Definition: Infant mortality is the death of a child Infant Mortality under one year of age. These deaths are often divided into two groups: Neonatal mortality (death of an infant within the first 27 days of life) and Postneonatal mortality (death of an infant 28-364 days of age). Key Findings: . In 2011, 387 Washington State infants died County1,2,a in their first year of life. The infant WA Infant Mortality Rate (Period) by County mortality rate for 2011 was 4.5 per 1,000 Linked Birth Infant Death Data, 2009-2011 live births, compared to the 2009 national 1,2,4 rate of 6.3 per 1,000 live births. Clallam 6.5

. Washington’s infant mortality rate Grant 6.4 declined sharply through the 1990s. In the Pierce 5.7 past ten years, the decline has slowed as it has for the US overall.1,2 Kitsap 5.7 . The three leading causes of infant death in Spokane 5.6

Washington State in 2011 were birth Clark 5.4 defects (21 percent), Sudden Infant Death Yakim a Syndrome (SIDS) (13 percent), and Short 5.1 Gestation/Low Birth Weight (9 percent).1 Thurston 4.8 . Most (63 percent) infant deaths for 2009- WA STATE 4.6

2011 occurred in the first month of life. Skagit 4.5 . Infants whose mothers were American Indian/Alaska Native have over twice the Cowlitz 4.5 mortality of infants whose mothers were Benton 4.5 White. Infants of Black mothers also have Whatcom 4.1 d higher mortality compared to White. Snohomish 3.9 . High infant mortality rates are also seen among teen mothers, male infants, and Franklin 3.9 infants whose mothers received Medicaid King 3.8 coverage (except for undocumented 0 5 10 15 1,5 mothers). Rate per 1,000 live births

. Infant mortality increases dramatically as County rates were not calculated for Adams, Asotin, infant birthweight decreases. In 2009- Chelan, Columbia, Douglas, Ferry, Garfield, Grays 2011, the infant mortality rate of babies Harbor, Island, Jefferson, Kittitas, Klickitat, Lewis, born at >2,500g was 2.0 per 1,000 live Lincoln, Mason, Okanogan, Pacific, Pend Oreille, San Juan, Skamania, Stevens, Wahkiakum, Walla Walla births, between 1500-2499g was 13.1 per and Whitman counties. These counties had a relative 1,000 and those <1,500g 188.5 per 1,000. standard error of the rate ≥ 30%. . The Healthy People 2020 objective is to reduce the infant mortality rate to no more Significantly different from sta

than 6.0 per 1,000 live births. Washington based on significance testing has met this objective.3

MCH Data Report DOH 160-015- June 2014

Trend 1,2,a Singleton Infant Mortality 1,2,a Infant Mortality Rates (Period) Infant Mortality Rates (Period) Overall andSingleton WA and US, 1980-2011 WA Linked Birth Infant Death Data 16 2009-2011 16

12 12

8 6.3 8

6.0 4.5 4 4.5 4

Rate per 1,000 Live Births 4.1 Rate per 1,000 Live Births

0 0 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 1980 2008 2011 1990 1993 1996 1999 2002 2005

WA US HP 2020 Goal WA Overall WA Singleton

Age 1,2,a Infant Gender 1,2,a WA Infant Mortality Rate (Period) WA Infant Mortality Rate (Period) by Infant Age By Infant Gender Linked Birth Infant Death Data, 2009-2011 Linked Birth Infant Death Data, 2009-2011

0-27 days (Neonatal) 2.9 Male 5.0 Infant Age at Death

28-364 days 1.7 (Postneonatal) Female 4.3

0 4 8 0 4 8 12 16

Rate per 1,000 Live Births Rate per 1,000 Live Births

MCH Data Report DOH 160-015- June 2014

Birth Weight 1,2,a Race and Ethnicity 1,2,a

WA Infant Mortality Rate (Period) WA Infant Mortality Rate (Period) by Birth Weight by Maternal Race and Ethnicity, Linked Birth Infant Death Data, 2009-2011 Linked Birth Infant Death Data, 2009-2011

*Am Indian/ Alaska >=2500g 2.0 Native 10.3

*Asian 2.9 1500-2499g 13.1

*Black 6.9 1000-1499g 31.3 Hispanic 4.6 500-999g Birth Weight (grams) 269.3 *Pacific Islander 6.2 841.8 <500g *White 4.3

0 200 400 600 800 1000 0 5 10 15 20

Rate per 1,000 Live Births *Non-Hispanic Rate per 1,000 Live Births

Mother’s Age 1,2,a Medicaid Status 5,b,c

WA Infant Mortality Rate (Period) Infant Mortality Rate (Cohort) by Maternal Age by Medicaid Program Linked Birth Infant Death Data, 2009-2011 WA First Steps Database, 2008-2010 40+ 5.8 Non-Medicaid 3.9 35-39 3.9

30-34 3.7 Pregnancy 5.1 Medical 25-29 4.0

20-24 5.6 TANF 6.5 MaternalAge

15-19 7.7 Undocumented 4.4 <15*

0 4 8 12 0 4 8 12

Rate per 1,000 Live Births Rate per 1,000 Live Births

*Data not shown, RSE > .30

MCH Data Report DOH 160-015- June 2014

Data Sources

1. Washington State Death Certificate Data, Linked Infant Death-Birth File Vital Registration System Annual Statistical Files, Deaths 1980-2011 [Data File] (2012) Olympia, WA: Washington State Department of Health. 2. Washington State Birth Certificate Data, Vital Registration System Annual Statistical Files, Births 1980-2011 [Data file](2012). Olympia, WA: Washington State Department of Health. 3. U.S. Department of Health and Human Services. (2010). Healthy People 2020 Summary of Objectives. Maternal, Infant and Child Health.. http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/MaternalChildHealth.pdf. Accessed 2/11/2011. 4. Mathews TJ, MacDorman MF. Infant Mortality statistics from the 2009 period linked birth/infant death data set. National Vital Statistics Report, Vol . 61, No. 8 Hyattsville, MD: National Center for Health Statistics. 2013. 5. First Steps Database. Selected Measures by Medicaid Status for Live Births, Research and Data Analysis Division, Washington State Department of Social and Health Services, 11/21/2012.

Endnotes

a. Period Infant Mortality Rates use infant deaths in a given year as the numerator and infant births in the same year as the denominator. b. Cohort Infant Mortality Rates look at the experience of a birth cohort. The denominator includes all births in a specified year (cohort) and the numerator is the deaths that occurred to that cohort in the first year of life. c. Medicaid women received maternity care paid for by Medicaid. Medicaid recipients were divided into three major subgroups (from highest to lowest socioeconomic status) based on program eligibility. Pregnancy Medical were women eligible for the pregnancy medical assistance program. These women were U.S. citizens or legal US residents, and were eligible to receive Medicaid because they were pregnant and had incomes at or below 185% the federal poverty line; TANF were women enrolled in the Temporary Assistance for Needy Families (TANF) program. These women were very low income (generally < 50% the federal poverty level) and received cash assistance (TANF) in addition to Medicaid. Undocumented were women who were not legally admitted for permanent residence, lack temporary residence status, or were not lawfully present in the U.S. They were eligible to receive Medicaid because they were pregnant and had incomes at or below 185% the federal poverty level. Undocumented women were not eligible for TANF although their incomes were often lower than women on TANF. All three Medicaid groups had incomes below most non-Medicaid women. Note that Medicaid eligibility status for pregnant legal residents who were not US Citizens changed in Spring 2009. Prior to Spring 2009, legal residents who were not US Citizens were grouped with Undocumented women (and called Non-Citizens). d. Hispanic is treated as a separate racial category. American Indian/Alaska Native, Asian, Black, Pacific Islander and White are all non- Hispanic.

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MCH Data Report DOH 160-015- June 2014