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Ohio Infant Mortality Data Brief

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Ohio Infant Mortality Data Brief Ohio Infant Mortality Data Brief Deaths to Ohio Infants, 2017 In August of 2018, the Ohio Department of Health (ODH) reported that 982 Ohio babies died before their first birthday in 2017. While Ohio’s infant mortality rate has been trending downward during the past decade, progress has been slower than desired and racial disparities are persistent. ODH continues to investigate those deaths to further describe infant mortality in Ohio and identify new prevention opportunities. This brief provides findings from ODH’s continued investigation, which includes analyses by duration of gestation, underlying cause of death, and risk factors. Several key demographic and maternal and child health indicators are presented for all deaths, among deaths due to leading causes, and among deaths to infants born before 24 weeks of gestation. Figure 1. Ohio Infant Mortality Rate, 2011-20171 10.0 7.9 8.0 7.6 7.4 7.4 7.2 7.2 6.8 1,000 Live Births 1,000 Live 6.0 Infant Mortality Rate per Rate Mortality Infant 4.0 2011 2012 2013 2014 2015 2016 2017 1Annual percent change from 2011-2014= -4.17; Annual percent change from 2014-2017= 1.71 Ohio Department of Health Data Brief 1 Summary This report has three main conclusions. 1) Prematurity remains the leading cause of infant death in Ohio, comprising almost one-third of deaths. Half of all infants who died were born prior to 28 weeks gestation (a full-term pregnancy is at least 37 weeks). 2) Mortality rates from prematurity, congenital anomaly, and Sudden Infant Death Syndrome (SIDS) have all been trending downward. 3) Preventable risk factors and opportunities for intervening were both common among infants who died. Opportunities to intervene-prematurity and obstetric conditions: A woman with a previous preterm birth is at risk for another preterm birth, but we found that fewer than 20 percent of infants who died due to prematurity or obstetric conditions had a mother with a previous preterm birth. However, over two-thirds had a prior pregnancy and that prior pregnancy could be a touchpoint with the medical system for optimizing the mother’s health between pregnancies and thus improving the outcome of a subsequent pregnancy. First trimester prenatal care is an opportunity to identify and alleviate risks for a preterm birth. But over 30 percent of these mothers lack first trimester prenatal care, indicating a need to remove barriers both to early pregnancy identification and access to prenatal care. About one in four of these mothers was likely eligible for WIC but not receiving benefits. Two-thirds lived in an OEI county and a disproportionate number were black, supporting the focus of efforts to prevent prematurity within those nine counties and black families. Opportunities to intervene-prematurity and SIDS: SIDS deaths are often considered highly preventable, however, in 2017, 67 Ohio infants died from SIDS and it was the fourth most common cause of infant death. More than half of the mothers of infants who died of SIDS participated in WIC while pregnant, indicating that WIC is an appropriate venue for advocating SIDS prevention including smoking cessation during pregnancy, keeping baby free of second hand smoke, breastfeeding, and safe sleep. Preventable preconception risk factors–prematurity and obstetric conditions: Over one-third (36 percent) of deaths were among infants born before 24 weeks of gestation, and therefore highly unlikely to survive. Preventable risk factors for preterm birth were relatively common among the mothers of these infants and all infants who died of prematurity or obstetric conditions: over 40 percent were obese and one-third conceived after a shorter- than-recommended interpregnancy interval. Additionally, one in five deaths due to prematurity were born to women who smoked before pregnancy. Preventable preconception risk factors - SIDS: Almost half of infants who died of SIDS had mothers who smoked before pregnancy and 39 percent continued smoking into the third trimester of pregnancy. ODH continues to examine vital statistics and other data sources to better understand infant deaths so they may be prevented. Ohio Department of Health Data Brief 2 Prematurity and congenital anomaly together accounted for half of the infant deaths in 2017. Prematurity-related causes were the Figure 2. Cause of Infant Death, Ohio 2017 underlying cause of death for 314 (32 percent) infants. Among these infants Other 16% Prematurity- • Almost two-thirds (63 percent) lived in related Other 32% a county served by the Ohio Institue for Infections 3% Equity in Birth Outcomes (OEI). Birth Asphyxia 1% Perinatal • Most (54 percent) of their mothers were low Infections 7% income (presumed to receive Medicaid at External Obstetric delivery) but only half of those received WIC Injury 8% Conditions 9% benefits during pregnancy. SIDS 7% Congential • 39 percent of their mothers received no Anomaly 18% prenatal care in the first trimester. • The mothers of 41 percent were black. Congenital Anomaly was the underlying cause of death for 179 (18 percent) infants. • Among these infants, 75 percent of mothers had a previous pregnancy and 65 percent had a previous live birth, indicating potential opportunities for potential prevention between pregnancies. • The mothers of 66 percent of these infants were white. Obstetric Conditions were the underlying cause of death for 90 (9 percent) infants. Among infants who died of obstetric conditions • More than half (64 percent) died before the end of the first day of life. • Almost all (80 percent) were born before 24 weeks gestation. • 74 percent of mothers had a previous pregnancy while 50 percent had a previous live birth. • The mothers of 48 percent were obese before pregnancy. External Injury was the underlying cause of death for 79 (8 percent) infants. • 38 percent of mothers received no prenatal care during the first trimester. • Over half (68 percent) of the mothers received WIC benefits during pregnancy. • The mothers of 77 percent of these infants had a previous pregnancy and 77 percent had a previous live birth, presenting potential opportunities for intervention between pregnancies. Ohio Department of Health Data Brief 3 Prematurity and congenital anomaly together accounted for half of the infant deaths in 2017. SIDS was the underlying cause of death for 67 (7 percent) infants. Among infants who died of SIDS • Most (84 percent) died after the first month of life but before their first birthday. • More than two-thirds (69 percent) lived in an OEI county. • The majority (84 percent) of mothers were low income (presumed to receive Medicaid at delivery) and 59 percent received WIC benefits during pregnancy. • The mothers of almost half (45 percent) smoked in the three months before becoming pregnant. • Over one-third (39 percent) of the mothers smoked into the third trimester of pregnancy. Mortality rates for 2 of the 5 top causes have been decreasing. • Congenital anomaly deaths decreased by a -3.5 annual percent change from 2011-2017. • SIDS deaths decreased by a -6.4 annual percent change from 2011-2017. Figure 3. Cause-Specific Infant Mortality Rates for Top Causes, 2008-2017 2.5 2.0 Prematurity-related Congenital Anomaly 1.5 1.0 External Injury Obstetric Conditions 0.5 SIDS Rate per 1,000 Live Births per 1,000 Live Rate 0.0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Ohio Department of Health Data Brief 4 Infant Mortality by Duration of Gestation Infant survival is highly associated with gestational age Figure 4. Proportion of Infant Births Figure 5. Proportion of Infant Deaths by Gestational Age, Ohio 2017 by Gestational Age, Ohio 2017 24-27 weeks <20 weeks 0.5% 0.1% 28-33 weeks 2.2% 20-23 weeks 34-36 <20 0.2% weeks weeks 7.4% 11% 37 or more weeks 20-23 30% weeks 26% 37 or more weeks 89.6% 34-36 weeks 24-27 28-33 10% weeks weeks 14% 9% Although infants born less than 24 weeks accounted for 0.3 percent of total infants born, 356, over one-third, accounted for infant deaths. Among infants who died and were born at less than 24 weeks gestation, only 14 percent of the mothers had a prior preterm birth, but 68 percent had previously been pregnant. Ohio Department of Health Data Brief 5 Infant Mortality by Duration of Gestation Figure 6. Maternal and Infant Attributes of Infants who Died and were Born Before 24 Weeks Gestation, Ohio 2017 Smoked 20.8 Obese 44.4 Prior Pregnancy 74.9 Prior Live Birth 57.0 Prior Preterm Birth 16.7 Pre-pregnancy Interpregnancy Interval <18 months 33.3 Twin or Higher Order Pregnancy 24.1 No 1st Trimester Prenatal Care 36.6 st 18.0 Pregnancy Smoked 1 Trimester Spontaneous Labor 88.2 Born in Wrong Level Hospital 18.6 Delivery Black 47.2 White 45.5 Hispanic 5.9 Non-Hispanic** 94.1 and Ethnicity Maternal Race Maternal OEI County 68.4 Large Metro County 48.6 Residence County of County of Metro County 41.3 Prematurity 63.2 Obstetric Condition 20.2 Cause of Death of **Non-Hispanic deaths include those of unknown or missing ethnicity. 0 10 20 30 40 50 60 70 80 90 100 Percent of Infant Deaths with Attribute Ohio Department of Health Data Brief 6 Almost half of the infants who died did not survive Figure 7. Age at death among infants their first day of life. who died Ohio, 2017 • Within the first hour of life, 13 percent of infant deaths occurred. • By the end of the first day of life, 32 percent more had died. 30% • After the first month, but before the first birthday (called post-neonatal death), 30 percent died. Most of the infants who died were born early or small.
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