Infant Mortality in California

Infant Mortality in California

Michael Curtis, PhD

Jennifer Troyan, MPH

Nannie Song, MPH

Carrie Florez, MPH

Maternal, Child and Adolescent Health Division

Center for Family Health

Overview

• Data sources for infant mortality surveillance

• California infant mortality comparisons

• Selected key contributors to infant mortality:

– Preterm birth

– Safe sleep environments

Vital Statistics Datasets

•

The Birth Statistical Master Files contain data for all live births that

occurred in a calendar year

•

The Death Statistical Master Files contain data for all deaths that

occurred in a calendar year.

•

The Birth Cohort Files contain data for all live births that occurred

in a calendar year and death information for those infants who were

born in that year but subsequently died within 12 months of birth.

In 2012, California ranked 5

th

_{in state infant mortality rates.}

Source: Deaths: Final Data for 2012. National Vital Statistics Reports; vol 63 no 9. Hyattsville, MD: National Center for Health Statistics. Martin JA, Hamilton BE, Osterman MJ, et al. Births: Final data for

2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health Statistics. 2013.

If California was an independent nation, it would have

ranked 26

th

_{in infant mortality in the world}

in 2011. (The US ranked 29

th

_.)

Sources: OECD (2013), "Infant mortality", Health: Key Tables from OECD, No. 14, doi: 10.1787/inf-mort-table-2013-2-en http://www.oecd-ilibrary.org/social-issues-migration-health/infant-mortality_20758480-table9 Accessed 2/27/2014. Hoyert DL, Xu JQ. Deaths: Preliminary Data for 2011. National Vital Statistics Reports; vol 61 no 6. Hyattsville, MD: National Center for Health Statistics. 2012. Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2011. National vital statistics reports; vol 62 no 1. Hyattsville, MD: National Center for Health Statistics. 2013.

California, 2011

Infant Mortality by Race/Ethnicity

10.5

3.8

10.7

4.6

3.9

9.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

In

fa

n

t

D

ea

th

s p

e

r

1

,00

0

L

iv

e B

ir

th

s

Number of Infant Deaths

Asian

Hispanic

White

B

lack

P

aci

fic I

sl

an

d

er

237

23

1,156

542

263

A

m

er

ican

Indi

a

n

19

California = 4.8

Note: Red line shows the 2011 California Infant Mortality Rate of 4.8 infant deaths per 1,000 live births. Width of bar shows percentage of population in each race/ethnicity group. Data Sources: California Birth Cohort File, 2011.

Infant Mortality among the Top 15 Counties with the

Largest Number of Infant Deaths, 2009-2011

County

2009-2011

Number of

Live Births

Number of

Infant Deaths

Infant Deaths per

1,000 Live Births

California

1,539,210

7,498

4.9

Los Angeles

403,343

1,969

4.9

San Bernardino

93,937

609

6.5

San Diego

133,462

586

4.4

Orange

116,786

469

4.0

Riverside

92,899

469

5.0

Fresno

48,714

339

7.0

Sacramento

60,493

329

5.4

Kern

43,537

268

6.2

Alameda

58,637

263

4.5

Santa Clara

72,795

242

3.3

San Joaquin

31,793

192

6.0

Contra Costa

37,095

185

5.0

Ventura

33,160

148

4.5

Stanislaus

23,486

125

5.3

Tulare

24,488

123

5.0

Note: Counties are sorted by descending order of infant death counts in combined years 2009-2011.

Blue highlight indicates the selected 9 counties with infant mortality rates greater than the CA state infant mortality rate of 4.9 infant deaths per 1,000 live births. Data Sources: California Birth Cohort File, 2009-2011.

Infant Mortality Rate and Number of Infant Deaths in

Counties with High Rates and Deaths, 2009-2011

5.3

5.0

5.0

5.0

7.0

6.5

6.2

_6.0

5.4

0.0

2.0

4.0

6.0

8.0

In

fa

n

t

D

ea

th

s p

e

r

1

,00

0

L

iv

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ir

th

s

Number of Infant Deaths by County

Sa

n

J

oa

qui

n

609

Fresno

San Bernardino

Kern

Sacramento

Riverside

469

329

339

268

125

C

ont

ra

C

os

ta

S

tan

isl

au

s

Tul

a

re

Sa

n

J

oa

qi

n

123

185

192

Note: The 9 selected counties are sorted by descending order of infant mortality rates in combined years 2009-2011.

Red line indicates the 2009-2011 CA state infant mortality rate of 4.9 infant deaths per 1,000 live births. Width of bar shows number of infant deaths in each county. Data Sources: California Birth Cohort File, 2009-2011.

Prepared by the Epidemiology, Assessment and Program Development Branch, Maternal, Child and Adolescent Program, Center for Family Health

California, 2009-2011

Infant Mortality Rate by Race/Ethnicity

in Alameda and San Diego County

4.5

3.8

7.7

8.7

3.7

4.1

2.7

3.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Alameda

San Diego

In

fa

n

t

D

ea

th

s p

e

r

1

,00

0

L

iv

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ir

th

s

Hispanic

Black

Asian

White

Note: 2009-2011nfant Mortality Rate is 4.5 infant deaths per 1,000 live births in Alameda and 4.4 per 1,000 live births in San Diego Source: California Department of Public Health, 2009-2011 Birth Cohort Files

Contributors to Infant Mortality: Selected Examples

• Preterm births

• Sudden Unexpected Infant Deaths

• Social Determinants of Health

The Contribution of Preterm Births

to Infant Mortality

Leading Causes of Infant Death:

National Center for Health Statistics (NCHS)

•

The NCHS List of 71 Rankable Causes of Infant Death is organized by

major ICD code groupings. However, this classification system does not

capture adequately the overall contribution of preterm birth to the infant

mortality rate.

•

Only deaths resulting from “disorder related to short gestation and low birth

weight not elsewhere classified” (ICD-10: P07.0-P07.3) seem to be explicitly

attributable to preterm birth. Therefore, many deaths involving preterm

births are classified elsewhere, in separate categories.

•

Example: Infant deaths attributable to respiratory distress syndrome, which

almost always results from incomplete lung maturation in preterm infants,

are counted in the category of respiratory distress of the newborn (ICD-10:

P22), instead of the category of disorders related to short gestation/low birth

Callaghan et al. Classification of Preterm-related Mortality

•

To more accurately reflect deaths attributable to prematurity, Callaghan et

al. used an alternative analytic approach to identify “preterm-related”

mortality.

•

First, the analysis was restricted to the 20 leading causes of death

•

For an underlying cause of death to be considered attributable to preterm

birth, ≥75% of infants whose deaths were attributed to that cause had been

born at <37 weeks of gestation.

•

Third, there must be a biomedical reason that the reported cause of death

was a direct consequence of preterm birth and one rarely seen at term or

that the cause of death resulted in preterm birth.

•

Lastly, the infant must be born preterm.

Leading Causes of Infant Death, California 2011

Short

gestation

and low

birth weight

16.1%

Congenital

anomalies

26.0%

6.1%

SIDS

6.4%

4.9%

All other

causes

40.5%

NCHS List of 71 Rankable

Causes of Infant Death

Maternal

complications of

pregnancy

Complications

of placenta,

cord and

membranes

Preterm-Related

Causes

35.6%

All

Other

Causes

64.4%

Callaghan et. al

Classification

Gestational age based on obstetric estimate with LMP replacement when OE missing. Valid gestational age range 17-47 weeks, excludes unknown gestational age Data Source: California Birth Cohort File, 2011.

Sudden Unexpected Infant Death

(SUID)

What is Sudden Unexpected Infant Death (SUID)*?

•

SUID is the sudden and unexpected death of an infant under one

year of age.

•

Most SUID deaths occur while an infant is sleeping; many are found

to have been in an unsafe sleep environment, which may or may not

have contributed to the infant’s death.

•

Most SUID are classified to a death diagnostic code of either:

– SIDS, R95

– Unknown/Undetermined, R99

Rate of Combined Causes of Infant Death (R95,W75,R99),

California, 2009-2013

49.4

53.3

51.6

51.4

54.4

0

10

20

30

40

50

60

70

2009

2010

2011

2012

2013

R

at

e

(p

e

r

10

0

,0

0

0

li

v

e

b

ir

th

s)

Sources: California Department of Public Health: Birth Statistical and Death Statistical Master File, years 2009-2013.

SIDS = ICD-10 Code R95 (Sudden Infant Death Syndrome); Accidental Suffocation = ICD-10 Code W75 (Accidental Suffocation and Strangulation in Bed); Undetermined = ICD-10 Code R99 (Other

Ill-Defined and Unspecified Causes of Mortality).

ICD-10 = International Classification of Diseases, 10th _Revision

Prepared by: California Department of Public Health, Center for Family Health, Maternal, Child & Adolescent Health Division

269

Deaths

260

Deaths

272

Deaths

259

Deaths

259

Deaths

Rate of Combined Causes of Infant Death (R95,W75,R99)

by Non-Hispanic Black and White, 2009-2013

146.8

162.4

166.2

203.5

216.7

46.0

52.6

52.4

51.7

_43.6

0

50

100

150

200

250

2009

2010

2011

2012

2013

R

at

e

(p

e

r

10

0

,0

0

0

li

v

e

b

ir

th

s)

Non-Hispanic Black

Non-Hispanic White

56

Deaths

42

Deaths

45

Deaths

45

Deaths

54

Deaths

65

Deaths

74

Deaths

73

Deaths

71

Deaths

60

Deaths

Sources: California Department of Public Health: Birth Statistical and Death Statistical Master File, years 2009-2013.

SIDS = ICD-10 Code R95 (Sudden Infant Death Syndrome); Accidental Suffocation = ICD-10 Code W75 (Accidental Suffocation and Strangulation in Bed); Undetermined = ICD-10 Code R99 (Other

Ill-Defined and Unspecified Causes of Mortality).

ICD-10 = International Classification of Diseases, 10th _Revision

Individual and Neighborhood Income

• Individual income can impact health

• Individual income can also shape neighborhood

environments. Neighborhoods impact health:

– Availability of parks

– Community safety

– Access to healthy food

Measuring Health Status by the Concentration of

Poverty in a Neighborhood

•

Percent of the total population living below federal poverty level by

census tract. Data source is five year grouped data from the

American Community Survey (ACS)

•

Birth Cohort file geocoded and then merged with ACS census tract

level poverty rates.

•

Neighborhood level infant mortality rates based upon census tracts

categorized by the percent of the total population living below the

federal poverty level:

– 0 - 4.9%

– 5 - 9.9%

– 10 - 19.9%

California, 2013

Percent of Births by Neighborhood Poverty Concentration

11.0

20.9

31.6

36.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

0 - 4.9%

5 - 9.9%

10 - 19.9%

>= 20%

P

e

rc

e

nt

of

Li

v

e

Bi

rt

hs

Percent of Population below Poverty

Includes resident live births with a valid geocoded address

Data Sources: California Birth Statistical Master File, 2013; 2012 American Community Survey (ACS) 5-year file (2009-2013)

California, 2013

Percent of Births by Race/Ethnicity by Neighborhood

Poverty Concentration

4.8

5.2

18.7

_18.3

13.2

_12.4

31.0

_30.0

30.5

28.9

32.7

33.3

51.4

53.5

17.6

18.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Hispanic

Black

Asian

White

P

e

rc

e

nt

of

Li

v

e

Bi

rt

hs

0 - 4.9%

5 - 9.9%

10 - 19.9%

>= 20%

Includes resident live births with a valid geocoded address

Data Sources: California Birth Statistical Master File, 2013; 2012 American Community Survey (ACS) 5-year file (2009-2013)

California, 2008-2011

Infant Mortality Rate by Neighborhood Poverty Concentration

3.7

4.3

4.8

5.8

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0 - 4.9%

5 - 9.9%

10 - 19.9%

>= 20%

In

fa

n

t

D

ea

th

s p

e

r

1

,00

0

L

iv

e B

ir

th

s

Percent of Population below Poverty

Includes resident live births with a valid geocoded address

Data Sources: California Birth Cohort Files, 2008-2011; 2012 American Community Survey (ACS) 5-year file (2008-2012)