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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 DivisionMinnesota Department of Health

May 1, 2014

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Background

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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!

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What is Infant Mortality?

Infant mortality is the death of an infant before age one.

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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.

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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.

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Disparities

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What is a health disparity?

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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.

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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.

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Some Data

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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

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Number of Births in Minnesota, 2000-2011

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

67,451 66,617 68,037 70,053 70,614 70,920 73,515 73,675 72,382 70,083 68,407 68,783

Num

ber

of B

irth

s

Year

Source: Minnesota Center for Health Statistics

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Number of Infant Deaths in Minnesota, 2000-2011

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

50

100

150

200

250

300

350

400

450

500

380346 353

324 325

370 375404

429

315 313 324

Num

ber

of B

irth

s

Year

Source: Minnesota Center for Health Statistics

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Percent of Black/African American Births by Maternal Nativity in Minnesota, 1990-2010

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Foreign-born

U.S. Born

Year

Perc

ent

Source: MDH, MCHS linked Infant Death/Birth File

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Infant Mortality Rates by Year of Birth in Minnesota and U.S. (3-year Averages)

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009

2008-2010

0

1

2

3

4

5

6

7

87.2 7.1 7 6.9 6.9 6.9 6.9 6.8 6.8 6.8 6.7 6.6

6.35.9 5.9 5.9 5.65.3 5.0 4.8 4.8 5.0

5.3 5.5 5.35.0

U.S. MinnesotaRate

per

1,0

00 L

ive

Birt

hs

Healthy People2020 Goal: 6.0 infant deaths per 1000Live births

Year

Source: National Center for Health Statistics

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Infant Mortality Rates by Geography1 in Minnesota, 2006-2010

Central Metro Northeast Northwest South Cen-tral

South East Southwest West Cen-tral

Total0

1

2

3

4

5

6

7

8

5.1 5.24.7

6.9

4.1

5.1

4.3

5.1 5.1

Rate

per

1,0

00 L

ive

Birt

hs

Geography

1Geographic classification is based on Minnesota’s 50 health boards which are grouped into 8 geographic regionsCommunity Health Boards by SCHSAC Region. Community Health Services Advisory Committee. http://www.health.state.mn.us/divs/cfh/ophp/about/maps.htmlSources: Minnesota Department of Health, Center for Health Statistics.

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Infant Mortality Rates by Race/Ethnicity of Mother in Minnesota, 1995-1999 and 2006-2010

African-Amer-ican

American Indian Asian Hispanic* White Total0

2

4

6

8

10

12

14

16

12.9 13.5

7.1 6.8

5.56.2

9.89.1

4.9 4.8 4.45.1

1995-1999 2006-2010

Rate

per

1,0

00 L

ive

Birt

hs

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

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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 28.2 100.0Total 1,836 100.0

Source: Minnesota Department of Health, Center for Health Statistics* The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

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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

ConditionsSIDS/Sleep Disorders*

Obstetric Conditions4 Obstetric

ConditionsObstetric

ConditionsObstetric

ConditionsSIDS/Sleep Disorders *

5 Injury Birth AsphyxiaBirth Asphyxia

and Injury(tied)

Birth Asphyxia Injury

Source: Minnesota Department of Health, Center for Health Statistics*The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

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Source: Disparities in Infant Mortality, January 2009http://www.health.state.mn.us/divs/chs/infantmortality/infantmortality09.pdf

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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)

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Infant Mortality in Minnesota by Selected Contributing Factors

• Age of Mother• Adequacy of prenatal care• Infant Birth Weight• Infant Gestational Age• Maternal Education

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Infant Mortality Rates by Age and Race/Ethnicity of Mother in Minnesota, 2006-2010

African-Amer-ican

American Indian Asian Hispanic* White Total0

2

4

6

8

10

12

14

16

11.2

14.7

9.1

4.1

8.5 8.99.4

7.7

4.3 4.84.1

4.7

10.4

5.8 5.74.8 5.4

Under 20 years

20 to 34 years

35 years and older

Rate

per

1,0

00 L

ive

Birt

hs

Race/Ethnicity

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

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

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Infant Mortality Rates by Adequacy of Prenatal Care and Race/Ethnicity of Mother in Minnesota, 2006-2010

African-Amer-ican

American Indian Asian Hispanic* White Total0

2

4

6

8

10

12

14

16

8.4

6.3

4.1 4.23.4 3.9

12.912.1

3.2 3.7

10.79.8

Intensive/Adequate Inadequate/None

Rate

per

1,0

00 L

ive

Birt

hs

Race/Ethnicity

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

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Leading Causes of Infant Deaths in Minnesota by Adequacy of Prenatal Care, 2006-2010

Rank All Intensive/Adequate Care Inadequate/No Care

1 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.

African-American American Indian Asian Hispanic* White Total0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

62.8

67.8

37.7

53

43.1

47.4

3.3 4.71.8 1.8 1.9 2.1

<2,500g >=2,500g

Rate

per

1,0

00 L

ive

Bir

ths

Infant Mortality Rates by Infant Birth Weight andRace/Ethnicity of Mother in Minnesota, 2006-2010

Race/Ethnicity

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

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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 Congenital Anomalies Congenital Anomalies

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.

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Age at Death and Infant Mortality Rates in Minnesota by Race/Ethnicity of Mother, 2006-2010

African-Amer-ican

American Indian Asian Hispanic* White Total0

1

2

3

4

5

6

7

8

6.5

4.03.6

3.22.9

3.33.3

5.1

1.3 1.6 1.61.8

Neonatal(<28 days) Post-Neonatal(28 to 364 days)

Rate

per

1,0

00 L

ive

Birt

hs

Race/Ethnicity

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

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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 Congenital Anomalies Congenital Anomalies

3 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.

African-American American Indian Asian Hispanic* White Total0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

55.0

47.8

34.3

26.229.2

2325.7

3.5 4.51.8 2 1.9 2.1

<37 Weeks >=37 Weeks

Rate

per

1,0

00 Li

ve B

irth

s

Infant Mortality Rates by Infant Gestational Age and Race/Ethnicity of Mother in Minnesota, 2006-2010

Race/Ethnicity*Can be of any raceSource: Minnesota Center for Health Statistics

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Leading Causes of Infant Deaths by Gestational Age in Minnesota, 2006-2010

Rank All <37 Weeks (pre-term)

>=37 Weeks (full-term)

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.

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Less than High School High School Greater than High School0.0

2.0

4.0

6.0

8.0

10.0

12.0

0.0

0.5

1.0

1.5

2.0

2.5

9.4 9.9

6.8

5.74.8

3.4

1.62.1

1.7

African American White African American : White Ratio

Mother’s Education

Rate

per

1,0

00 b

irth

s

Afr

ican

Am

eric

an/W

hite

Rati

o

Source: MDH, MCHS Linked Infant Death/Birth File

Infant Mortality Rates in Minnesota by Race and Education of Mother, 2006-2010

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Leading Causes of Infant Deaths by Maternal Education in Minnesota, 2006-2010

Rank All Less than High School College Graduate

1 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 deathsSource: Minnesota Department of Health, Center for Health Statistics

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The Data are Used to Inform Local Efforts

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

Healthy Babies are Worth the Wait CampaignAmerican Indian Community Action TeamsMN Prematurity CoalitionTwin Cities Healthy StartEliminating Health Disparities grants2013 Breastfeeding Summit DHS Elective Induction Coverage PolicyMN Medicaid Family Planning WaiverMDH Preconception Health Work GroupInfant Mortality Reduction PlanLow Birth Weight InitiativeMDH Health Equity Efforts

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The Data help to Inform Regional & National Efforts!

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Region V CoIIN

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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.

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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.

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Infant Mortality Rates by Race/Ethnicity Among States in Region V, 2008-2010

  Total Non-Hispanic

Black

Non-Hispanic American Indian or

Alaska Native1

Asian or Pacific

Islander

Hispanic Non-Hispanic

White

Region V Rank

Illinois 7.0 13.6 -- 5.5 5.8 5.5 3

Indiana 7.4 14.1 -- 6.1 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

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

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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.

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Region V CoIIN

The Four topics selected for Region V’s CoIIN are:

1. Social Determinants of Health2. SIDS/SUIDS/Safe Sleep3. Preconcpetion Health/Interconception Care4. Early Elective Deliveries

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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.

Draft Infant Mortality Plan Recommendations

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The Data help to Inform Research!

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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/preconceptiondatabook.pdf

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“Unnatural Causes: When the Bough Breaks”

http://www.unnaturalcauses.org/episode_descriptions.php?page=2

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• 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-9bd0-df91d2eba74a%7D/SOWM-FULL-REPORT_2013.PDF

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For Information about Minnesota’s Infant Mortality Reduction Plan:

Michelle A. ChiezahInfant Mortality Consultant

Maternal and Child Health SectionCommunity and Family Health Division

Minnesota Department of Healthmichelle.chiezah@state.mn.us

For More Information about Minnesota’s Infant Mortality Data:

Minnesota Center for Health StatisticsMinnesota Department of Health

david.stroud@state.mn.ushttp://www.health.state.mn.us/divs/chs/infantmortality/index.html

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THANK YOU!