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Infant Mortality – Impact on overall Child Mortality in Kansas

Infant Mortality – Impact on overall Child Mortality in Kansas. Effective Strategies to reduce infant mortality July 17, 2009. Presentation Goals:. 1. Describe the impact of fetal and infant deaths on the overall child mortality rate for the US and Kansas

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Infant Mortality – Impact on overall Child Mortality in Kansas

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  1. Infant Mortality – Impact on overall Child Mortality in Kansas Effective Strategies to reduce infant mortality July 17, 2009

  2. Presentation Goals: 1. Describe the impact of fetal and infant deaths on the overall child mortality rate for the US and Kansas 2. Identify the risk factors contributing to infant deaths due to conditions originating in the perinatal period. 3. Conduct effective reviews of infant deaths using lessons learned from FIMR

  3. Definition: The death of any live born infant prior to his/her first birthday. “The most sensitive index we possess of social welfare . . . ” Julia Lathrop, Children’s Bureau, 1913 Infant Mortality

  4. Definition of Live Birth ‘‘Live Birth’’ means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes, or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Source: K.S.A. 1995 Supplement 65-2401, subsection (2), amended and effective July 1, 1995.

  5. Definition of Fetal Death ‘‘Stillbirth’’ means any complete expulsion or extraction from its mother of a product of human conception the weight of which is in excess of 350 grams, irrespective of the duration of the pregnancy, resulting in other than a live birth as defined in this act and which is not an induced termination of pregnancy. Source: K.S.A. 1995 Supplement 65-2401, subsection (3), amended and effective July 1, 1995.

  6. Recommended Reporting of Fetal Deaths The 1992 Revision of the Model State Vital Statistics Act and Regulations recommends: ‘‘Each fetal death of 350 grams or more, or if weight is unknown, of 20 completed weeks gestation or more, calculated from the date last normal menstrual period began to the date of delivery, is reported to the office of Vital Records.

  7. Variation in Fetal Death Reporting across States • Eleven areas report all periods of gestation • 25 areas report gestation periods of 20 weeks or more • 13 areas specify birth weight of 350 grams or more or 20 weeks of gestation or more; • 1 area specifies 20 weeks or more or birth weight of 400 grams • 1 area specifies 20 weeks or more or birth weight of 500 grams • 1 area specifies 16 weeks of gestation or more • 1 area specifies 5 months of gestation or more.

  8. Additional Definitions • Perinatal Death • Fetal deaths (stillbirths) plus infant deaths under 7 days • Neonatal Death • Live birth dying within 28 days • Post-Neonatal Death • Live birth dying between 28 days and 1 year Source: National Center for Health Statistics, CDC

  9. US Infant Mortality Rate Deaths per 1000 live births

  10. US Infant Death Rates 1995 - 2006 2006 = 28, 527 infant deaths

  11. US Fetal Death Rates 1995 - 2005 2005, 25,894 Fetal Deaths

  12. Maternal Mortality • 569 Maternal Deaths in the US in 2006 • Rate = 13.3/100,000 live births • White Rate = 9.5/100,000 • Hispanic Rate = 10.5/100,000 • Black Rate = 32.7/100,000 • Disparity Ratio for Black to White of 3.5/1

  13. Total US Deaths of Children ages 0 – 19 years 53,501 Child deaths in 2005, 0 – 19 years 28,440 or 53% are infant under 1

  14. Kansas: Percent of Child Deaths by age at Death In 2005, 547 Child Deaths 0 – 19. 294, or 54% were Infants under one

  15. Infant mortality rates by maternal race/ethnicity US, 1996-2005 All race categories exclude Hispanics. An infant death occurs within the first year of life. Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved April 8, 2009, from www.marchofdimes.com/peristats.

  16. Infant mortality rates by maternal race/ethnicity US, 2005 All race categories exclude Hispanics. An infant death occurs within the first year of life. Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved April 8, 2009, from www.marchofdimes.com/peristats.

  17. Neonatal and postneonatal mortality rates US, 1960-2005 A neonatal death occurs in the first 28 days of life. A postneonatal death occurs between 28 days and one year of life. Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved April 8, 2009, from www.marchofdimes.com/peristats.

  18. Preterm births among singleton deliveries US, 2006 Preterm is less than 37 completed weeks gestation. Source: National Center for Health Statistics, final natality data. Retrieved April 8, 2009, from www.marchofdimes.com/peristats.

  19. Mississippi (11.3) Louisiana (10.1) South Carolina (9.4) Alabama (9.4) Delaware (9.0) Tennessee (8.9) North Carolina (8.8) Ohio (8.3) Georgia (8.2) Oklahoma (8.1) West Virginia (8.1) Indiana (8.0) Arkansas (7.9) Michigan (7.9) Missouri (7.5) Virginia (7.5) State Rankings for Overall Infant Mortality • Kansas (7.4) Source: National Kids Count Database

  20. Kansas Infant Mortality: Black and White Deaths per 1000 live births Source: 1995-2007 The Kansas Department of Health and Environment Vital Records

  21. Kansas’ Disparity Ratio B/W ratio 2.8 Source: 1995-2007 The Kansas Department of Health and Environment Vital Records

  22. Kansas Ranks 47th among States for Black Infant Mortality Rate Source: National Center for VS, CDC

  23. Percent of all Kansas Births by Race, 2007 • Total births: 41,951 • White births: 30,170 (72%) • Black births: 2,856 (6.8%) • Hispanic Moms, all races: 6,676 (15.9%) • Other/Multiple races, non-hispanic: 5.3% Source: 1995-2007 The Kansas Department of Health and Environment Vital Records

  24. Percent of Births by Race and EthnicityUS Compared to Kansas

  25. Kansas Infant Mortality trendRates by Race & Ancestry Deaths per 1000 live births Source: 1995-2007 The Kansas Department of Health and Environment Vital Records

  26. Leading Causes of Infant Death (2007)from Death Certificates 62% Source: 1995-2007 The Kansas Department of Health and Environment Vital Records

  27. Preterm and Low Birth Weight in KansasPercent of all Live Births Source: March of Dimes, Peristats http://www.marchofdimes.com/peristats/

  28. Infant Mortality Weathering Racism Bad Housing Unemployment Fatherless households Bad Neighborhoods Hopelessness Premature Birth Stress Poverty Low Birth Weight Limited Access to Care Smoking Substance Use Family Support Under- Education Poor Working Conditions Genetics Nutrition With permission from Arthur James, MD

  29. When Vital Statistics alone cannot tell us the story . . . . . . . Communities turn to FIMR to tell us how and why babies are dying

  30. Addison and Aiden were the most popular names given tonewborns by Kansas parents in 2008. Source: 1996-2009 The Kansas Department of Health and Environment

  31. A process that tells us How and Why babies die in a community Fetal Infant Mortality Review1988 - 2009

  32. National Fetal and Infant Mortality Review (NFIMR) NFIMR is a Collaborative Effort between the: • American College of Obstetricians and Gynecologists (ACOG) • Federal Maternal and Child Health Bureau, Health Resources and Services Administration (MCHB, HRSA)

  33. FIMR 1988

  34. FIMR Today Over 240 projects in 42 states

  35. Characteristics of State FIMR Programs • Over 240 Local FIMR projects in 42 States • 25 States have a State Coordinator with training and technical assistance available • Most FIMR’s are administered through local public health

  36. FIMR brings a multidisciplinary community team together to examine confidential, de-identified cases of infant deaths. Review Team The FIMR Process

  37. CRT Case Review Team CAT Community Action Team FIMR: Two Tiered Process

  38. Selected Components of FIMR

  39. Confidentiality • FIMR cases are de-identified so that the names of families, providers and institutions are confidential – the FIMR focus is on improving systems, NOT assigning blame.

  40. FIMR Focuses on Systems • Each FIMR case review provides an opportunity to improve communication among medical, public health and human service providers and develop strategies to improve services and resources for women, children and families.

  41. “The process that brings together people to learn from the story of a family that experienced a fetal or infant loss helps awaken both commitment and creativity. The stories illustrate community needs that are concrete, local and significant. The interaction among diverse community participants generates ideas for action that might lie beyond the imagination and power of an individual provider or agency.” Seth Foldy, MD Former Commissioner of Health, Milwaukee WI

  42. FIMR Includes a Family Perspective Home Interview • Gives insight into the mother’s experience before and during pregnancy • Conveys the mother’s story of her encounters with local service systems

  43. “Maternal interviews give a voice to the disenfranchised in my community, those without clout or power. FIMR provides a rare opportunity for the ‘providers’ in a community to hear from the consumers.” Patt Young, FIMR Interviewer, Alameda/Contra Costa Counties, CA

  44. FIMR Promotes Broad Community Participation • FIMR is a community coalition that can represent all ethnic and cultural community views and becomes a model of respect and understanding.

  45. “The Growing Into Life FIMR Task Force…has built respect and friendship among races, between classes, around language, and among those of differing political and economic interests.”Karen Papouchoado, Former MayorAiken, SC

  46. FIMR is Action-Oriented. FIMR leads to multiple creative community actions to improve resources and service systems for women, infants and families.

  47. FIMR’s Strength • Access to medical records • Home Interviews (Qualitative Data) • Community specific determinants of Infant Mortality

  48. Use of Data • Death certificates provide an overview of all infant deaths • When matched with birth certificates, we know maternal characteristics, prenatal care, and labor complications • FIMR provides information on more specific psychosocial issues, gaps in care, factors which contribute to infant death in specific communities

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