infant mortality in miami-dade...
TRANSCRIPT
Infant Mortality in Miami-Dade County WILLIAM M. SAPPENFIELD, MD, MPH, CPH
DIRECTOR, THE CHILES CENTER
USF COLLEGE OF PUBLIC HEALTH
3
County Infant Mortality Analysis
The Florida Department of Health in Miami-Dade County conducted a County Infant Mortality Analysis● to review infant mortality rates● to examine select maternal and infant health factors● to assess social determinants of health
Introduction
What is infant mortality and why does it matter to health equity and health disparity?
4
5
OverviewAlthough Miami-Dade County experienced declining infant mortality rates, persistent racial and ethnic disparities continue.
Non-Hispanic Black infants experience high infant mortality rates, almost three times the rates of Non-Hispanic White and Hispanic infants.
Such health disparities are generally associated with social determinants.
Key Miami-Dade County Findings ● The infant mortality rate is 4.6, decreasing 24% over
last 10 years.
● This rate is lower than Florida’s and U.S.’s rate.
● This rate is the same or lower than Hillsborough,
Broward, and Palm Beach Counties.
● Neighborhoods with high Low Birth Weight (LBW)
percentages and high infant mortality rates are
strongly correlated.
● Neighborhoods with increasing social disadvantage
correlated with areas with high infant mortality rates.
6
BackgroundHealth is determined in part by social conditions in the places where residents live, learn, work, and play (CDC, 2015).
7
Perinatal Mortality
12
8.1
6.1
3.9
2.1
7.3
4.6
3
1.7
0
1
2
3
4
5
6
7
8
9
Fetal MortalityRate
Infant MortalityRate
Neonatal MortalityRate
PostneonatalMortality RateR
ate
s p
er
1,0
00
Liv
e B
irth
s
Years
Perinatal Mortality Rates, Miami-Dade County, 2006-2013
2006
2013
Source: 2016 Miami-Dade County Infant Mortality Analysis
13
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Years
3-Year Infant Mortality RatesMiami-Dade County, 2005-2014
Total IMR Black IMR White IMR Other Race IMR Hispanic IMR (All Races)
Source: 2016 Miami-Dade County Infant Mortality Analysis
14
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Year
3-Year Infant Mortality Rates across Florida, 2005-2014
Miami-Dade County Broward County
Palm Beach County Hillsborough County
Source: 2016 Miami-Dade County Infant Mortality Analysis
15
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Year
3-Year Infant Mortality Rates, Florida & U.S., 2005-2014
Miami-Dade County Florida United States
Source: 2016 Miami-Dade County Infant Mortality Analysis
Fetal Rate
Fetal mortality represents a spontaneous intrauterine death of a fetus. In Florida, fetal death registration occurs for fetal deaths at 20+ gestational weeks.
16
17
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Years
3-Year Fetal Mortality RatesMiami-Dade County, 2005-2014
Total Fetal Death Rate Black Fetal Death Rate
White Fetal Death Rate Hispanic Fetal Death Rate
Source: 2016 Miami-Dade County Infant Mortality Analysis
18
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Years
3-Year Neonatal Infant Mortality RatesMiami-Dade County, 2005-2014
Total Neonatal IMR Black Neonatal IMR
White Neonatal IMR Hispanic Neonatal IMR (All Races)
Source: 2016 Miami-Dade County Infant Mortality Analysis
19
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Years
3-Year Postneonatal Infant Mortality RatesMiami-Dade County, 2005-2014
Total Postneonatal IMR Black Postneonatal IMR
White Postneonatal IMR Hispanic Postneonatal IMR (All Races)
Source: 2016 Miami-Dade County Infant Mortality Analysis
20
Infant Health Factors
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2006 2007 2008 2009 2010 2011 2012 2013
Pe
rce
nt
of
Live
Bir
ths
Years
Preterm Births, Low Birth Weight (LBW), and VLBW Births in Miami-Dade County, 2005-2014
Preterm Births Total Low Birth Weight (LBW) Total VLBW Births
Source: 2016 Miami-Dade County Infant Mortality Analysis
21
Select Causes of Infant Death Over the last ten years, the leading causes of Infant Mortality:
1. Congenital Anomaly/Birth Defect
2. Sudden Unexpected Infant Death (SUID)
3. Prematurity/Low Birth Weight
4. Unintentional Injury (non-SUID accidents)
5. Intentional Injury (homicide)
22
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Years
3-Year Cause Specific Infant Mortality RatesMiami-Dade County, 2005-2014
Congenital Anomaly/Birth Defect Prematurity/Low Birth Weight
Sudden Unexpected Infant Death (SUID) Unintentional Injury (non-SUID accidents)
Intentional Injury (homicide)
Source: 2016 Miami-Dade County Infant Mortality Analysis
23Source: 2016 Miami-Dade County Infant Mortality Analysis
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2006 2007 2008 2009 2010 2011 2012 2013
Rat
e p
er
1,0
00
Liv
e B
irth
s
Years
Sudden Unexpected Infant Death (SUID) in Miami-Dade County, 2005-2014
Total Non-Hispanic Black Race Non-Hispanic White Race Hispanic Ethnicity (All Races)
Neighborhood Area Analysis
26
Group Area Group Area
A South Dade/Homestead H Miami Shores/Morningside
B Kendall IDowntown/East Little Havana/
Liberty City/Little Haiti/Overtown
C Westchester/West Dade J Hialeah/Miami Lakes
D Coral Gables/Kendall K Opa-Locka/Miami Gardens/Westview
EBrownsville/Coral Gables/
Coconut Grove M North Miami/North Miami Beach
FCoral Gables/Coconut Grove/
Key Biscayne N Aventura/Miami Beach
G Doral/Miami/Springs/Sunset
A
B
CD
G
J K M
NH
F
EI
27
2.5
2.5
2.58
2.66
3.04
3.22
3.62
3.96
4.34
6.08
6.14
7.58
8.92
0 2 4 6 8 10
Group D
Group G
Group F
Group C
Group H
Group N
Group J
Group B
Group E
Group M
Group A
Group K
Group I
Rate per 1,000 Live Births
Ne
igh
bo
rho
od
Gro
up
5-Year Infant Mortality Rate by Neighborhood Miami-Dade County, 2010-2014
Highest Neighborhood Rates:
• Group I: Downtown/East Little Havana
/Liberty City/Little Haiti/Overtown
• Group K: Opa-Locka/Miami Gardens
/Westview
• Group A: South Dade/Homestead
• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral Gables
/Coconut Grove
• Group B: Kendall
Infant Mortality Rate
Source: 2016 Miami-Dade County Infant Mortality Analysis
28
7.02
7.14
7.5
7.6
7.6
7.64
8.04
8.74
8.76
9.16
10.48
11.78
12.52
0 2 4 6 8 10 12 14
Group G
Group J
Group D
Group F
Group N
Group C
Group B
Group H
Group A
Group E
Group M
Group K
Group I
Percent
Ne
igh
bo
rho
od
Gro
up
5-Year Low Birthweight Percentages by Neighborhood, Miami-Dade County, 2010-2014
Highest Neighborhood Percentages:
• Group I: Downtown/East Little Havana
/Liberty City/Little Haiti/Overtown
• Group K: Opa-Locka/Miami
Gardens/Westview
• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral
Gables/Coconut Grove
• Group A: South Dade/Homestead
• Group H: Miami Shores/Morningside
Low Birthweight
Source: 2016 Miami-Dade County Infant Mortality Analysis
29
8.1
8.66
8.66
8.7
9.04
9.08
9.14
9.64
9.76
10.8
11.2
12.82
13.32
0 2 4 6 8 10 12 14
Group F
Group G
Group N
Group D
Group C
Group B
Group J
Group A
Group H
Group E
Group M
Group K
Group I
Percent
Ne
igh
bo
rho
od
Gro
up
5-Year Preterm Birth Percentages by Neighborhood, Miami-Dade County, 2010-2014
Highest Neighborhood Percentages:
• Group I: Downtown/East Little Havana
/Liberty City/Little Haiti/Overtown
• Group K: Opa-Locka/Miami
Gardens/Westview
• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral Gables
/Coconut Grove
• Group H: Miami Shores/Morningside
• Group A: South Dade/Homestead
Preterm Birth
Source: 2016 Miami-Dade County Infant Mortality Analysis
30
Summary of Neighborhood Findings: Maternal and Child Health Outcomes
Grp
A
Grp
B
Grp
C
Grp
D
Grp
E
Grp
F
Grp
G
Grp
H
Grp
I
Grp
J
Grp
K
Grp
M
Grp
N
High Infant Mortality
RateX X X X X X
High % of Low Birth
WeightX X X X X X
High % of Preterm
BirthsX X X X X X
• Group A: South Dade/Homestead
• Group B: Kendall
• Group E: Brownsville/Coral Gables/Coconut Grove
• Group H: Miami Shores/Morningside
• Group I: Downtown/East Little Havana/Liberty
City/Little Haiti/Overtown
• Group K: Opa-Locka/Miami Gardens/Westview
• Group M: North Miami/North Miami Beach
Source: 2016 Miami-Dade County Infant Mortality Analysis
Highest Neighborhood Rates and Percentages
31
21.6
23.7
26.26
37.84
41.84
42.28
43.74
50.7
54.06
58.9
64.56
68.34
77.04
0 20 40 60 80 100
Group F
Group D
Group N
Group G
Group B
Group H
Group C
Group M
Group J
Group A
Group E
Group K
Group I
Percent
Ne
igh
bo
rho
od
Gro
up
5-Year Percent of Unwed Mothers by Neighborhood, Miami-Dade County, 2010-2014
Highest Neighborhood Percentages:
• Group I: Downtown/East Little Havana/
Liberty City/Little Haiti/Overtown
• Group K: Opa-Locka/Miami Gardens
/Westview
• Group E: Brownsville/Coral Gables
/Coconut Grove
• Group A: South Dade/Homestead
• Group J: Hialeah/Miami Lakes
• Group M: North Miami/North Miami Beach
Unwed Mothers
Source: 2016 Miami-Dade County Infant Mortality Analysis
32
76.76
77.88
79.7
79.7
81.74
82.3
83.14
83.28
83.74
84.28
84.8
84.88
86.84
70 75 80 85 90
Group K
Group A
Group J
Group I
Group M
Group E
Group G
Group C
Group B
Group N
Group H
Group D
Group F
Percent
Ne
igh
bo
rho
od
Gro
up
Highest 5-Year Percent of Early Prenatal Care by Neighborhood, Miami-Dade County, 2010-2014
Lowest Neighborhood Percentages:
• Group K: Opa-Locka/Miami Gardens/
Westview
• Group A: South Dade/Homestead
• Group J: Hialeah/Miami Lakes
• Group I: Downtown/East Little Havana
/Liberty City/Little Haiti/Overtown
• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral Gables
/Coconut Grove
Early Prenatal Care
Source: 2016 Miami-Dade County Infant Mortality Analysis
33
7.2
5.5
5.5
5.4
3.9
3.6
3.4
3.3
2.1
2
1.6
1.5
1.5
0 2 4 6 8
Group N
Group F
Group I
Group C
Group H
Group D
Group M
Group B
Group E
Group K
Group J
Group A
Group G
Percent
Ne
igh
bo
rho
od
Gro
up
Highest Percent of Illicit Drug Use by Neighborhood Miami-Dade County, 2014
Highest Neighborhood Percentages:
• Group N: Aventura/Miami Beach
• Group F: Coral Gables/Coconut Grove /Key Biscayne
• Group I: Downtown/East Little Havana /Liberty City/Little Haiti/Overtown
• Group C: Westchester/West Dade
• Group H: Miami Shores/Morningside
• Group D: Coral Gables/Kendall
Illicit Drug Use
Source: 2016 Miami-Dade County Infant Mortality Analysis
34
Summary of Neighborhood Findings: Substance Abuse and Tobacco Use
Grp
A
Grp
B
Grp
C
Grp
D
Grp
E
Grp
F
Grp
G
Grp
H
Grp
I
Grp
J
Grp
K
Grp
M
Grp
N
% Current Drinker X X X X X X
% Illicit Drug Use in
Past MonthX X X X X X
% Current Smoker X X X X X X
%Someone Smokes
at homeX X X X X X
• Group C: Westchester/West Dade
• Group D: Coral Gables/Kendall
• Group E: Brownsville/Coral Gables/Coconut Grove
• Group F: Coral Gables/Coconut Grove/Key Biscayne
• Group H: Miami Shores/Morningside
• Group I: Downtown/East Little Havana/Liberty
City/Little Haiti/Overtown
• Group J: Hialeah/Miami Lakes
• Group N: Aventura/Miami Beach
Source: 2016 Miami-Dade County Infant Mortality Analysis
Highest Neighborhood Percentages
35
Highest Neighborhood Percentages:
• Group A: South Dade/Homestead (33034, 33039,
33030)
• Group I: Downtown/East Little Havana/Liberty
City/Little Haiti/Overtown (33136, 33128, 33127,
33150, 33147)
• Group E: Brownsville/Coral Gables/Coconut
Grove (33142, 33130, 33135, 33125)
• Group K: Opa-Locka/Miami Gardens /Westview
(33034)
• Group J: Hialeah/Miami Lakes (33010)
• Group M: North Miami/North Miami Beach (33161)
Poverty
44.6
43.5
42.3
42.1
41.5
40
39.8
39.3
38.6
38.1
34.3
33
32.4
31.4
30.1
0 10 20 30 40 50
33034
33039
33030
33142
33130
33135
33125
33136
33128
33127
33150
33147
33010
33054
33161
Percent
Zip
Co
de
Highest Percent of Poverty by Zip CodeMiami-Dade County, 2010-2014
Source: 2016 Miami-Dade County Infant Mortality Analysis
36
Highest Neighborhood Rates:
• Group E: Brownsville/Coral Gables
/Coconut Grove (33142, 33130, 33145)
• Group H: Miami Shores/Morningside
(33034)
• Group I: Downtown/East Little Havana
/Liberty City/Little Haiti/Overtown (33010)
• Group K: Opa-Locka/Miami Gardens
/Westview (33167, 33056)
• Group M: North Miami/North Miami Beach
(33181)
• Group N: Aventura/Miami Beach (33139)
Infectious Syphilis
132.1
114.6
82.9
67.4
57.6
57
34.9
32.8
31.2
28.4
28
26.5
25.7
25.3
24.9
0 20 40 60 80 100 120 140
33128
33139
33136
33132
33138
33137
33167
33142
33056
33130
33181
33133
33145
33147
33126
Rate per 100,000 population
Zip
Co
de
Highest Infectious Syphilis Rate by Zip CodesMiami-Dade County, 2014
Source: 2016 Miami-Dade County Infant Mortality Analysis
37
Highest Neighborhood Rates:
• Group E: Brownsville/Coral Gables /Coconut
Grove (33142, 33130, 33145)
• Group H: Miami Shores/Morningside (33137,
33138)
• Group I: Downtown/East Little Havana /Liberty
City/Little Haiti/Overtown (33136, 33128, 33147,
33150, 33127)
• Group K: Opa-Locka/Miami Gardens /Westview
(33056)
• Group M: North Miami/North Miami Beach
(33181, 33161)
• Group N: Aventura/Miami Beach (33139, 33141)
HIV Rates
339.3
207.8
156.6
128.7
118.9
106.3
101.1
90.4
88.4
87.4
86.2
82.7
81.1
79.4
74.9
0 100 200 300 400
33136
33139
33137
33138
33128
33181
33147
33150
33131
33142
33127
33141
33130
33056
33161
Rate per 100,000 population
ZIp
Co
de
Highest Reported HIV Rate by Zip CodeMiami-Dade County, 2014
Source: 2016 Miami-Dade County Infant Mortality Analysis
38
Summary of Neighborhood Findings: Sexually Transmitted Diseases
Grp
A
Grp
B
Grp
C
Grp
D
Grp
E
Grp
F
Grp
G
Grp
H
Grp
I
Grp
J
Grp
K
Grp
M
Grp
N
Syphilis Rate X X X X X X
Gonorrhea Rate X X X X X X
Chlamydia Rate X X X X X X
HIV Rate X X X X X X
AIDS Rate X X X X X X X
• Group E - Brownsville/Coral Gables/Coconut Grove
• Group H - Miami Shores/Morningside
• Group I - Downtown/East Little Havana/Liberty
City/Little Haiti/Overtown
• Group K - Opa-Locka/Miami Gardens/Westview
• Group M - North Miami/North Miami Beach
• Group N - Aventura/Miami Beach
Source: 2016 Miami-Dade County Infant Mortality Analysis
Highest Neighborhood Rates:
39
Initial Conclusions
Neighborhoods with increasing social
disadvantage correlated with areas with high
infant mortality rates and other adverse birth
outcomes.