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2018 Infant Mortality Annual Report 2 Ohio Infant Mortality Report 2018 TABLE of CONTENTS

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2018 Infant Mortality Annual Report 2 Ohio Infant Mortality Report 2018 TABLE of CONTENTS 2018 Infant Mortality Annual Report 2 Ohio Infant Mortality Report 2018 TABLE OF CONTENTS EXECUTIVE SUMMARY 4 SECTION 1: GENERAL FINDINGS 5-10 Ohio Infant Mortality Rate by Race and Ethnicity (2016-2018) 5 Trends in Ohio Infant Mortality (2009-2018) 6 Ohio Five-Year Average Infant Mortality Rates by County 8 Neonatal and Postneonatal Mortality Rates 9-10 SECTION 2: A DEEPER LOOK 11-19 Infant Mortality by Duration of Gestation and Birthweight 11-12 Risk Factors among Ohio Infant Deaths 13-14 Leading Causes of Infant Deaths 15-16 Prematurity-Related Infant Deaths 17 External Injury-Related Infant Deaths 18 Deaths to Infants Less Than 24 Weeks Gestation 19 DATA SOURCES AND METHODS 20 DEFINITIONS 21-22 REFERENCES 23 APPENDICES 24-45 Appendix A: The Ohio Equity Institute (OEI) 24-25 Appendix B: Sleep-Related Deaths 26-29 Appendix C: Supplementary Data Tables 30-45 Section 1: County-Level Infant Mortality Data 30-36 Section 2: A Deeper Look 37-45 3 EXECUTIVE SUMMARY Ohio has identified infant mortality as a priority in its 2017-2019 State Health Improvement Plan (SHIP)1. Infant mortality is the death of an infant before his or her first birthday. The Infant Mortality Rate is the number of infant deaths per 1,000 live births. The Infant Mortality Rate not only serves as a key indicator of maternal and infant health but is also an important measure of the health status of a community. In 2018, the infant mortality rate fell to 6.9 from 7.2 in 2017 for all races. The rate among black infants fell to 13.9 in 2018 from 15.6 in 2017. However, the Ohio and national goal is 6.0 or fewer infant deaths per 1,000 live births in every racial and ethnic group. Additionally, racial and socio-economic inequities persist. ODH continues to examine vital statistics and other data sources to monitor our progress and to better understand infant deaths so they may be prevented. The following report presents results of analyses performed on infant deaths that occurred in 2018. Key Findings Section 1: General Findings In 2018, Ohio’s infant mortality rate was 6.9 per 1,000 live births compared with 7.2 in 2017. From 2009 through 2018, Ohio’s infant mortality rate decreased at an average of 1.1% per year. After a five-year increase, the black infant mortality rate went from 15.6 per 1,000 live births in 2017 to 13.9 in 2018. Black infants still die at a rate 2.5 to 3 times higher than white infants. Section 2: A Deeper Look Prematurity-related conditions remain the leading cause of infant death in Ohio, comprising almost one-third of deaths. Infant deaths attributable to external injuries increased from 79 deaths (8%) in 2017 to 95 (10%) in 2018. Almost a third (32%) of all infants who died were born prior to 24 weeks gestation. A full-term pregnancy is at least 37 weeks. Preventable risk factors and opportunities for intervening were identified among infants who died. 4 Ohio Infant Mortality Report 2018 SECTION 1: GENERAL FINDINGS Ohio Infant Mortality Rate by Race and Ethnicity (2016-2018) In 2018, 938 Ohio infants died before their first birthday, 44 fewer than in 2017 (Table 1, Figure 1). In 2017, Ohio registered 982 deaths. Ohio’s infant mortality rate for all races was 7.2 in 2017 and 6.9 in 2018 (Table 1). The black infant mortality rate was 15.6 in 2017 and 13.9 in 2018 (Table 1). Black infants were still more than 2.5 times more likely to die than white infants. From 2009 through 2018, the infant mortality rate for all races decreased at an average of 1.1% per year while the white infant mortality rate decreased an average of 2.4% per year (Figure 2). The black infant mortality rate has not changed significantly since 2009. Table 1: Ohio Infant Mortality by Race and Ethnicity (2016-2018) 2016 2017 2018 Infant Deaths IMR* Infant Deaths IMR* Infant Deaths IMR* All Races** 1,024 7.4 982 7.2 938 6.9 Race White 610 5.8 550 5.3 553 5.4 Black 369 15.2 384 15.6 339 13.9 American Indian 2 **** 0 **** 4 **** Asian/Pacific Islander 18 3.8^ 20 4.2 15 3.2^ Ethnicity Hispanic 54 7.3 54 7.2 45 6.1 Non-Hispanic*** 970 7.4 928 7.2 893 7.0 Data Source: Ohio Department of Health, Bureau of Vital Statistics * Infant mortality rate per 1,000 live births. ** The total for all races includes 26 infant deaths of unknown race. *** Non-Hispanic deaths include those of unknown or missing ethnicity. **** Rates based on fewer than 10 deaths do not meet standards of reliability or precision and are suppressed. ^ Rates based on fewer than 20 infant deaths should be interpreted with caution. 5 Trends in Ohio Infant Mortality (2009-2018) Figure 1: Trends in the Number of Ohio Infant Deaths, by Race (2009 – 2018) 1,200 1,109 1,064 1,086 1,047 1,100 1,024 1,005 1,024 955 982 1,000 938 900 800 738 687 672 700 675 641 568 580 610 600 550 553 Number of Infant Deaths Infant Number of 500 362 363 371 367 369 384 400 330 338 344 339 300 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 —— Overall —— Black —— White Data Source: Ohio Department of Health, Bureau of Vital Statistics Figure 2: Trends in Ohio Infant Mortality Rate (per 1,000 live births), by Race (2009 – 2018) 18.0 15.5 16.0 15.1 15.2 15.6 16.0 14.3 14.2 13.9 14.0 13.9 14.0 12.0 10.0 7.7 7.7 7.9 7.6 7.4 7.2 7.4 7.2 6.9 8.0 6.8 6.0 6.4 6.4 6.4 6.4 6.1 5.3 5.5 5.8 5.3 5.4 IMR per 1,000 Live Births IMR per 1,000 Live 4.0 2.0 0.0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 —— Overall —— Black —— White Data Source: Ohio Department of Health, Bureau of Vital Statistics 6 Ohio Infant Mortality Report 2018 Racial Disparity in Infant Mortality Despite seeing gains in the overall and white infant mortality rates, there has been no significant improvement in the black infant mortality rate in the past 10 years. After five years of steady increase, the black infant mortality rate went from 15.6 per 1,000 live births in 2017 to 13.9 in 2018. This is an encouraging sign. However, there is still much work that needs to be done as black infants continue to die at a rate 2.5 to 3 times that of white infants (Figure 3). Figure 3: Black/White Infant Mortality Ratio*, Ohio (2009-2018) 3.5 3.0 2.9 2.5 2.7 2.7 2.6 2.6 2.5 2.4 2.3 2.0 2.2 2.2 Ratio 1.5 1.0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Data Source: Ohio Department of Health, Bureau of Vital Statistics *Black Infant Mortality Rate divided by the White Infant Mortality Rate 7 Ohio Five-Year Average Infant Mortality Rates by County Figure 4: Ohio Five-Year Infant Mortality Rate (per 1,000 live births), by County (2014-2018) Lake Ashtabula Williams Fulton Lucas Ottawa Geauga Cuyahoga Wood Sandusky Defiance Henry Erie Lorain Trumbull Huron Portage Paulding Seneca Medina Summit Hancock Mahoning Putnam Ashland Van Wert Wyandot Crawford Wayne Stark Columbiana Allen Richland Hardin Marion Holmes Carroll Mercer Auglaize Morrow Jefferson Knox Tuscarawas Shelby Logan Harrison Union Delaware Coshocton Darke Miami Champaign Licking Guernsey Belmont Franklin Muskingum Clark Madison Montgomery Noble Monroe Preble Fairfield Perry Greene Pickaway Morgan Fayette Hocking Washington Butler Warren Clinton Ross Athens Vinton Hamilton Highland Meigs Clermont Pike Infant Mortality Rate Jackson Per 1,000 Live Births Gallia Brown Adams Scioto 3.1 - 4.9 5.0 - 6.1 Lawrence 6.2 - 7.1 7.2 - 8.2 8.3 - 10.1 N Rate not reported Miles 0 15 30 60 (<10 infant deaths) Data Source: Ohio Department of Health, Bureau of Vital Statistics 8 Ohio Infant Mortality Report 2018 Neonatal and Postneonatal Mortality Rates Neonatal deaths occur during the first 27 days of life while postneonatal deaths occur at 28 through 364 days of life. Neonatal deaths are the largest contributor to the overall infant death rate, accounting for about two-thirds of all infant deaths (Table 2). The difference in the overall infant mortality rate from 2017 to 2018 can be largely attributed to fewer neonatal deaths in 2018 compared with 2017. This is especially true in the black population. This is likely due to a drop in premature births, especially those born prior to 23 weeks gestation. The neonatal mortality rate for all races was 5.0 in 2017 and 4.7 in 2018. The black neonatal mortality rate was 11.3 in 2017 and 8.5 in 2018. Table 2: Ohio Neonatal, Postneonatal, and Overall Infant Mortality (per 1,000 live births), by Race and Ethnicity (2014-2018) Neonatal Neonatal Postneonatal Postneonatal Total Infant Infant Race/Ethnicity Year Deaths Mortality Rate Deaths Mortality Rate Deaths Mortality Rate Births 2014 406 3.8 162 1.5 568 5.3 106,371 2015 379 3.6 201 1.9 580 5.5 106,028 White 2016 429 4.1 181 1.7 610 5.8 104,957 2017 375 3.6 175 1.7 550 5.3 103,709 2018 393 3.8 160 1.6 553 5.4 102,570 2014 252 10.4 92 3.8 344 14.3 24,133 2015 252 10.4 115 4.7 367 15.1 24,288 Black 2016 255 10.5 114 4.7 369 15.2 24,316 2017 278 11.3 106 4.3 384 15.6 24,542 2018 208 8.5 131 5.4 339 13.9 24,359 2014 692 5.0 263 1.9 955 6.8 139,514 2015 667 4.8 338 2.4 1,005 7.2 139,312 All Races 2016 713 5.2 311 2.3 1,024 7.4 138,198 2017 684 5.0 298 2.2 982 7.2 136,895 2018 632 4.7 306 2.3 938 6.9 135,226 2014 32 4.6 11 1.6* 43 6.2 6,885 2015 30 4.3 12 1.7* 42 6.0 6,974 Hispanic Ethnicity (Any Race) 2016 38 5.1 16 2.2* 54 7.3 7,425 2017 42 5.6 12 1.6* 54 7.2 7,473 2018 35 4.7 10 1.3* 45 6.1 7,434 Data Source: Ohio Department of Health, Bureau of Vital Statistics * Rates based on fewer than 20 infant deaths should be interpreted with caution.
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