Infant Mortality am ong African Am erican & Rural Populations - PowerPoint PPT Presentation

Infant Mortality am ong African Am erican & Rural Populations in Maryland Lawrence D. Reid, PhD, MPH Prevention and Health Promotion Administration Maternal and Child Health Bureau lawrence.reid@maryland.gov

Prevention and Health Prom otion Adm inistration MISSION AND VISION MISSION The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community-based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations. VISION The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well-being . 2

Overview • Study Objectives • Background on Maryland Infant Mortality Rates (IMR) • IMR in rural and urban areas • Conclusions 3

Study Question • Investigate infant mortality trends by race & rural residence areas. 4

Background • Approximately 74,000 live births annually • More than half (58%) are non-White NH (national = 49% in 2016). • An average of 525 infant deaths per year (478 deaths in 2016). • About 7 deaths for every 1,000 live births (Ranked 16 th highest in 2016). • About three-quarters (72%) of infant deaths are neonatal. • Most occur in urban counties (78%), but some of highest rates are in rural counties. • Leading causes of death (2011-2015) • Neonatal (<28 days old): preterm/low birth weight, maternal complications, congenital anomalies, placenta/cord complications • Postneonatal (28-364 days old): SIDS, congenital anomalies, accidents, infectious diseases 5

Background Infant Mortality Rates, Maryland & US, 1990 - 20 16 12 Infant deaths per 1,000 live births 10 8 6 4 2 0 Maryland IMR’s have decreased 32% since 1990 6 Source: Maryland Vital Statistics Administration

Background National and Maryland Infant Mortality Com parisons 11.8 10.5 per 1,000 live births Infant deaths 6.7 6.7 6.3 6.1 5.5 5.4 5.2 4.8 4.3 Black NH, White NH, Hispanic, Rural counties, Small/medium Large urban 2016 2016 2016 2013-2015 urban counties, counties, 2013-2015 National Maryland 2013-2015 7 Source: Maryland Vital Statistics Administration and National Vital Statistics System. NH: non-Hispanic

8 Background Infant deaths Source: Maryland Vital Statistics Administration and National Vital Statistics System. NH: non-Hispanic per 1,000 live births 15.6 15.2 14.9 14.8 14.3 14.3 14.1 14.0 13.9 13.6 Wisconsin Ohio Alabama Black NH Infant Mortality Rates by State, 20 16 Nebraska 10 Highest Kansas Pennsylvania Iowa Indiana Kentucky Oklahoma 10.7 10.7 10.6 10.5 10.0 New Jersey Texas Virginia Maryland 10 Lowest Arizona Minnesota 9.8 California 9.5 New York 8.5 Massachusetts 7.5 Washington 6.9

Background Infant Mortality Rates by Race, Maryland, 1990 - 20 16 20 14 18 Infant deaths per 1,000 live births 12 16 B/W Difference 10 14 12 8 10 6 8 6 4 4 2 Average 2 Period Annual Percent Percent 0 0 Change Change 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 -32.8* -1.5 White 6.4 6.7 6.7 6.1 6.0 6.0 5.9 5.3 5.5 5.1 4.7 5.5 5.4 5.4 5.6 4.7 5.7 4.6 5.2 4.1 4.1 4.0 4.1 4.5 4.2 4.3 4.3 Black 17.3 14.3 16.9 17.6 15.3 15.3 14.5 16.1 15.4 14.7 13.0 13.6 12.7 14.7 14.9 12.7 12.7 14.0 13.4 13.6 11.8 12.0 10.3 10.5 10.6 11.2 10.4 -39.9* -1.9 B/W Diff 10.9 7.6 10.2 11.5 9.3 9.3 8.6 10.8 9.9 9.5 8.3 8.1 7.3 9.3 9.4 7.9 7.0 9.4 8.2 9.5 7.7 8.0 6.2 6.0 6.4 6.9 6.1 -44.0 -2.2 9 Source: Maryland Vital Statistics Administration. * 2016 rate differs significantly from 1990 rate (p<0.05).

Background Infant Mortality Rates by Race/ Ethnicity, Maryland, 20 0 7 - 20 16 16 14.0 Percent Average Infant deaths per 1,000 live births 14 Change Annual 2007-11 to Percent 2012-16 Change 12 -18.0%* -3.1% 10.5 10 8 5.4 5.9 +48.0%* +4.0% 6 +88.1%* +8.7% 5.3 3.8 4 -20.0%* -3.5% 4.3 2 2.5 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 White NH Black NH Hispanic Other 10 Source: Maryland Vital Statistics Administration. NH: non-Hispanic years 2010 and on. * denotes 2012-2016 IMR differs significantly from 2007-2011 IMR (p<0.05). Other includes Asian Pacific Islanders & American Indians/Alaskan Natives

Background Distribution of Live Births and Infant Deaths by Race/ Ethnicity, Maryland, 20 0 7 - 20 16 56.6 45.2 Percent, % 32.9 31.0 21.9 14.4 12.3 8.9 White NH Black NH Hispanic Other Live births Infant deaths 11 Source: Maryland Vital Statistics Administration. NH: non-Hispanic

Infant Mortality Trends by Rural/Urban Residence 12

Rural Counties Urban Counties Region County Anne Arundel Baltimore City Northwest Allegany, Garrett Baltimore County Washington Howard Eastern Shore Caroline, Cecil Dorchester, Kent Montgomery Queen Anne's Prince George’s Somerset, Talbot Wicomico, Worcester Central Maryland Calvert, Carroll Charles, Frederick Harford, St. Mary’s 13

Background Infant Mortality Rates by Rural/ Urban Counties, Maryland, 20 0 7 - 20 16 9 Infant deaths per 1,000 live births 8 7 6 5 4 3 +37%, +4% per year 2 Average 1 Period Annual 0 Percent Percent 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Change Change Rural 6.7 6.7 5.3 5.7 5.5 4.7 6.2 6.0 6.1 6.5 -3.7 -0.4 Urban 8.4 8.4 7.9 7.1 7.2 6.8 6.7 6.6 6.9 6.6 -21.4* -2.6 Source: Maryland Vital Statistics Administration. * denotes 2016 rate differs significantly from 2005 rate (p<0.05). Rural includes Allegany, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Kent, Queen Anne's, 14 Somerset, Saint Mary's, Talbot, Washington, Wicomico, and Worcester counties. Urban includes Baltimore County and City, Anne Arundel, Howard, Montgomery, and Prince George’s Counties.

Infant Mortality Rates by Race & Rural/ Urban Counties, Maryland, 20 0 7 - 20 16 18 Infant deaths per 1,000 live births 16 14 statistically 12 significant 10 difference 8 6 4 Percent 2 Change Average 2007-11 Annual 0 to Percent 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2012-16 Change Black NH, Rural 15.9 13.1 12.8 11.1 13.3 13.1 14.0 10.8 13.7 14.3 -0.8 -1.2 Black NH, Urban 13.7 13.5 13.7 12.1 12.1 10.0 10.1 10.6 10.9 9.9 -20.8* -3.6 White NH, Rural 5.0 5.5 4.1 4.4 4.0 3.3 4.5 5.4 4.5 4.2 -5.4 -2.0 White NH, Urban 6.5 7.4 5.9 4.1 4.5 4.1 4.7 3.7 3.6 4.3 -28.5* -4.5 Source: Maryland Vital Statistics Administration. NH: non-Hispanic years 2010 and on. * denotes 2016 rate differs significantly 15 from 2005 rate (p<0.05). Rural includes Allegany, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Kent, Queen Anne's, Somerset, Saint Mary's, Talbot, Washington, Wicomico, and Worcester counties.

Infant Mortality Rates by Age at Death and Rural/ Urban Counties, Maryland, 20 0 7 - 20 16 Three year rolling averages 6 Infant deaths per 1,000 live births 5 4 3 2 1 Average 0 Period Interval 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- Percent Percent 2009 2010 2011 2012 2013 2014 2015 2016 Change Change Rural - Neonatal 4.3 3.9 3.8 3.8 3.9 3.9 4.1 4.2 -2.3 -0.3 Rural - Postneonatal 2.0 2.0 1.7 1.5 1.6 1.7 2.0 2.0 0.0 0.0 Urban - Neonatal 5.7 5.4 5.1 4.9 4.9 4.7 4.7 4.8 -15.8 -2.4 Urban - Postneonatal 2.1 2.1 1.9 1.8 1.8 1.9 1.9 1.8 -14.3 -2.2 Source: Maryland Vital Statistics Administration. NH: non-Hispanic years 2010 and on. 16 Rural includes Allegany, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Kent, Queen Anne's, Somerset, Saint Mary's, Talbot, Washington, Wicomico, and Worcester counties.

Num ber of Infant Deaths, 20 16 94 75 73 Number infant deaths Most infant deaths occur in Urban counties 58 39 19 17 13 12 12 10 9 8 8 6 5 5 4 4 3 2 1 1 0 17 Source: Maryland Vital Statistics Administration.

Average Annual Num ber of Infant Deaths, 20 0 7-20 16 110 97 Number infant deaths Most infant deaths occur in Urban counties 69 65 41 18 14 13 12 11 10 10 6 6 5 5 4 4 4 3 3 3 2 1 18 Source: Maryland Vital Statistics Administration. U: urban R: rural

Ten-Year Infant Mortality Rates by Jurisdiction, Maryland, 20 0 7-20 16 Eastern Shore areas, Baltimore City & Prince George’s county have the highest rates 11.6 10.6 10.4 Number infant deaths per 1,000 live births 9.0 8.9 8.6 8.4 8.0 7.3 7.0 6.8 6.7 6.6 6.5 5.9 5.8 5.3 5.3 5.2 5.2 5.1 5.0 4.3 3.8 19 Source: Maryland Vital Statistics Administration.

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Is a more specific rural definition needed? 23

Census tract specific rural areas, Maryland 20 10 US Census 24