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