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Investigating Troubling Trends: The State Infant Mortality Initiative

Investigating Troubling Trends: The State Infant Mortality Initiative. State Infant Mortality Toolkit. William Sappenfield—CDC Greg Alexander—USF. 2006 Annual AMCHP Conference Arlington, VA – March 6, 2006. Toolkit Purpose. State Infant Mortality Toolkit.

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Investigating Troubling Trends: The State Infant Mortality Initiative

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  1. Investigating Troubling Trends: The State Infant Mortality Initiative State Infant Mortality Toolkit William Sappenfield—CDC Greg Alexander—USF 2006 Annual AMCHP Conference Arlington, VA – March 6, 2006

  2. Toolkit Purpose State Infant Mortality Toolkit To provide a systematic approach for state public health agencies to examine their state’s high and/or increasing infant mortality rate based on current knowledge and available information.

  3. Toolkit Framework State Infant Mortality Toolkit Stage 1 – Overview Investigation Stage 2 – Focused Investigation

  4. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation

  5. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation Environmental Attributes Health Services Maternal Attributes

  6. U A B SCHOOL OF PUBLIC HEALTH Maternal and Child Health Infant Mortality Assessment Manual Greg R. Alexander, RS, MPH, ScDSara Nabukera, M.D., MPHDeren Bader, MPHMartha Slay-Wingate, MPH University of Alabama at BirminghamSchool of Public HealthDepartment of Maternal and Child Health Introduction Purposes and Objectives Data Sources Questions for Assessment Statistical Analysis and Interpretation SAS Program References Appendix Home Website: http://www.soph.uab.edu/mch-imrm/index.htm

  7. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation Environmental Attributes Health Services Maternal Attributes

  8. Birth Weight for Gestational Age Categories * Based on 1991 US reference curve

  9. Temporal Change in Outcomes1985-88 (reference) & 1995-2000

  10. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation Environmental Attributes Health Services Maternal Attributes

  11. Maturity & Mortality TrendsUSA

  12. Maturity & Mortality TrendsHawaii

  13. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation Environmental Attributes Health Services Maternal Attributes

  14. Why recommend themodified Dollfus method • Has only 9 categories • Good ICD-9 to ICD-10 comparability ratios • Practical and preventive perspective • Developed by a North Carolina researcher

  15. Cause-specific infant mortality rates in North Carolina, 2001-2003 and the U.S., 2001-2002

  16. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation Environmental Attributes Health Services Maternal Attributes

  17. Reported Vital Events Conception 1 Year Live Birth Gestation Infancy 20 wks 4 wks Infant Death Fetal Death Feto-Infant Death

  18. Vital Events: In-State Trends Reporting • Change in reporting regulation, process, or training? • Change in reporting type of event? • Clarification of viability or gestation? • Change in quality processing?

  19. NSFG--73% MO DE NC HI LA Number of States by Percent of All Fetal Deaths 20 to 27 Weeks Gestation, 2000-02

  20. So What? Assumptions: • The “real” percentage of 20-27 wks is 73% • Your state’s percentage is 35% or 35 deaths of 100 deaths (35 + ?) / (100 + ?) = 73% Answer 143 additional deaths

  21. Number of States by Percent of All Live Birth <1,500 Grams, 2000-02

  22. Infant Mortality Rates for <500g Live BirthsLouisiana & US

  23. Toolkit Framework Stage 1 – Overview Investigation Maturation-Specific Maturation Data Reporting Age & Cause Stage 2 – Focused Investigation Environmental Attributes Health Services Maternal Attributes

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