Magnitude of the Problem

Infant Mortality

Infant Mortality

Improving the health of mothers and infants is both a national as well as a state priority. Infant mortality is an important indicator of the health of a nation, as it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices.1

Size of the Problem:

The Healthy People 2010 target goal for the U.S. infant mortality rate is 4.5 infant deaths per 1,000 live births.2 The current U.S. rate (6.7 deaths/1,000 live births in 2006) is about 50% higher than the goal.

The Healthy Kentuckian (HK) 2010 goal is to reduce infant mortality in Kentucky to 6 infant deaths per 1000 live births.3 Kentucky has over 55,000 births annually with an estimated 861,910 women of childbearing age (15-44 years old) in the state.4 In the last twenty years, the infant mortality rate in Kentucky has fallen dramatically and has been running very close or lower to the national average since 2000. Each year nearly 400 infants die before their first birthday. The three leading causes of infant mortality in Kentucky are prematurity, congenital anomalies and sudden unexpected infant deaths (SUID).

Seriousness:

Birth weight and gestational age predict the health and mortality of an infant. Babies born too small are often born too soon. Preterm birth (births at less than 37 completed weeks of pregnancy) is a key risk factor for infant death.5 Kentucky has one of the highest rates of preterm birth in the nation, up to 15.2% in 2007. Prematurity/lowbirth weight is the leading cause of neonatal death in Kentucky and in the United States.6 In 2004, 36.5% of all infant deaths in the United States were from preterm-related causes of death.7 Even those infants who are just a few weeks early, now called “late preterm” infants, are three times more likely to die in the first year of life than full term infants.8 Late preterm infants now comprise 72% of all premature births in Kentucky and in the nation.9 Late-preterm infants have greater morbidity and total health care costs than term infants, and these differences persist throughout the first year of life.10 Preterm infants also have more learning and behavior problems as well as higher risk for long term disability. This affects not only the health care system, but also early intervention, educational, and other community systems. a cost burden shared by insurers and state taxpayers.

MacDorman and Atkinson11 found that infant mortality rates were highest for teenagers and for women in their 40's and lowest for women in their 20's and early 30's. The infant mortality rate was nearly twice as high for unmarried women as for married women. In general, infant mortality declined with increasing education of the mother. Mothers who had not completed high school had infant mortality rates which were twice that of women with a college education. There was a more than two-fold difference in infant mortality rates by race and ethnicity with African American mothers having the highest rate. This information was confirmed in an analysis of Kentucky’s linked birth and death certificate data from 2004-2007 (Fig 1).

Disparities

According to Kentucky vital statistics data for 2003-2007, African Americans experienced an infant mortality rate of 13.4 per 1,000 live births in comparison to whites which had a rate of 6.3 per 1,000. The gap has widened since 1995-1999 (Fig 2). There are also geographic disparities: It was found that rural regions in Kentucky had the highest infant mortality rate (7.3 infant deaths per 1000 live births) as compared to urban (6.7 infant deaths per 1000 births) and semi-rural(6.1infant deaths per 1000 births) population.

Capacity

Kentucky has several surveillance systems that monitor the health status of women and children. These include Pregnancy Risk Associated Monitoring (PRAMS) and two pilot programs for Fetal & Infant Mortality Review (FIMR). As part of its broader efforts to reduce infant mortality, Kentucky’s Department for Public Health (DPH) supports a wide range of outreach and education efforts aimed at reducing behaviors that increase the risks of infant mortality. Health departments assure access to prenatal care for women and infant care, through partnerships in their communities. “Healthy Babies are Worth the Wait” is a multidisciplinary intervention in three target sites to reduce the rates of prematurity, especially late preterm births. The HANDS home visiting program serves first time overburdened parents, and if they enter the program prenatally, these families have lower risks for preterm birth.

Interventions

Several types of interventions can help reduce the rates of infant mortality. Approaches include case management, positive supports, and increasing access for women who have had previous premature infant.

Recommendations

National recommendations13 to prevent infant mortality include:

1. Availability of programs such as Healthy Start, Medicaid and State Children’s Health Insurance Program (SCHIP) to improve access to prenatal and newborn care,

2. Organized public health campaigns to promote healthy habits among parents expecting a child or caring for an infant to prevent child malnutrition,

3. Medical research aimed towards a better understanding and prevention of birth defects, premature birth and Sudden Infant Death Syndrome (SIDS)

Figures

Source: Linked Vital Statistics Birth and Death Files 2004-2007.

Source: Vital Statistics Death Files. *2007 data is preliminary

References:

1. G K Singh and S M Yu. Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010. Am J Public Health. 1995. 85(7): 957.

2. U.S. Department of Health and Human Services. Healthy People 2010, 2nd ed. With Understanding and Improving Health and Objectives for Improving Health, 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.

3. Healthy Kentuckian 2010. Mid-Decade Review. Kentucky Cabinet for Health and Family Services, Department for Public Health. Chapter 12 Maternal, Infant and Child Health, pg 187.

4. Kentucky State Data Center: http://ksdc.louisville.edu/

5. 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.

6. Kentucky Child Fatality Review Report. 2007(in press).

7. MacDorman MF, Callaghan, WM, Mathews TJ, Hoyert, DM, and Kochanek, KD. Trends in Preterm-Related Infant Mortality by race and Ethnicity: United States, 1999-2004. Health E Stats. Hyattsville, MD: National Center for Health Statistics. 2007.

8. Tomashek, KM, Shapiro-Mendoza, K, Davidoff, MJ, and Petrini, JR. Differences in mortality Between Late-Preterm and Term Singleton Infants in the United States, 1995 to 2002. J Pediatr. 2007.

9. Jain, L. Morbidity and Mortality in Late-Preterm Infants: More Than Just Transient Tachypnea! J Pediatrics. 2007. 151(5):445.

10. McLaurin, KK, Hall, CB, Jackson, EA, Owens, OE, and Mahadevia, PJ. Persistence of Morbidity and Cost Differences between Late-Preterm and Term Infants during the First Year of Life. Pediatrics. 2009. 123(2): 653

11. MacDorman MF, Atkinson JO. Infant mortality statistics from the 1996 period linked birth/infant death data set. Monthly vital statistics report; vol 46 no 12, supp. Hyattsville, Maryland: National Center for Health Statistics. 1998.

12. Salihu, HM, Ambah, AK, Jeffers, D, Alio, AP, and Berry, Lo. Healthy Start Program and Feto-Infant Morbidity Outcomes:Evaluation of Program Effectiveness, Matern Child Health J. 2009, 13(1).

13. http://www.hhs.gov/news/factsheet/infant.html

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