Using Birth Data to Reduce Infant Mortality
in Minnesota
2014 Excellence in Birth Registration Conference
Presented by: Michelle A. Chiezah, M.A., M.P.H.
Maternal and Child Health Section
Community and Family Health Division
Minnesota Department of Health
May 1, 2014
1
Background
2
Minnesota’s Infant Mortality Reduction Initiative
(MIMRI)
•
Is an effort of the Minnesota Department of Health to improve birth outcomes and
reduce infant mortality in Minnesota with an emphasis on reducing disparities in rates
(e.g., racial/ethnic).
•
MIMRI provides the following:
– Statewide leadership
– Resources
– Education and information
– Technical assistance to tribal governments, local public health departments, and
community agencies
•
MIMRI also uses the most current data (e.g., vital records) to help plan, coordinate, and evaluate
interventions and activities.
–
•
Birth Data are Essential!!
MIMRI has numerous partners including: MN Chapter of the March of Dimes, Minnesota Perinatal
Organization, Tribal Governments, Local Public Health Departments, Twin-Cities Healthy Start, WIC,
MN Center for Health Statistics, Office of Minority and Multicultural Health (OMMH), to name a few!
3
What is Infant Mortality?
Infant mortality is the death of an infant before age one.
4
What Is the Infant Mortality Rate?
• The infant mortality rate (IMR) is expressed as the number of
infant deaths per 1,000 live births.
• For example: In 2011, there were 324 infant deaths and
68,783 live births in Minnesota. What was the infant mortality
rate?
324/68,783 x 1,000 = 4.7 infant deaths per 1,000 live births
Interpretation: In 2011, the IMR in Minnesota was 4.7 infant
deaths per 1,000 live births.
5
What Does the Infant Mortality Rate Indicate or
Suggest?
• The IMR is one of the most important indicators of health.
• The IMR reflects “…a variety of factors such as maternal health,
quality and access to medical care, socioeconomic conditions,
and public health practices.”1
1MacDorman
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.
6
Disparities
7
What is a health disparity?
8
A health disparity is not:
• A type of disease or a health condition.
• A person of color with a disease or health
condition.
• A poor person or other persons from disparate
populations with a disease or other adverse
health conditions.
9
Health disparities are:
“Differences in the incidence, prevalence, mortality and
burden of disease and other adverse health conditions that
exists between specific populations groups.”
Source: “Advancing Health Equity in Minnesota.” Minnesota Department of Health (Flyer).
http://www.health.state.mn.us/divs/chs/healthequity/definitions2013.pdf. 21 October 2003. Accessed
on 4/25/2014.
10
Some Data
11
Infant Mortality 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
12
Number of Births in Minnesota, 2000-2011
80,000
70,000
67,451
70,053 70,614
66,617 68,037
70,920
73,515
73,675 72,382
70,083
68,407 68,783
Number of Births
60,000
50,000
40,000
30,000
20,000
10,000
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
Source: Minnesota Center for Health Statistics
13
Number of Infant Deaths in Minnesota, 2000-2011
500
450
400
404
380
346
Number of Births
350
370
353
324
325
2003
2004
429
375
315
313
324
300
250
200
150
100
50
0
2000
2001
2002
2005
2006
2007
2008
2009
2010
2011
Year
Source: Minnesota Center for Health Statistics
14
Percent of Black/African American Births by Maternal
Nativity in Minnesota, 1990-2010
100.0
90.0
80.0
Percent
70.0
60.0
50.0
40.0
30.0
20.0
Foreign-born
10.0
U.S. Born
0.0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Source: MDH, MCHS linked Infant Death/Birth File
15
Infant Mortality Rates by Year of Birth in Minnesota and
U.S. (3-year Averages)
8
7.2
7.1
Rate per 1,000 Live Births
7
6
5.9
5.9
7.0
5.9
6.9
6.9
6.9
6.9
6.8
6.8
6.7
6.6
6.3
5.6
5.3
5
6.8
5.0
4.8
4.8
5.0
5.3
5.5
5.3
5.0
4
Healthy People
2020 Goal: 6.0 infant deaths per 1000
Live births
3
2
U.S.
Minnesota
1
0
Year
Source: National Center for Health Statistics
16
Infant Mortality Rates by Geography1 in Minnesota,
2006-2010
8
6.9
7
Rate per 1,000 Live Births
6
5
5.1
5.2
5.1
4.7
5.1
West
Central
Total
4.3
4.1
4
5.1
3
2
1
0
Central
Metro
Northeast Northwest
South
Central
South East Southwest
Geography
1Geographic
classification is based on Minnesota’s 50 health boards which are grouped into 8 geographic regions
Community Health Boards by SCHSAC Region. Community Health Services Advisory Committee.
http://www.health.state.mn.us/divs/cfh/ophp/about/maps.html
Sources: Minnesota Department of Health, Center for Health Statistics.
17
Infant Mortality Rates by Race/Ethnicity of Mother in
Minnesota, 1995-1999 and 2006-2010
16
14
1995-1999
2006-2010
13.5
12.9
Rate per 1,000 Live Births
12
10
9.8
9.1
8
7.1
6.8
6.2
6
4.9
4.8
5.5
5.1
4.4
4
2
0
African-American American Indian
Asian
Hispanic*
White
Total
Race/Ethnicity
*Can be of any race
Source: Minnesota Department of Health, Center for Health Statistics
18
Leading Causes of Infant Deaths in Minnesota,
2006-2010
Rank
Cause of Death
Number
Percent
Cumulative
Percent
1
Congenital Anomalies
469
25.5
25.5
2
Prematurity
353
19.3
44.8
3
SIDS/Sleep Disorders*
253
13.8
58.6
4
Obstetric Conditions
202
11.0
69.6
5
Injury
41
2.2
71.8
All Other
518
28.2
100.0
1,836
100.0
Total
Source: Minnesota Department of Health, Center for Health Statistics
* The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
19
Leading Causes of Infant Deaths by Race/Ethnicity of
Mother in Minnesota, 2006-2010
Rank
White
African
American
American
Indian
Asian
Hispanic
1
Congenital
Anomalies
Prematurity
SIDS/Sleep
Disorders *
Congenital
Anomalies
Congenital
Anomalies
2
Prematurity
Congenital
Anomalies
Congenital
Anomalies
Prematurity
Prematurity
3
SIDS/Sleep
Disorders *
SIDS/Sleep
Disorders*
Prematurity
Obstetric
Conditions
SIDS/Sleep
Disorders*
4
Obstetric
Conditions
Obstetric
Conditions
SIDS/Sleep
Disorders *
Obstetric
Conditions
5
Injury
Birth
Asphyxia
Injury
Obstetric
Conditions
Birth Asphyxia
Birth Asphyxia
and
Injury(tied)
Source: Minnesota Department of Health, Center for Health Statistics
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
20
Source: Disparities in Infant Mortality, January 2009
http://www.health.state.mn.us/divs/chs/infantmortality/infantmortality09.pdf
21
Contributing Factors to Infant Mortality
• Individual
-Mother ( Health, Demographic, ...)
-Infant ( Birth Health Status )
• Environment / Community
-Physical (Housing, Safety, Environmental Hazards, . . )
-Economic (Income, Employment, Education, . . )
-Social (Culture, Racism, Stress, . . .)
• Systems
-Health Care Delivery
-Public Health (National, State, Local)
22
Infant Mortality in Minnesota by Selected Contributing
Factors
•
•
•
•
•
Age of Mother
Adequacy of prenatal care
Infant Birth Weight
Infant Gestational Age
Maternal Education
23
Infant Mortality Rates by Age and Race/Ethnicity of
Mother in Minnesota, 2006-2010
Under 20 years
20 to 34 years
16
35 years and older
14.7
Rate per 1,000 Live Births
14
12
10
8
11.2
10.4
9.4
9.1
8.9
8.5
7.7
5.8
6
5.7
4.8
4.3
4.1
Asian
Hispanic*
Race/Ethnicity
4
4.8
4.1
4.7
5.4
2
0
African-American American Indian
*Can be of any race
Source: Minnesota Department of Health, Center for Health Statistics
White
Total
24
Leading Causes of Infant Deaths by Age of Mother in
Minnesota, 2006-2010
Rank
All
Under 20
years
20 to 34 years
35 years and
older
1
Congenital
Anomalies
SIDS/Sleep
Disorders*
Congenital
Anomalies
Congenital
Anomalies
2
Prematurity
Prematurity
Prematurity
Prematurity
3
SIDS/Sleep
Disorders *
Congenital
Anomalies
SIDS/Sleep
Disorders
Obstetric
Conditions
4
Obstetric
Conditions
Obstetric
Conditions
Obstetric
Conditions
SIDS/Sleep
Disorders *
5
Injury
Injury
Injury
Injury
Source: Minnesota Department of Health, Center for Health Statistics
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
25
Infant Mortality Rates by Adequacy of Prenatal Care
and Race/Ethnicity of Mother in Minnesota, 2006-2010
16
Intensive/Adequate
Rate per 1,000 Live Births
14
Inadequate/None
12.9
12.1
12
10.7
9.8
10
8.4
8
6.3
6
4.2
4.1
4
3.2
3.7
3.4
3.9
2
0
African-American American Indian
Asian
Hispanic*
Race/Ethnicity
White
Total
*Can be of any race
Source: Minnesota Department of Health, Center for Health Statistics
26
Leading Causes of Infant Deaths in Minnesota by
Adequacy of Prenatal Care, 2006-2010
Rank
1
All
Intensive/
Adequate Care
Inadequate/No Care
Congenital Anomalies Congenital Anomalies Congenital Anomalies
2
Prematurity
SIDS/Sleep Disorders
Prematurity
3
SIDS/Sleep Disorders *
Prematurity
SIDS/Sleep Disorders
4
Obstetric Conditions
Obstetric Conditions
Obstetric Conditions
5
Injury
Injury
Injury
Source: Minnesota Department of Health, Center for Health Statistics
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
27
Infant Mortality Rates by Infant Birth Weight and
Race/Ethnicity of Mother in Minnesota, 2006-2010
80.0
70.0
67.8
<2,500g
62.8
>=2,500g
Rate per 1,000 Live Births
60.0
53.0
47.4
50.0
43.1
40.0
37.7
30.0
20.0
10.0
3.3
4.7
1.8
1.8
1.9
2.1
0.0
African-American American Indian
Asian
Race/Ethnicity
*Can be of any race
Source: Minnesota Center for Health Statistics
Hispanic*
White
Total
Leading Causes of Infant Deaths by Infant Birth Weight
in Minnesota, 2006-2010
Rank
All
Less than 2,500
grams
2,500 grams or more.
1
Congenital Anomalies
Prematurity
SIDS/Sleep
Disorders*
2
Prematurity
3
Congenital Anomalies Congenital Anomalies
SIDS/Sleep Disorders * Obstetric Conditions
Injury
4
Obstetric Conditions
SIDS/Safe Sleep
Disorder
Obstetric Conditions
5
Injury
Injury
Prematurity
Source: Minnesota Department of Health, Center for Health Statistics
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
29
Age at Death and Infant Mortality Rates in Minnesota
by Race/Ethnicity of Mother, 2006-2010
8
Rate per 1,000 Live Births
7
Neonatal(<28 days)
Post-Neonatal(28 to 364 days)
6.5
6
5.1
5
4
4.0
3.3
3.6
3.2
2
1.3
3.3
2.9
3
1.6
1.6
1.8
1
0
African-American American Indian
Asian
Hispanic*
Race/Ethnicity
White
Total
*Can be of any race
Source: Minnesota Department of Health, Center for Health Statistics
30
Leading Causes of Infant Deaths by Age at Death In
Minnesota, 2006-2010
Rank
All
Neonatal
Post Neonatal
1
Congenital Anomalies
Prematurity
SIDS/Sleep
Disorders*
2
Prematurity
3
Congenital Anomalies Congenital Anomalies
SIDS/Sleep Disorders * Obstetric Conditions
Injury
4
Obstetric Conditions
SIDS/Safe Sleep
Disorder
Prematurity
5
Injury
Injury
Injury
Source: Minnesota Department of Health, Center for Health Statistics
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
31
Infant Mortality Rates by Infant Gestational Age and Race/
Ethnicity of Mother in Minnesota, 2006-2010
55.0
Rate per 1,000 Live Births
50.0
<37 Weeks
>=37 Weeks
47.8
45.0
40.0
34.3
35.0
30.0
29.2
26.2
25.7
25.0
23.0
20.0
15.0
10.0
5.0
3.5
4.5
1.8
2.0
1.9
2.1
0.0
African-American
American Indian
Asian
Race/Ethnicity
*Can be of any race
Source: Minnesota Center for Health Statistics
Hispanic*
White
Total
Leading Causes of Infant Deaths by Gestational Age in
Minnesota, 2006-2010
Rank
All
<37 Weeks (preterm)
>=37 Weeks (fullterm)
1
Congenital Anomalies
Prematurity
Congenital Anomalies
2
Prematurity
Congenital Anomalies
SIDS/Sleep
Disorders*
3
SIDS/Sleep Disorders * Obstetric Conditions
Injury
4
Obstetric Conditions
SIDS/Safe Sleep
Disorder
Obstetric Conditions
5
Injury
Injury
Prematurity
Source: Minnesota Department of Health, Center for Health Statistics
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.
33
Infant Mortality Rates in Minnesota by Race and
Education of Mother, 2006-2010
Rate per 1,000 births
10.0
2.5
9.9
9.4
2.0
2.1
1.6
1.7
8.0
1.5
6.8
6.0
5.7
1.0
4.8
4.0
3.4
2.0
0.0
0.5
African American/White Ratio
12.0
0.0
Less than High School
African American
High School
Mother’s Education
White
Greater than High School
African American : White Ratio
Source: MDH, MCHS Linked Infant Death/Birth File
34
Leading Causes of Infant Deaths by Maternal Education
in Minnesota, 2006-2010
Rank
1
All
Less than High
School
College Graduate
Congenital Anomalies Congenital Anomalies Congenital Anomalies
2
Prematurity
SIDS/Sleep
Disorders*
Prematurity
3
SIDS/Sleep Disorders *
Prematurity
Obstetric Conditions
4
Obstetric Conditions
Obstetric Conditions
SIDS/Sleep
Disorders*
5
Injury
Injury
Injury
*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths
Source: Minnesota Department of Health, Center for Health Statistics
35
The Data are Used to Inform Local Efforts
36
Examples of Past or Ongoing Infant Mortality
Activities/Programs in Minnesota
Healthy Babies are Worth the Wait Campaign
American Indian Community Action Teams
MN Prematurity Coalition
Twin Cities Healthy Start
Eliminating Health Disparities grants
2013 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
37
The Data help to Inform Regional & National
Efforts!
38
Region V CoIIN
39
Federally Designated Public Health and Human Services
Regions
Regions IV and VI states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma,
South Carolina, Tennessee, and Texas.
40
Definition
A Collaborative Improvement and Innovation Network (CoIIN) has been
defined as a “cyberteam of self-motivated people with a collective vision, that
innovatively collaborate by sharing ideas, information, and work enabled by
technology.”1
1Gloor,
PA. Swarm Creativity: Competitive Advantage through collaborative Innovation Networks. New York, NY: Oxford University Press, 2006.
41
Infant Mortality Rates by Race/Ethnicity Among
States in Region V, 2008-2010
Total
NonHispanic
Black
Illinois
7.0
13.6
Non-Hispanic
American
Indian or
Alaska
Native1
--
Asian or
Pacific
Islander
Hispanic
NonHispanic
White
Region V
Rank
5.5
5.8
5.5
3
Indiana
7.4
14.1
--
6.8
6.5
4
Michigan
7.4
14.3
12.3
4.5
6.9
5.9
4
Minnesota
5.0
9.6
8.6
4.8
4.6
4.6
1
Ohio
7.7
14.5
--
4.5
7.3
6.3
5
Wisconsin
6.3
13.9
8.0
6.4
6.2
5.4
2
U.S.
6.4
12.2
8.4
4.8
5.1
9.0
N/A
6.1
Source: National Center for Health Statistics
*Ranking is from best to worst, i.e., Minnesota has the lowest (best) infant mortality rate in region V
--Data not available.
1 Includes Aleuts and Eskimos
42
Purposes of Region V CoIIN
• Region V CoIIN encourages2:
– Distance-based communication using existing
technologies (e.g., web).
– Innovation as well as constant communication of
cyberteam members across various levels of the
network.
– Cyberteam members to engage in collaborative
learning, work, and the development, implementation,
and evaluation of strategies to address a problem.
Sources:
1Gloor, PA. Swarm Creativity: Competitive Advantage through collaborative Innovation Networks. New York, NY: Oxford University Press, 2006.
2Ghandour, RM. Collaborative Improvement and Innovation Network (COIN) to Reduce Infant Mortality. Secretary’s Advisory Committee on Infant
Mortality. Bethesda, Maryland. www.hrsa.gov/advisorycommittees/mchbadvisory/.../Meetings/.../coin.pp...Accessed on: 7/19/2013.
43
Region V CoIIN
The Four topics selected for Region V’s CoIIN are:
1.
2.
3.
4.
Social Determinants of Health
SIDS/SUIDS/Safe Sleep
Preconcpetion Health/Interconception Care
Early Elective Deliveries
44
Draft Infant Mortality Plan Recommendations
1. Improve health equity and address the social determinants
of health that most significantly impact disparities in birth
outcomes.
2. Reduce the rate of SIDS/SUIDS deaths in Minnesota.
3. Assure a comprehensive statewide system that monitors
infant mortality.
4. Provide comprehensive, culturally-appropriate,
coordinated health care to all women during the
preconception, pregnancy and post-partum periods.
5. Reduce the rate of preterm births in Minnesota.
6. Improve the rate of pregnancies that are planned,
including reducing the rate of teen pregnancies.
7. Establish an ongoing task force of stakeholders to oversee
implementation of recommendations and action steps.
45
The Data help to Inform Research!
46
2012 Preconception Health Databook
Preconception Health and Health Care Indicators Databook,
Minnesota, 2004- 2008. Minnesota Department of Health, St.
Paul, Minnesota. September 2012
http://www.health.state.mn.us/divs/fh/mch/preconception/documents/preconcept
iondatabook.pdf
47
“Unnatural Causes: When the Bough Breaks”
http://www.unnaturalcauses.org/episode_descriptions.php?page=2
48
49
• It is estimated that in the U.S., about
11,300 babies die each year on the
same day they are born.
• The highest among
industrialized countries.
• About 50% more infants die on their
first day of life in the U.S. than in all
other industrialized countries
combined.
• The other 33 industrialized countries
have a total of 7,500 first-day infant
deaths each year combined.
Source: Surviving the First Day: State of the World’s Mothers 2013. Save
the Children. 2013.
http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0df91d2eba74a%7D/SOWM-FULL-REPORT_2013.PDF
50
For Information about Minnesota’s Infant Mortality Reduction Plan:
Michelle A. Chiezah
Infant Mortality Consultant
Maternal and Child Health Section
Community and Family Health Division
Minnesota Department of Health
michelle.chiezah@state.mn.us
For More Information about Minnesota’s Infant Mortality Data:
Minnesota Center for Health Statistics
Minnesota Department of Health
david.stroud@state.mn.us
http://www.health.state.mn.us/divs/chs/infantmortality/index.html
51
THANK YOU!
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