Download - INFANT MORTALITY ALABAMA 2007 ALABAMA DEPARTMENT OF PUBLIC HEALTH CENTER FOR HEALTH STATISTICS
INFANT MORTALITYALABAMA 2007
ALABAMA DEPARTMENT OF PUBLIC HEALTH
CENTER FOR HEALTH STATISTICS
2
INFANT MORTALITY RATESALABAMA, 1997-2007
9.510.2 9.8 9.4 9.4 9.1 8.7 8.7
9.3 9.010.0
0
2
4
6
8
10
12
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e pe
r 1,
000
Liv
e B
irth
s
3
INFANT MORTALITY RATESALABAMA AND UNITED STATES1 1965-2007
0
5
10
15
20
25
30
35
1965 1970 1975 1980 1985 1990 1995 2000
Year
Rat
e p
er 1
,000
Liv
e B
irth
s
10.0
6.6
1 2004 US rate is provisional.
ALABAMA
UNITED STATES
4
INFANT MORTALITY RATES, WHITE INFANTSALABAMA, 1997-2007
7.5 7.66.9 6.5 6.8 7.0
6.5 6.77.2
6.7
8.0
0123456789
10
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e pe
r 1,
000
Liv
e B
irth
s
5
INFANT MORTALITY RATES, BLACK INFANTSALABAMA, 1997-2007
15.4 15.214.0 14.1 13.3
14.4 14.3 14.615.6
13.8
16.0
02468
1012141618
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e pe
r 1,
000
Liv
e B
irth
s
Multivariate Analysis of Linked Birth/Infant Death File
from 1991-2005
Analysis was conducted controlling for the following factors:● Low birth weight● Multiple births● Teen age mother● Adequate weight gain ● Birth order● Maternal smoking ● Educational attainment of mother● Race● Method of payment for delivery● Marital status● Adequacy of prenatal care
2.00
1.22
0
0.5
1
1.5
2
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH BLACK MOTHERS
VERSUS OTHER RACES
Multivariate result is statistically significant
8
INFANT MORTALITY RATESALABAMA AND UNITED STATES1 BY RACE,
1997-2007
02468
1012141618
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e pe
r 1,
000
Liv
e B
irth
s
8.0
5.7
13.7
14.6
1 2004 US rate is provisional 2005 US rate is not available.
US-BLACK
AL-BLACK
AL-WHITE
US-WHITE
9
INFANT MORTALITY RATES HISPANIC INFANTS, ALABAMA, 1997-2007
2.8
5.2 5.0 4.7 4.85.7 5.4
6.5
8.4
7.2 7.3
0
2
4
6
8
10
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
YEAR
Rat
e pe
r 1,
000
Liv
e B
irth
s
10
PERCENT OF BIRTHS TO TEENAGERSALABAMA, 1997-2007
17.6 17.116.2 15.7
14.9 14.6 13.9 14.013.1 13.8 13.7
0
24
6
810
12
14
1618
20
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cen
t of
All
Liv
e B
irth
s
11
INFANT MORTALITY RATESTEENAGERS vs. ADULTS ALABAMA, 2007
13.8
9.4
0
2
4
6
8
10
12
14
Teenagers Adults
Rat
e pe
r 1,
000
Liv
e B
irth
s
1.47
1.25
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH TEEN MOTHER VERSUS
ADULT MOTHER
Multivariate result is statistically significant
13
PERCENT OF LOW WEIGHT BIRTHS BY RACE ALABAMA, 1960-2007
9.9 10.0 10.5 10.7 10.5 10.4
6.8 6.95.6
6.27.1
7.7 7.6 7.9 8.1 8.4 8.6 8.3 8.2
11.2
13.311.9 12.5 12.8
13.7 13.9 14.2 14.214.8 15.0 15.1 15.4
9.69.79.08.4
7.98.59.0
02468
10121416
Year
Perc
ent o
f Liv
e B
irth
s
Total White Black & Other
14
INFANT MORTALITY RATESLOW vs. NORMAL WEIGHT BIRTHS
ALABAMA, 1997-2007
0
10
20
30
40
50
60
70
80
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e pe
r 1,
000
Liv
e B
irth
s
LOW WEIGHT
NORMAL WEIGHT
63.5
3.2
20.86
16.71
0
5
10
15
20
25
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH LOW BIRTH WEIGHT
VERSUS NORMAL BIRTH WEIGHT
Multivariate result is statistically significant
16
NUMBER OF BIRTHS WEIGHING LESS THAN 500 GRAMS, ALABAMA, 1997-2007
143161 160 155
136 134 137126
147 147
171
0
20
40
60
80
100
120
140
160
180
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Nu
mb
er o
f L
ive
Bir
ths
17
MULTIPLE BIRTHS AS A PERCENT OF TOTAL BIRTHS
ALABAMA, 1997-2007
2.93.1 3.0
3.4 3.4 3.4 3.33.5 3.5 3.6
3.4
0
1
2
3
4
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cent
of
All
Liv
e B
irth
s
18
INFANT MORTALITY RATESSINGLETON AND MULTIPLE BIRTHS
ALABAMA, 1997-2007
0
10
20
30
40
50
60
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e pe
r 1,
000
Liv
e B
irth
s 53.7
8.5
MULTIPLE
SINGLETON
5.43
1.22
0
1
2
3
4
5
6
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH MULTIPLE BIRTH VERSUS
SINGLETON BIRTH
Multivariate result is statistically significant
20
PERCENT OF BIRTHS WITH ADEQUATE PRENATAL CARE1
ALABAMA, 1997-2007
76.2 76.6
77.877.2 76.8
77.778.2 78.1
76.7
75.3
72.8
70717273747576777879
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cent
of
All
Liv
e B
irth
s
1 Adequacy of care measured using the Kessner index.
21
INFANT MORTALITY RATES BY ADEQUACY OF PRENATAL CARE1
ALABAMA, 2007
8.7
12.7
0
2
4
6
8
10
12
14
Adequate Less than Adequate
Adequacy of Prenatal Care
Rat
e pe
r 1,
000
Liv
e B
irth
s
1 Adequacy of care measured using the Kessner index.
1.5
1.03
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH LESS THAN ADEQUATE
PRENATAL CARE VERSUS ADEQUATE
Multivariate result is not statistically significant
BIRTHS WITH NO PRENATAL CAREALABAMA 1997-2007
689 710 702 672 675727
791
987
12461496
620
0200400600800
1000120014001600
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Num
ber o
f bir
ths
24
INFANT MORTALITY RATE BY METHOD OF PAYMENT, ALABAMA, 2007
11.0
7.7
18.3
0
5
10
15
20
Medicaid Private Insurance Self Pay
Method of Payment
Rat
e pe
r 1,
000
Liv
e B
irth
s
1.62
1.04
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH MEDICAID VERSUS
NONMEDICAID
Multivariate result is not statistically significant
26
INFANT MORTALITY RATES BY EDUCATIONAL STATUS, ALABAMA, 2007
11.8 11.3
7.8
0
2
4
6
8
10
12
< 12 years H S Graduate 13 or moreEducational Status
Rat
e pe
r 1,
000
Liv
e B
irth
s
1.51
1.08
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH LESS THAN HIGH SCHOOL
GRADUATE VERSUS HIGH SCHOOL GRADUATE OR HIGHER
Multivariate result is statistically significant
28
MATERNAL SMOKING BY AGE OF MOTHERALABAMA, 2000-2007
10
11
12
13
14
15
16
2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cent
of
All
Liv
e B
irth
s
12.7
11.9
TEENS
ADULTS12.0
15.1
29
INFANT MORTALITY RATES BY SMOKINGSTATUS, ALABAMA, 2007
12.6
9.5
0
2
4
6
8
10
12
14
Smoked Did Not SmokeSmoking Status
Rat
e pe
r 1,
000
Liv
e B
irth
s
1.42
1.10
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH SMOKER VERSUS
NON-SMOKER
Multivariate result is statistically significant
Factors for Additional Investigation
• Twins• Prior Infant Death• Short Birth Interval• Maternal Weight Gain
4.19
2.55
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
OD
DS
RA
TIO
BIVARIATE MULTIVARIATE
Multivariate AnalysisODDS OF INFANT DEATH WITH LOW MATERNAL WEIGHT GAIN VERSUS NORMAL WEIGHT GAIN
Multivariate result is statistically significant
Summary
• Very low weight births are up• Prenatal care is down• Smoking by mother increases risk of infant death• Women who had prior infant death at risk• Low maternal weight gain during pregnancy
appears to be a factor• Deaths for multiple births are up
Interventions
• Fetal-Infant Mortality Review• Prenatal care for women receiving
inadequate or no prenatal care• Family planning• Interpregnancy care for targeted group• Smoking cessation/prevention and second
hand smoke