Infant Mortality in Miami-Dade County WILLIAM M. SAPPENFIELD, MD, MPH, CPH DIRECTOR, THE CHILES CENTER USF COLLEGE OF PUBLIC HEALTH
Special Thanks for Data Providing/Arranging! ● Nancy Vazquez ● Britney James ● Epidemiology Team 2
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 3
Introduction What is infant mortality and why does it matter to health equity and health disparity? 4
Overview Although 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. 5
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
Background Health is determined in part by social conditions in the places where residents live, learn, work, and play (CDC, 2015). 7
Conception Pregnancy Infant Mortality & Morbidity 8
Conception Preconception Pregnancy Infant Mortality & Morbidity 9
Conception Conception Preconception Pregnancy Infant Mortality & Morbidity 10
Life Course Perspective
Perinatal Mortality Perinatal Mortality Rates, Miami-Dade County, 2006-2013 9 8.1 Rates per 1,000 Live Births 7.3 8 2006 7 6.1 2013 6 4.6 5 3.9 4 3 3 2.1 1.7 2 1 0 Fetal Mortality Infant Mortality Neonatal Mortality Postneonatal Rate Rate Rate Mortality Rate Years Source: 2016 Miami-Dade County Infant Mortality Analysis 12
3-Year Infant Mortality Rates Miami-Dade County, 2005-2014 12.0 Rate per 1,000 Live Births 10.0 8.0 6.0 4.0 2.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total IMR Black IMR White IMR Other Race IMR Hispanic IMR (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 13
3-Year Infant Mortality Rates across Florida, 2005-2014 10.0 9.0 Rate per 1,000 Live Births 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Year Miami-Dade County Broward County Palm Beach County Hillsborough County Source: 2016 Miami-Dade County Infant Mortality Analysis 14
3-Year Infant Mortality Rates, Florida & U.S., 2005-2014 8.0 Rate per 1,000 Live Births 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Year Miami-Dade County Florida United States Source: 2016 Miami-Dade County Infant Mortality Analysis 15
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
3-Year Fetal Mortality Rates Miami-Dade County, 2005-2014 16.0 Rate per 1,000 Live Births 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Fetal Death Rate Black Fetal Death Rate White Fetal Death Rate Hispanic Fetal Death Rate Source: 2016 Miami-Dade County Infant Mortality Analysis 17
3-Year Neonatal Infant Mortality Rates Miami-Dade County, 2005-2014 8.0 Rate per 1,000 Live Births 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Neonatal IMR Black Neonatal IMR White Neonatal IMR Hispanic Neonatal IMR (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 18
3-Year Postneonatal Infant Mortality Rates Miami-Dade County, 2005-2014 5.0 4.5 Rate per 1,000 Live Births 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Postneonatal IMR Black Postneonatal IMR White Postneonatal IMR Hispanic Postneonatal IMR (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 19
Infant Health Factors Preterm Births, Low Birth Weight (LBW), and VLBW Births in Miami-Dade County, 2005-2014 12.0 Percent of Live Births 10.0 8.0 6.0 4.0 2.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Preterm Births Total Low Birth Weight (LBW) Total VLBW Births Source: 2016 Miami-Dade County Infant Mortality Analysis 20
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) 21
3-Year Cause Specific Infant Mortality Rates Miami-Dade County, 2005-2014 1.6 Rate per 1,000 Live Births 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years 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 22
Sudden Unexpected Infant Death (SUID) in Miami-Dade County, 2005-2014 2.0 1.8 Rate per 1,000 Live Births 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Non-Hispanic Black Race Non-Hispanic White Race Hispanic Ethnicity (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 23
Maternal Health Factors Covered in a later presentation 24
Life Course Perspective
Neighborhood Area Analysis K M Group Area Group Area J N I A H G South Dade/Homestead Miami Shores/Morningside H E Downtown/East Little Havana/ B I C Kendall Liberty City/Little Haiti/Overtown F D C J Westchester/West Dade Hialeah/Miami Lakes B D K Coral Gables/Kendall Opa-Locka/Miami Gardens/Westview Brownsville/Coral Gables/ E M North Miami/North Miami Beach Coconut Grove A Coral Gables/Coconut Grove/ F N Aventura/Miami Beach Key Biscayne G Doral/Miami/Springs/Sunset 26
Infant Mortality Rate 5-Year Infant Mortality Rate by Neighborhood Miami-Dade County, 2010-2014 Highest Neighborhood Rates: Group I 8.92 • Group I: Downtown/East Little Havana Group K 7.58 /Liberty City/Little Haiti/Overtown Group A 6.14 Neighborhood Group Group M 6.08 • Group K: Opa-Locka/Miami Gardens Group E 4.34 /Westview Group B 3.96 Group J 3.62 • Group A: South Dade/Homestead Group N 3.22 • Group M: North Miami/North Miami Beach Group H 3.04 Group C 2.66 • Group E: Brownsville/Coral Gables Group F 2.58 /Coconut Grove Group G 2.5 Group D 2.5 • Group B: Kendall 0 2 4 6 8 10 Rate per 1,000 Live Births Source: 2016 Miami-Dade County Infant Mortality Analysis 27
Low Birthweight 5-Year Low Birthweight Percentages by Neighborhood, Miami-Dade County, 2010-2014 Highest Neighborhood Percentages: Group I 12.52 Group K 11.78 • Group I: Downtown/East Little Havana Group M 10.48 /Liberty City/Little Haiti/Overtown Group E 9.16 Neighborhood Group • Group K: Opa-Locka/Miami Group A 8.76 Gardens/Westview Group H 8.74 Group B 8.04 • Group M: North Miami/North Miami Beach Group C 7.64 • Group E: Brownsville/Coral Group N 7.6 Gables/Coconut Grove Group F 7.6 Group D 7.5 • Group A: South Dade/Homestead Group J 7.14 • Group H : Miami Shores/Morningside Group G 7.02 0 2 4 6 8 10 12 14 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 28
Preterm Birth 5-Year Preterm Birth Percentages by Neighborhood, Miami-Dade County, 2010-2014 Highest Neighborhood Percentages: Group I 13.32 • Group I: Downtown/East Little Havana Group K 12.82 Group M 11.2 /Liberty City/Little Haiti/Overtown Group E 10.8 Neighborhood Group • Group K: Opa-Locka/Miami Group H 9.76 Gardens/Westview Group A 9.64 Group J 9.14 • Group M: North Miami/North Miami Beach Group B 9.08 • Group E: Brownsville/Coral Gables Group C 9.04 /Coconut Grove Group D 8.7 Group N 8.66 • Group H : Miami Shores/Morningside Group G 8.66 • Group A: South Dade/Homestead Group F 8.1 0 2 4 6 8 10 12 14 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 29
Summary of Neighborhood Findings: Maternal and Child Health Outcomes Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp A B C D E F G H I J K M N High Infant Mortality X X X X X X Rate High % of Low Birth X X X X X X Weight High % of Preterm X X X X X X Births Highest Neighborhood Rates and Percentages • Group A: South Dade/Homestead • Group I: Downtown/East Little Havana/Liberty City/Little Haiti/Overtown • Group B: Kendall • Group K: Opa-Locka/Miami Gardens/Westview • Group E: Brownsville/Coral Gables/Coconut Grove • Group M: North Miami/North Miami Beach • Group H : Miami Shores/Morningside Source: 2016 Miami-Dade County Infant Mortality Analysis 30
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