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Michelle Chiezah, MA, MPH Maternal and Child Health Section
Community and Family Health DivisionMinnesota Department of Health
November 16, 2016
Infant Mortality in Minnesota: A Focus on Black/African Americans
Maternal and Child Health Section, Minnesota Department of Health
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Background
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What is Infant Mortality?
Infant mortality is defined as the death of a live born infant during the first year of life.
Infant mortality is usually divided into two categories based on age:
(1) Neonatal mortality— death of infants aged 0-27 days
(2) Post-neonatal mortality— death of infants aged 28 days to 1 year old
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What Does the Infant Mortality Rate Indicate or Suggest?
The infant mortality rate is the number of infant deaths per 1,000 live births.
It is an important indicator of the health status of a population. Factors affecting the health of populations can also affect infant mortality
The IMR reflects “…a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices.”1
1Source: MacDorman 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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Source: Disparities in Infant Mortality, January 2009
http://www.health.state.mn.us/divs/chs/infantmortality/infantmortality09.pdf
A Complex Multi-Factorial Problem
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Contributing Factors to Infant Health Outcomes
• Individual-Mother ( Health, Demographic, ...)-Infant ( Birth Health Status )
• Environment / Community-Physical (e.g., Housing, Safety, Environmental Hazards)-Economic (Income, Employment, Education, . . )-Social (Culture, Racism, Stress, . . .)
• Systems-Health Care Delivery-Public Health (National, State, Local)-Other (transportation, interpreters, cultural competence of services)
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Infant Mortality Data 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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Births and Deaths
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Percentage of Births by Maternal Nativity, Minnesota, 1990-2013
94.6
82.0
5.4
18.0
0
10
20
30
40
50
60
70
80
90
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Perc
en
t
Year
US-born
Foreign
Source: MDH, MCHS linked Infant Death/Birth File
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Percentage of Black/African American Births by Maternal Nativity, Minnesota1990-2013
6.1
53.0
93.9
47.0
0
10
20
30
40
50
60
70
80
90
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Pe
rce
nt
Year
Foreign-born
U.S. Born
Source: MDH, MCHS linked Infant Death/Birth File
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Year
Source: Minnesota Department of Health, Center for Health Statistics
380
346353
324 325
370 375
404
429
315 313324
340349
5.65.0
0
50
100
150
200
250
300
350
400
450
0
1
2
3
4
5
6
7
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er o
f In
fan
t D
eat
hs
Infa
nt
Mo
rtal
ity
Rat
e
Number of Infant Deaths and Infant Mortality Rates, Minnesota 2000-2013
Number of Deaths
Infant Mortality Rates
11
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Year
Source: Minnesota Department of Health, Center for Health Statistics
62
39
47
37
49
70
60
70
90
55
49
5856
75
14.2
9.9
0
10
20
30
40
50
60
70
80
90
100
0
2
4
6
8
10
12
14
16
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er
of
Infa
nt
Dea
ths
Infa
nt
Mo
rtal
ity
Rat
e
Number of Infant Deaths and Infant Mortality Rates for Black/African Americans, Minnesota, 2000-2013
Number of Deaths
Infant Mortality Rates
12
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Percentage of Black/African American Infant Deaths by Maternal Nativity Minnesota, 2000-2013
U.S.-Born65.3%
Foreign-born34.7%
Source: Minnesota Department of Health, Center for Health Statistics
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Percent Distribution of U.S.-Born Black/African American Infant Deaths by Minnesota County, 2010-2014
Hennepin46.5%
Ramsey25.7%
Anoka, Carver, Dakota, Scott, Washington
11.4%
All Other Counties
16.3%
Source: Minnesota Department of Health, Center for Health Statistics
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Black/African American Infant Mortality Rates by County and City, Minnesota2010-2014
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National and Regional Comparisons
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Infant Mortality Rates by Year of Birth, Minnesota and U.S.3-Year Averages
7.2
5.95.9
4.9
0
1
2
3
4
5
6
7
8
Ra
te p
er
1,0
00
Liv
e B
irth
s
Year
US Minnesota Healthy People 2020 Target
Source: National Center for Health Statistics*HP 2020 Infant Mortality Target is 6.0 infant deaths per 1,000 live births
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Black/African-American Infant Mortality Rates,1 Minnesota, 2000-2004 through 2009-2013
5.0 5.0 4.9 5.05.3 5.2 5.1 5.0 4.9 4.8
9.5 9.3 9.49.6
10.8 10.7
9.8 9.79.2
8.5
4.5 4.4 4.4 4.44.6 4.5 4.4 4.4 4.3
4.1
0
1
2
3
4
5
6
7
8
9
10
11
2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2009-2013
Rate
per
1,0
00 L
ive B
irth
s
MN Total African American White HP 2020 Target
Year
1Five-year averages *HP 2020 Infant Mortality Target is 6.0 infant deaths per 1,000 live birthsSource: Minnesota Department of Health, Center for Health Statistics
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Infant Mortality Rates & Rank by Race/Ethnicity Among Region V States, 2011-2013
State Total Non-
Hispanic
Black
Non-Hispanic
American
Indian or
Alaska Native1
Asian or
Pacific
Islander
Hispanic Non-
Hispanic
White
Region V
Rank
Illinois 6.3 12.9 -- 4.6 5.2 4.8 3
Indiana 7.1 12.8 -- 5.1 6.0 6.4 5
Michigan 6.8 13.1 8.8 4.3 5.9 5.3 4
Minnesota 4.9 8.8 11.2 4.5 5.3 4.2 1
Ohio 7.6 13.5 -- 4.2 6.9 6.3 6
Wisconsin 6.0 14.0 8.0 6.7 5.2 5.0 2
U.S. 5.9 11.2 8.0 4.1 5.0 5.0 N/ASource: National Center for Health Statistics--Data not available.1 Includes Aleuts and Eskimos
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Infant Mortality Rates1 by Race/Ethnicity of Mother, Minnesota, 2000-2004 through 2009-2013
0
1
2
3
4
5
6
7
8
9
10
11
2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011 2008-2012 2009-2013
Rate
per
1,0
00 L
ive B
irth
s
Total African AmericanAmerican Indian or Alaska Native AsianHispanic* WhiteHP 2020
Year
*Hispanic can be of any race1Five-year rolling averages Source: Minnesota Department of Health, Center for Health Statistics
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Infant Mortality Rates1 and Rate Ratios2 among Infants born to Black/African American Mothers, Minnesota, 2000-2004 through 2009-
2013
2000-2004
2001-2005
2002-2006
2003-2007
2004-2008
2005-2009
2006-2010
2007-2011
2008-2012
2009-2013
African American 9.5 9.3 9.4 9.6 10.8 10.7 9.8 9.7 9.2 8.5
White 4.5 4.4 4.4 4.4 4.6 4.5 4.4 4.4 4.3 4.1
African American-White Ratio 2.1 2.1 2.1 2.2 2.4 2.4 2.2 2.2 2.1 2.1
White Comparison Group 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
0.0
0.5
1.0
1.5
2.0
2.5
3.0
0
1
2
3
4
5
6
7
8
9
10
11
Afr
ican
Am
eric
an: W
hit
e R
ate
Rat
io
Rate
pe
r 1
,00
0 liv
e b
irth
s
*1Five-year rolling averages 2Rate Ratios are calculated by dividing a specific population’s IMR by the White rateSource: Minnesota Department of Health, Center for Health Statistics
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Causes
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Percent Distribution of the Leading Causes of Infant Deaths, Minnesota, 2009-2013
Congenital Anomalies
25.7
Prematurity19.6
SUID*11.9
11.7 Obstetric Conditions
Injury2.1
Birth Asphyxia0.9
Other28.3
*SUID includes SIDS and sleep-related infant deathsSource: Minnesota Department of Health, Center for Health Statistics
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Top Five Leading Causes1 of Infant Mortality by Race/Ethnicity of Mother, Minnesota,2009-2013
Race/Ethnicity First Second Third Fourth Fifth
African American Prematurity
(23.2%)
Congenital Anomalies
(22.9%)
Obstetric Conditions
(11.9%)
SUID (includes SIDS
and Sleep-Related
Infant Deaths
(11.6%)
Birth Asphyxia
(1.0%)
American Indian SUID (includes SIDS and
Sleep-Related Infant
Deaths
(29.9%)
Congenital
Anomalies
(16.4%)
Prematurity
(11.9%)
Obstetric Conditions
(9.0%)
Injury
(3.0%)
Asian Congenital Anomalies
(30.4%)
Prematurity
(23.2%)
Obstetric Conditions
(14.3%)
SUID (include SIDS
and Sleep-Related
Infant Deaths
(5.4%)
Birth Asphyxia
(0.9%)
Hispanic* Congenital
Anomalies
(32.6%)
Prematurity
(20.5%)
SUID (includes SIDS
and Sleep-Related
Infant Deaths
(12.1%)
Obstetric Conditions
(8.3%)
Injury
(2.3%)
White Congenital Anomalies
(25.4%)
Prematurity
(18.3%)
SUID (includes SIDS
and Sleep-Related
Infant Deaths
(12.1%)
Obstetric Conditions
(11.7%)
Injury
(2.3%)
Total Congenital Anomalies
(25.7%)
Prematurity
(19.6%)
SUID (includes SIDS
and Sleep-Related
Infant Deaths
(11.9%)
Obstetric Conditions
(11.7%)
Injury
(2.1%)
24
1Excludes deaths classified as “other.”*Can be of any raceSource: Minnesota Department of Health, Center for Health Statistics
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5.7
4.6
3.5 3.5
2.8
3.2
2.8
4.9
0.9
1.8
1.31.5
0
1
2
3
4
5
6
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Neonatal and Post-Neonatal Mortality Rates by Race/Ethnicity of Mother, Minnesota, 2009-2013
Neonatal Post-Neonatal
*Can be of any raceSource: Minnesota Department of Health, Center for Health Statistics
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11.611.3
10.8 10.7
9.4 9.39.8
0
2
4
6
8
10
12
14
Black/AfricanAmerican
American Indian Asian Hispanic* White Other/Unknown MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Percentage of Preterm* births by Race/Ethnicity, Minnesota, 2014
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38.3
29.9
27.028.4
24.126.6
3.45.6
1.32.5 1.7 1.9
0
5
10
15
20
25
30
35
40
45
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Infant Mortality Rates by Gestational Age and Race/Ethnicity, Minnesota, 2009-2013
<37 Weeks >=37 Weeks
*Can be of any raceSource: Minnesota Department of Health, Center for Health Statistics
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56.853.8
41.0
52.7
41.945.2
3.05.9
1.1 2.1 1.7 1.8
0
5
10
15
20
25
30
35
40
45
50
55
60
65
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Infant Mortality Rates by Birth Weight and Race/Ethnicity, Minnesota, 2009-2013
<2,500g >=2,500g
*Can be of any raceSource: Minnesota Department of Health, Center for Health Statistics
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Maternal Characteristics
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11.7
9.7
#
5.8
4.14.7
5.4
4.2
5.0
3.8
4.7
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Infant Mortality Rates by Maternal Nativity and Race/Ethnicity of Mother, Minnesota, 2009-2013
U.S.-Born Foreign-Born
*Can be of any race#Indicates unstable rates; fewer than 20 casesSource: Minnesota Department of Health, Center for Health Statistics
4.9
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12.1
# #
6.5
8.4 8.57.9
9.1
4.2
5.6
3.94.5
9.5
#
6.0
#
4.04.7
0
2
4
6
8
10
12
14
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Infant Mortality Rates by Maternal Age and Race/Ethnicity of Mother, Minnesota, 2009-2013
<20 20-34 35+
*Can be of any race#Indicates unstable rates; fewer than 20 casesSource: Minnesota Department of Health, Center for Health Statistics
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9.5
# #
5.86.1
6.9
8.8
9.5
5.7
4.94.6
5.3
#
3.3
#
3.1 3.2
0
2
4
6
8
10
12
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Infant Mortality Rates by Maternal Education and Race/Ethnicity of Mother, Minnesota, 2009-2013
0 to 11 years 12 to 16 years 16+ years
*Can be of any race#Indicates unstable rates; fewer than 20 casesSource: Minnesota Department of Health, Center for Health Statistics
10.6
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16.1
12.5
# #
7.2
8.57.7 7.4
4.34.9
3.64.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
e p
er 1
,00
0 L
ive
Bir
ths
Race/Ethnicity
Infant Mortality Rates by Maternal Smoking Status and Race/Ethnicity of Mother, Minnesota, 2009-2013
Yes No
*Can be of any race#Indicates unstable rates; fewer than 20 casesSource: Minnesota Department of Health, Center for Health Statistics
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3.8**
6.6
7.7 7.8
4.9**
7.1
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Non-HispanicBlack
American Indian Hispanic* Non-HispanicWhite
Other Minnesota Total
Pe
rcen
t
Race/Ethnicity
Percent of Women Who Consumed Alcohol During the Last 3 Months of Pregnancy by Race/Ethnicity, 2009-2013
*Can be of any race
**Significantly different from Non-Hispanic Whites (p<.05)Consumed any amount of alcohol during pregnancy among those who drank any alcoholic beverages in the previous two years.Other includes Asians, Foreign-born, Mixed Race, and data for which the race of the respondent is unknown.Source: Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS), Minnesota Department of Health, Division of Community and Family Health, Maternal and Child Health.
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8.37.9
4.04.5
3.84.3
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Black/AfricanAmerican
American Indian Asian Hispanic* White MN Total
Rat
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er 1
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ive
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ths
Race/Ethnicity
Infant Mortality Rates by First Trimester Prenatal Care Initiation and Race/Ethnicity of Mother, Minnesota, 2009-2013
*Can be of any race#Indicates unstable rates; fewer than 20 casesSource: Minnesota Department of Health, Center for Health Statistics
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Plans To Reduce Infant Mortality in MN!
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Examples of Past or Ongoing Evidence-Based Infant Mortality Activities/Programs in Minnesota
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Healthy Babies are Worth the Wait Campaign
MN Prematurity Coalition
Minneapolis Healthy Start
Eliminating Health Disparities Community Grants
2015 Breastfeeding Summit
DHS Elective Induction Coverage Policy
MN Medicaid Family Planning Waiver
MDH Preconception Health Work Group
Infant Mortality Reduction Plan
Low Birth Weight Initiative
MDH Health Equity Efforts
Women’s Children and Infant’s Nutrition Program (WIC) Special
Supplementation Nutrition Program
MN SID Center Grant (SUID reduction)
Family Planning Special Projects Grants Programs
MCH Title V Black Grant
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New Clinical/Hospital-based Efforts
Reduce the incidence of Sleep-Related Infant Deaths Modeling safe sleep in hospitals via the National Safe
Sleep Certification Program
Reduce Prematurity MN 17P clinical quality improvement initiative to reduce
subsequent preterm births in the African American and American Indian populations
Place-based
MDH State Partnership Initiative to Improve Minority Health Grant *
New Efforts and Partnerships
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Next Steps
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“Health equity means achieving the conditions in which all people have the opportunity to realize their health potential — the highest level of health possible for that person — without limits imposed by structural inequities.”
MDH Advancing Health EquityReport to the Legislature
February 2014
Advance Health Equity
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The Determinants of Health
Source: Tarlov AR. (1999). Public policy frameworks for improving population health. Ann NY Acad Sci 1999; 896: 281-93.
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Layers of Influence on Health
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Advance Health Equity
Change the narrative about what creates health
Change our approach to improving health for all
Focus on the Triple Aim of Health Equity
Advance health equity across the life course!
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Questions and Discussion
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The Infant Mortality Reduction Plan (Part One) may be found here:
http://www.health.state.mn.us/divs/cfh/program/infantmortality/
Infant Mortality Reduction Plan
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Thank You!
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Contact
Michelle A. ChiezahState’s Infant Mortality ConsultantMinnesota Department of Health
[email protected]: (651) 201-3621