state of the state: infant mortality in indiana of the state: infant mortality in indiana jerome...

State of the State:

Infant Mortality in Indiana

Jerome Adams, MD, MPH

State Health Commissioner

Indiana State Department of Health

International Infant Mortality Rates

2010

6.1

5.7

5.5

5.3

5.0

4.2

4.1

3.9

3.8

3.8

3.8

3.8

3.7

3.6

3.6

3.4

3.4

3.4

3.2

3.2

2.8

2.7

2.5

2.5

2.3

2.3

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0

United States

Slovakia

New Zealand

Hungary

Poland

United Kingdom

Australia

Austria

Greece

Ireland

Netherlands

Switzerland

Israel

Belgium

France

Denmark

Germany

Italy

Korea

Spain

Norway

Czech Republic

Portugal

Sweden

Finland

Japan

Rate per 1,000 live births

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015]

Original Source: CDC/NCHS, linked birth/infant death data set (U.S. data); and OECD 2014 (all other data). Data are available from http://www.oecd.org

Infant Mortality Rates

United States, 2013 4.1

4

9.6

5

0.00

2.00

4.00

6.00

8.00

10.00

12.00Io

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New

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Ore

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Min

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Colo

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Ari

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Nebra

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Nevada

New

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Ala

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Idaho

New

Ham

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Monta

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Texas

Illinois

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Haw

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South

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Mary

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Pennsy

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Dis

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Okla

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South

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Georg

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Main

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Ohio

West

Vir

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Ark

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Ala

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Mis

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Rate

per

1,0

00 liv

e b

irth

s


Original Source: CDC/NCHS, National Vital Statistics Report “Deaths: Final Data for 2013”, Volume 64, Number 2

Infant Mortality Rates Indiana, U.S. and Healthy People 2020 Goal

2007 - 2013

2007 2008 2009 2010 2011 2012 2013

Indiana 7.5 6.9 7.8 7.5 7.7 6.7 7.15

U.S. 6.8 6.6 6.4 6.1 6.05 5.98 5.96

HP 2020 Goal 6.0 6.0 6.0 6.0 6.0 6.0 6.0

0.0

2.0

4.0

6.0

8.0

10.0

Rate

per

1,0

00 liv

e b

irth

s


United States Original: Centers for Disease Control and Prevention National Center for Health Statistics

Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team


County Level, All Races

2009 - 2013

HIGHEST Infant Mortality

Rates in State

• Adams, 9.9

• Henry, 9.8

• Montgomery, 9.7

• Grant, 9.5

• Marion, 9.5

• Daviess,9.5

• Cass, 9.2

• Bartholomew, 9.1

• LaPorte, 8.6

• Lake, 8.5

• St. Joseph, 8.2



Infant Mortality Rates by Zip Code

2009 – 2013 Combined, All Races *Zip codes with the highest Infant Mortality Rate for the 5 years

among zip codes that had at least 20 infant deaths.

Zip

Code County

# Total Infant

Deaths

Infant

Mortality Rate

46806 Allen 37 15.3

46312 Lake 39 15.1

46218 Marion 36 14.7

46201 Marion 44 14.6

46208 Marion 22 14.5

46226 Marion 50 14.4

46953 Grant 20 13.7

46203 Marion 42 12.2

46222 Marion 38 11.6

46205 Marion 28 11.6



Infant Mortality Rates by Race

Indiana

2002 - 2013

7.6 7.4 8.1 8.0 7.9 7.5 6.9

7.8 7.5 7.7

6.7 7.1

6.5 6.4 6.9 6.9 6.4 6.5

5.5

6.4 6.0 6.9

5.5 5.8

15.6 15.9 17.1 16.9

18.1

15.7 14.9

16.1 14.7

12.3

14.5

15.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Rate

per

1,0

00 liv

e b

irth

s

Indiana Whites Blacks Healthy People 2020



Infant Mortality Rates by Ethnicity

Indiana

2002 - 2013

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Indiana 7.6 7.4 8.1 8.0 7.9 7.5 6.9 7.8 7.5 7.7 6.7 7.15

Non-Hispanic 7.6 7.6 8.0 8.0 8.1 7.6 6.8 7.8 7.4 7.8 6.6 7.2

Hispanic 8.0 5.6 9.0 8.1 5.2 6.8 7.8 7.4 8.6 7.4 8.1 7.3

Healthy People 2020 Goal 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Rate

per

1,0

00 liv

e b

irth

s

Note: Hispanic ethnicity can be of any race.

Source: Indiana State Department of Health, Maternal & Child Health Epidemiology Division [October 26, 2015] Indiana Original Source: Indiana State Department of Health, PHPC, ERC, Data Analysis Team


County Level, by Race

2009 - 2013 Black Infant Mortality

• Worst counties for combined years:

– Allen County

• (Black IMR = 19.9)

– St. Joseph County


– Marion County


– Lake County


• These 4 counties account for nearly

80% of all the black infant deaths

in Indiana between 2009 and 2013



Infant Mortality Rates by Zip Code

2009 – 2013 Combined, by Race *Zip codes with the highest Infant Mortality Rate for the 5 years

among zip codes that had at least 20 infant deaths for each race.

Zip

Code County

# Total

White

Infant

Deaths

White

Infant

Mortality

Rate

46112 Hendricks 21 10.7

46203 Marion 28 10.3

46368 Porter 20 10.1

46350 LaPorte 21 8.7

46227 Marion 28 8.1



Zip

Code County

# Total

Black

Infant

Deaths

Black

Infant

Mortality

Rate

46312 Lake 33 26.6

46201 Marion 22 26.1

46806 Allen 29 25.6

46226 Marion 40 18.9

46222 Marion 22 17.7

46205 Marion 22 16.7

46218 Marion 30 16.2

46235 Marion 22 11.3

Zip Codes with Worst

White Infant Mortality

Zip Codes with Worst

Black Infant Mortality

CAUSES OF INFANT MORTALITY

IN INDIANA

Infant Mortality Distribution by Cause

Indiana

2013

47.6% Perinatal

Risks

21.7% Congenital

Malformations

14.0% SUIDs

1.3% Assaults / Accidents

15.3% Other

Indiana, All Races N = 594



44.5% Perinatal

Risks

24.4% Congenital

Malformations

14.5% SUIDs

1.8% Assaults/ Accidents

14.8% Other

Indiana, Whites N = 393

53.6% Perinatal

Risks

16.3% Congenital

Malformations

13.1% SUIDs

1.3% Assaults/ Accidents

15.7% Other

Indiana, Blacks N = 153

Factors Contributing to

Infant Mortality in Indiana • Obesity (ISDH #2 Priority)

– If woman is obese = 25% chance of delivering premature infant

– If woman is morbidly obese = 33% chance of delivering premature infant

– Indiana is 9th most obese state in U.S.

• Smoking (ISDH #3 Priority)

– 15.7% of mothers smoke during pregnancy (TWICE the U.S. average)

– 25.9% of mothers on Medicaid smoke

– Indiana has 7th worst smoking rate among pregnant women in U.S.

– Indiana has 12th highest smoking rate overall in U.S.

• Limited Prenatal Care

– Only 67.4% of mothers receive prenatal care during the 1st trimester

• Unsafe Sleep Practices

– 14.0% of infant deaths in 2013 can be attributed to SUIDs

31.5% 31.2%

37.9%

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Obese

Perc

ent

IN Non-Hispanic Whites Non-Hispanic Blacks

Percent of Women Ages 18-44 Who

are Obese (BMI >= 30)

Indiana, 2014

Source: Indiana State Department of Health, Division of Nutrition and Physical Activity , BRFSS 2014 [October 26, 2015]

HP2020 = 30.5%

15.7%

17.4%

11.8%

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Smoking During Pregnancy

Perc

ent

of

all L

ive B

irth

s

IN Whites Blacks

Percent of Mother’s Who Smoked

Anytime During Pregnancy

2013



HP2020 = 1.4%

Percent of Mother’s Who Smoked Anytime

During Pregnancy, by Race

3 Worst Counties

2013



Whites Blacks 33.0% 32.9% 32.3%

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Crawford Scott Owen

Perc

ent

of

all L

ive B

irth

s

Indiana = 17.4%

25.0%

22.9% 22.6%

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Grant Vanderburgh Madison

Perc

ent

of

all L

ive B

irth

s

Indiana = 11.8%

67.4% 69.9%

56.8%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Early Prenatal Care

Perc

ent

of

all L

ive B

irth

s

IN Whites Blacks

Percent of Mother’s Who Received

Prenatal Care in the 1st Trimester

2013



HP2020 = 77.9%

% Women Receiving PNC 1st Trimester

Indiana, by Race

2009 - 2013

66.1 68.5 68.1 68.4 67.4

68.5 70.7

70.3 70.7 69.9

53.1 56.0 56.1 57.4 56.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2009 2010 2011 2012 2013

Percent of all live births

Indiana Whites Blacks



Percent of Mother’s Who Received Prenatal

Care in the 1st Trimester, by Race

Worst Counties 2013



Whites Blacks

44.4% 39.2%

36.2%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

LaGrange Adams Kosciusko

Perc

ent

of

all L

ive B

irth

s

Indiana = 69.9%

48.8% 48.8%

42.0% 40.8%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

St. Joseph Grant Floyd Allen

Perc

ent

of

all L

ive B

irth

s Indiana = 56.8%

Closing the Disparity Gap

• If Indiana brought it’s Black infant mortality rate

(15.3 in 2013) down to the State’s infant

mortality rate of 7.15, 82 additional black

infants would have lived to see their first

birthday.

• If Indiana’s Black infant mortality rate were the

same as the white infant mortality rate (5.8), 96

additional black infants would have lived to see

their first birthday.

Closing the Disparity Gap

• If the counties with the worst infant mortality

rates lowered their combined infant mortality

rate to Indiana’s rate, 253 babies in those 11

counties would have lived to see their first

birthday.

• If the 10 zip codes with the worst infant mortality

rates would lower the rate to Indiana’s, 165

additional babies born in those areas would have

survived.

Infant Mortality

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state of the state: infant mortality in indiana of the state: infant mortality in indiana jerome...

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