequities.”

MDH Advancing Health EquityReport to the Legislature

February 2014

Advance Health Equity

The Determinants of Health

Source: Tarlov AR. (1999). Public policy frameworks for improving population health. Ann NY Acad Sci 1999; 896: 281-93.

Layers of Influence on Health

Advance Health Equity

Change the narrative about what creates health

Change our approach to improving health for all

Focus on the Triple Aim of Health Equity

Advance health equity across the life course!

Questions and Discussion

The Infant Mortality Reduction Plan (Part One) may be found here:

http://www.health.state.mn.us/divs/cfh/program/infantmortality/

Infant Mortality Reduction Plan

http://www.health.state.mn.us/divs/cfh/program/infantmortality/

Thank You!

Contact

Michelle A. ChiezahState’s Infant Mortality ConsultantMinnesota Department of Health

[email protected]: (651) 201-3621

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Presentation: Infant Mortality in Minnesota: A Focus on ... · Infant Mortality in Minnesota: A...

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