Using Birth Data to Reduce Infant Mortality in Minnesota

1. Using Birth Data to Reduce Infant Mortality in Minnesota 2014 Excellence in Birth Registration Conference Presented by: Michelle A. Chiezah, M.A., M.P.H. Maternal and Child Health Section Community and Family Health Division Minnesota Department of Health May 1, 2014

2. Background

3. Minnesota’s Infant Mortality Reduction Initiative (MIMRI) • Is an effort of the Minnesota Department of Health to improve birth outcomes and reduce infant mortality in Minnesota with an emphasis on reducing disparities in rates (e.g., racial/ethnic). • MIMRI provides the following: • Statewide leadership • Resources • Education and information • Technical assistance to tribal governments, local public health departments, and community agencies • MIMRI also uses the most current data (e.g., vital records) to help plan, coordinate, and evaluate interventions and activities. • Birth Data are Essential!! • MIMRI has numerous partners including: MN Chapter of the March of Dimes, Minnesota Perinatal Organization, Tribal Governments, Local Public Health Departments, Twin-Cities Healthy Start, WIC, MN Center for Health Statistics, Office of Minority and Multicultural Health (OMMH), to name a few!

4. What is Infant Mortality? Infant mortality is the death of an infant before age one.

5. What Is the Infant Mortality Rate? • The infant mortality rate (IMR) is expressed as the number of infant deaths per 1,000 live births. • For example: In 2011, there were 324 infant deaths and 68,783 live births in Minnesota. What was the infant mortality rate? 324/68,783 x 1,000 = 4.7 infant deaths per 1,000 live births Interpretation: In 2011, the IMR in Minnesota was 4.7 infant deaths per 1,000 live births.

6. What Does the Infant Mortality Rate Indicate or Suggest? • The IMR is one of the most important indicators of health. • The IMR reflects “…a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices.”1 1MacDorman 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.

7. Disparities

8. What is a health disparity?

9. A health disparity is not: • A type of disease or a health condition. • A person of color with a disease or health condition. • A poor person or other persons from disparate populations with a disease or other adverse health conditions.

10. Health disparities are: “Differences in the incidence, prevalence, mortality and burden of disease and other adverse health conditions that exists between specific populations groups.” Source: “Advancing Health Equity in Minnesota.” Minnesota Department of Health (Flyer). http://www.health.state.mn.us/divs/chs/healthequity/definitions2013.pdf. 21 October 2003. Accessed on 4/25/2014.

11. Some Data

12. Infant Mortality 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

13. Number of Births in Minnesota, 2000-2011 Source: Minnesota Center for Health Statistics

14. Number of Infant Deaths in Minnesota, 2000-2011 Source: Minnesota Center for Health Statistics

15. Percent of Black/African American Births by Maternal Nativity in Minnesota, 1990-2010 Source: MDH, MCHS linked Infant Death/Birth File

16. Infant Mortality Rates by Year of Birth in Minnesota and U.S. (3-year Averages) Source: National Center for Health Statistics

17. Infant Mortality Rates by Geography1 in Minnesota, 2006-2010 1Geographic classification is based on Minnesota’s 50 health boards which are grouped into 8 geographic regions Community Health Boards by SCHSAC Region. Community Health Services Advisory Committee. http://www.health.state.mn.us/divs/cfh/ophp/about/maps.html Sources: Minnesota Department of Health, Center for Health Statistics.

18. Infant Mortality Rates by Race/Ethnicity of Mother in Minnesota, 1995-1999 and 2006-2010 *Can be of any race Source: Minnesota Department of Health, Center for Health Statistics

19. Leading Causes of Infant Deaths in Minnesota, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics * The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

20. Leading Causes of Infant Deaths by Race/Ethnicity of Mother in Minnesota, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

21. Source: Disparities in Infant Mortality, January 2009 http://www.health.state.mn.us/divs/chs/infantmortality/infantmortality09.pdf

22. Contributing Factors to Infant Mortality • Individual • -Mother ( Health, Demographic, ...) • -Infant ( Birth Health Status ) • Environment / Community • -Physical (Housing, Safety, Environmental Hazards, . . ) • -Economic (Income, Employment, Education, . . ) • -Social (Culture, Racism, Stress, . . .) • Systems • -Health Care Delivery • -Public Health (National, State, Local)

23. Infant Mortality in Minnesota by Selected Contributing Factors • Age of Mother • Adequacy of prenatal care • Infant Birth Weight • Infant Gestational Age • Maternal Education

24. Infant Mortality Rates by Age and Race/Ethnicity of Mother in Minnesota, 2006-2010 *Can be of any race Source: Minnesota Department of Health, Center for Health Statistics

25. Leading Causes of Infant Deaths by Age of Mother in Minnesota, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

26. Infant Mortality Rates by Adequacy of Prenatal Care and Race/Ethnicity of Mother in Minnesota, 2006-2010 *Can be of any race Source: Minnesota Department of Health, Center for Health Statistics

27. Leading Causes of Infant Deaths in Minnesota by Adequacy of Prenatal Care, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

28. Race/Ethnicity *Can be of any race Source: Minnesota Center for Health Statistics

29. Leading Causes of Infant Deaths by Infant Birth Weight in Minnesota, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

30. Age at Death and Infant Mortality Rates in Minnesota by Race/Ethnicity of Mother, 2006-2010 *Can be of any race Source: Minnesota Department of Health, Center for Health Statistics

31. Leading Causes of Infant Deaths by Age at Death In Minnesota, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

32. Race/Ethnicity *Can be of any race Source: Minnesota Center for Health Statistics

33. Leading Causes of Infant Deaths by Gestational Age in Minnesota, 2006-2010 Source: Minnesota Department of Health, Center for Health Statistics *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths.

34. Infant Mortality Rates in Minnesota by Race and Education of Mother, 2006-2010 Source: MDH, MCHS Linked Infant Death/Birth File

35. Leading Causes of Infant Deaths by Maternal Education in Minnesota, 2006-2010 *The SIDS category includes Sudden Infant Death Syndrome and other sleep-related infant deaths Source: Minnesota Department of Health, Center for Health Statistics

36. The Data are Used to Inform Local Efforts

37. Examples of Past or Ongoing Infant Mortality Activities/Programs in Minnesota • Healthy Babies are Worth the Wait Campaign • American Indian Community Action Teams • MN Prematurity Coalition • Twin Cities Healthy Start • Eliminating Health Disparities grants • 2013 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

38. The Data help to Inform Regional & National Efforts!

39. Region V CoIIN

40. Federally Designated Public Health and Human Services Regions Regions IV and VI states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas.

41. Definition A Collaborative Improvement and Innovation Network (CoIIN) has been defined as a “cyberteam of self-motivated people with a collective vision, that innovatively collaborate by sharing ideas, information, and work enabled by technology.”1 1Gloor, PA. Swarm Creativity: Competitive Advantage through collaborative Innovation Networks. New York, NY: Oxford University Press, 2006.

42. Infant Mortality Rates by Race/Ethnicity Among States in Region V, 2008-2010

43. Purposes of Region V CoIIN • Region V CoIIN encourages2: • Distance-based communication using existing technologies (e.g., web). • Innovation as well as constant communication of cyberteam members across various levels of the network. • Cyberteam members to engage in collaborative learning, work, and the development, implementation, and evaluation of strategies to address a problem. Sources: 1Gloor, PA. Swarm Creativity: Competitive Advantage through collaborative Innovation Networks. New York, NY: Oxford University Press, 2006. 2Ghandour, RM. Collaborative Improvement and Innovation Network (COIN) to Reduce Infant Mortality. Secretary’s Advisory Committee on Infant Mortality. Bethesda, Maryland. www.hrsa.gov/advisorycommittees/mchbadvisory/.../Meetings/.../coin.pp...Accessed on: 7/19/2013.

44. Region V CoIIN The Four topics selected for Region V’s CoIIN are: • Social Determinants of Health • SIDS/SUIDS/Safe Sleep • Preconcpetion Health/Interconception Care • Early Elective Deliveries

45. Draft Infant Mortality Plan Recommendations • Improve health equity and address the social determinants of health that most significantly impact disparities in birth outcomes. • Reduce the rate of SIDS/SUIDS deaths in Minnesota. • Assure a comprehensive statewide system that monitors infant mortality. • Provide comprehensive, culturally-appropriate, coordinated health care to all women during the preconception, pregnancy and post-partum periods. • Reduce the rate of preterm births in Minnesota. • Improve the rate of pregnancies that are planned, including reducing the rate of teen pregnancies. • Establish an ongoing task force of stakeholders to oversee implementation of recommendations and action steps.

46. The Data help to Inform Research!

47. 2012 Preconception Health Databook Preconception Health and Health Care Indicators Databook, Minnesota, 2004- 2008. Minnesota Department of Health, St. Paul, Minnesota. September 2012 http://www.health.state.mn.us/divs/fh/mch/preconception/documents/preconceptiondatabook.pdf

48. “Unnatural Causes: When the Bough Breaks” http://www.unnaturalcauses.org/episode_descriptions.php?page=2

50. It is estimated that in the U.S., about 11,300 babies die each year on the same day they are born. • The highest among industrialized countries. • About 50% more infants die on their first day of life in the U.S. than in all other industrialized countries combined. • The other 33 industrialized countries have a total of 7,500 first-day infant deaths each year combined. • Source: Surviving the First Day: State of the World’s Mothers 2013. Save the Children. 2013. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SOWM-FULL-REPORT_2013.PDF