Infant Mortality in Miami-Dade County WILLIAM M

Home , Little Haiti, Little Havana, Overtown (Miami)

Infant Mortality in Miami-Dade County WILLIAM M. SAPPENFIELD, MD, MPH, CPH DIRECTOR, THE CHILES CENTER USF COLLEGE OF PUBLIC HEALTH Special Thanks for Data Providing/Arranging!

●Nancy Vazquez ●Britney James ●Epidemiology Team

2 County Infant Mortality Analysis

The Florida Department of Health in Miami-Dade County conducted a County Infant Mortality Analysis ● to review infant mortality rates ● to examine select maternal and infant health factors ● to assess social determinants of health

3 Introduction What is infant mortality and why does it matter to health equity and health disparity?

4 Overview Although Miami-Dade County experienced declining infant mortality rates, persistent racial and ethnic disparities continue. Non-Hispanic Black infants experience high infant mortality rates, almost three times the rates of Non-Hispanic White and Hispanic infants. Such health disparities are generally associated with social determinants.

5 Key Miami-Dade County Findings ● The infant mortality rate is 4.6, decreasing 24% over last 10 years. ● This rate is lower than Florida’s and U.S.’s rate. ● This rate is the same or lower than Hillsborough, Broward, and Palm Beach Counties. ● Neighborhoods with high Low Birth Weight (LBW) percentages and high infant mortality rates are strongly correlated. ● Neighborhoods with increasing social disadvantage correlated with areas with high infant mortality rates.

6 Background Health is determined in part by social conditions in the places where residents live, learn, work, and play (CDC, 2015).

7 Pregnancy Conception Morbidity & Mortality Infant 8 Preconception

Pregnancy Conception Morbidity & Mortality Infant 9 Conception Preconception

Pregnancy Conception Morbidity & Mortality Infant 10 Life Course Perspective Perinatal Mortality

Perinatal Mortality Rates, Miami-Dade County, 2006-2013

9 8.1 8 7.3 2006 7 6.1 6 2013 4.6 5 3.9 4 3 3 2.1 2 1.7 1 0 Fetal Mortality Infant Mortality Neonatal Mortality Postneonatal Rates per 1,000 Live Births Live 1,000 per Rates Rate Rate Rate Mortality Rate Years

Source: 2016 Miami-Dade County Infant Mortality Analysis 12 3-Year Infant Mortality Rates Miami-Dade County, 2005-2014 12.0

10.0

8.0 Live Births Live 6.0

4.0

2.0 Rate per 1,000per Rate 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total IMR Black IMR White IMR Other Race IMR Hispanic IMR (All Races)

Source: 2016 Miami-Dade County Infant Mortality Analysis 13 3-Year Infant Mortality Rates across Florida, 2005-2014 10.0 9.0 8.0 7.0

Live Births Live 6.0 5.0 4.0 3.0 2.0

Rate per 1,000per Rate 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Year Miami-Dade County Broward County Palm Beach County Hillsborough County

Source: 2016 Miami-Dade County Infant Mortality Analysis 14 3-Year Infant Mortality Rates, Florida & U.S., 2005-2014 8.0 7.0 6.0

5.0 Live Births Live 4.0 3.0 2.0

Rate per 1,000per Rate 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Year

Miami-Dade County Florida United States

Source: 2016 Miami-Dade County Infant Mortality Analysis 15 Fetal Rate

Fetal mortality represents a spontaneous intrauterine death of a fetus. In Florida, fetal death registration occurs for fetal deaths at 20+ gestational weeks.

16 3-Year Fetal Mortality Rates Miami-Dade County, 2005-2014 16.0 14.0 12.0 10.0 8.0 6.0 4.0

2.0 Rate per 1,000 Live Births Live 1,000per Rate 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Fetal Death Rate Black Fetal Death Rate White Fetal Death Rate Hispanic Fetal Death Rate

Source: 2016 Miami-Dade County Infant Mortality Analysis 17 3-Year Neonatal Infant Mortality Rates Miami-Dade County, 2005-2014 8.0 7.0 6.0

5.0 Live Births Live 4.0 3.0 2.0

1.0 Rate per 1,000per Rate 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Neonatal IMR Black Neonatal IMR White Neonatal IMR Hispanic Neonatal IMR (All Races)

Source: 2016 Miami-Dade County Infant Mortality Analysis 18 3-Year Postneonatal Infant Mortality Rates Miami-Dade County, 2005-2014 5.0 4.5 4.0 3.5

Live Births Live 3.0 2.5 2.0 1.5 1.0

Rate per 1,000per Rate 0.5 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years

Total Postneonatal IMR Black Postneonatal IMR White Postneonatal IMR Hispanic Postneonatal IMR (All Races)

Source: 2016 Miami-Dade County Infant Mortality Analysis 19 Infant Health Factors

Preterm Births, Low Birth Weight (LBW), and VLBW Births in Miami-Dade County, 2005-2014 12.0

10.0

8.0

6.0

4.0

2.0 Percent of Live Births Live of Percent 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Preterm Births Total Low Birth Weight (LBW) Total VLBW Births

Source: 2016 Miami-Dade County Infant Mortality Analysis 20 Select Causes of Infant Death Over the last ten years, the leading causes of Infant Mortality: 1. Congenital Anomaly/Birth Defect 2. Sudden Unexpected Infant Death (SUID) 3. Prematurity/Low Birth Weight 4. Unintentional Injury (non-SUID accidents) 5. Intentional Injury (homicide)

21 3-Year Cause Specific Infant Mortality Rates Miami-Dade County, 2005-2014 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 Rate per 1,000 Live Births Live per 1,000 Rate 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years

Congenital Anomaly/Birth Defect Prematurity/Low Birth Weight Sudden Unexpected Infant Death (SUID) Unintentional Injury (non-SUID accidents) Intentional Injury (homicide)

Source: 2016 Miami-Dade County Infant Mortality Analysis 22 Sudden Unexpected Infant Death (SUID) in Miami-Dade County, 2005-2014 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6

0.4 Rate per 1,000 Live Births Live 1,000 per Rate 0.2 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years

Total Non-Hispanic Black Race Non-Hispanic White Race Hispanic Ethnicity (All Races)

Source: 2016 Miami-Dade County Infant Mortality Analysis 23 Maternal Health Factors

Covered in a later presentation

24 Life Course Perspective Neighborhood Area Analysis

J K M Group Area Group Area G I N A South Dade/Homestead H Miami Shores/Morningside H E Downtown/East Little Havana/ Kendall C B I Liberty City/Little Haiti/Overtown D F B C Westchester/West Dade J Hialeah/Miami Lakes D Coral Gables/Kendall K Opa-Locka/Miami Gardens/Westview

Brownsville/Coral Gables/ E M North Miami/North Miami Beach A Coconut Grove Coral Gables/Coconut Grove/ Aventura/Miami Beach F Key Biscayne N G Doral/Miami/Springs/Sunset

26 5-Year Infant Mortality Rate by Neighborhood Infant Mortality Rate Miami-Dade County, 2010-2014 Highest Neighborhood Rates: Group I 8.92 Group K 7.58 • Group I: Downtown/East Little Havana Group A 6.14 /Liberty City/Little Haiti/Overtown Group M 6.08 Group E 4.34 • Group K: Opa-Locka/Miami Gardens Group B 3.96 /Westview Group J 3.62 Group N 3.22 • Group A: South Dade/Homestead Group H 3.04 • Group M: North Miami/North Miami Beach

Neighborhood Group Neighborhood Group C 2.66 Group F 2.58 • Group E: Brownsville/Coral Gables Group G 2.5 /Coconut Grove Group D 2.5 • Group B: Kendall 0 2 4 6 8 10 Rate per 1,000 Live Births

Source: 2016 Miami-Dade County Infant Mortality Analysis 27 5-Year Low Birthweight Percentages by Neighborhood, Miami-Dade County, 2010-2014 Low Birthweight

Group I 12.52 Highest Neighborhood Percentages: Group K 11.78 • Group I: Downtown/East Little Havana Group M 10.48 /Liberty City/Little Haiti/Overtown Group E 9.16 Group A 8.76 • Group K: Opa-Locka/Miami Group H 8.74 Gardens/Westview Group B 8.04 • Group M: North Miami/North Miami Beach Group C 7.64 Group N 7.6 • Group E: Brownsville/Coral

Neighborhood Group Neighborhood Group F 7.6 Gables/Coconut Grove Group D 7.5 • Group A: South Dade/Homestead Group J 7.14 Group G 7.02 • Group H: Miami Shores/Morningside 0 2 4 6 8 10 12 14 Percent

Source: 2016 Miami-Dade County Infant Mortality Analysis 28 5-Year Preterm Birth Percentages by Preterm Birth Neighborhood, Miami-Dade County, 2010-2014

Group I 13.32 Highest Neighborhood Percentages: Group K 12.82 • Group I: Downtown/East Little Havana Group M 11.2 /Liberty City/Little Haiti/Overtown Group E 10.8 Group H 9.76 • Group K: Opa-Locka/Miami Group A 9.64 Gardens/Westview Group J 9.14 • Group M: North Miami/North Miami Beach Group B 9.08 Group C 9.04 • Group E: Brownsville/Coral Gables

NeighborhoodGroup Group D 8.7 /Coconut Grove Group N 8.66 • Group H: Miami Shores/Morningside Group G 8.66 Group F 8.1 • Group A: South Dade/Homestead 0 2 4 6 8 10 12 14 Percent

Source: 2016 Miami-Dade County Infant Mortality Analysis 29 Summary of Neighborhood Findings: Maternal and Child Health Outcomes

Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp A B C D E F G H I J K M N High Infant Mortality X X X X X X Rate High % of Low Birth X X X X X X Weight High % of Preterm X X X X X X Births Highest Neighborhood Rates and Percentages • Group A: South Dade/Homestead • Group I: Downtown/East Little Havana/Liberty • Group B: Kendall City/Little Haiti/Overtown • Group E: Brownsville/Coral Gables/Coconut Grove • Group K: Opa-Locka/Miami Gardens/Westview • Group H: Miami Shores/Morningside • Group M: North Miami/North Miami Beach

Source: 2016 Miami-Dade County Infant Mortality Analysis 30 5-Year Percent of Unwed Mothers by Unwed Mothers Neighborhood, Miami-Dade County, 2010-2014

Group I 77.04 Highest Neighborhood Percentages: Group K 68.34 • Group I: Downtown/East Little Havana/ Group E 64.56 Liberty City/Little Haiti/Overtown Group A 58.9 Group J 54.06 • Group K: Opa-Locka/Miami Gardens Group M 50.7 /Westview Group C 43.74 • Group E: Brownsville/Coral Gables Group H 42.28 /Coconut Grove Group B 41.84

Neighborhood Group Neighborhood Group G 37.84 • Group A: South Dade/Homestead Group N 26.26 • Group J: Hialeah/Miami Lakes Group D 23.7 Group F 21.6 • Group M: North Miami/North Miami Beach 0 20 40 60 80 100 Percent

Source: 2016 Miami-Dade County Infant Mortality Analysis 31 Highest 5-Year Percent of Early Prenatal Care by Early Prenatal Care Neighborhood, Miami-Dade County, 2010-2014

Group F 86.84 Lowest Neighborhood Percentages: Group D 84.88 • Group K: Opa-Locka/Miami Gardens/ Group H 84.8 Westview Group N 84.28 Group B 83.74 • Group A: South Dade/Homestead Group C 83.28 • Group J: Hialeah/Miami Lakes Group G 83.14 Group E 82.3 • Group I: Downtown/East Little Havana Group M 81.74 /Liberty City/Little Haiti/Overtown Neighborhood Group Neighborhood Group I 79.7 • Group M: North Miami/North Miami Beach Group J 79.7 Group A 77.88 • Group E: Brownsville/Coral Gables Group K 76.76 /Coconut Grove 70 75 80 85 90 Percent

Source: 2016 Miami-Dade County Infant Mortality Analysis 32 Highest Percent of Illicit Drug Use by Illicit Drug Use Neighborhood Miami-Dade County, 2014

Group G 1.5 Highest Neighborhood Percentages: Group A 1.5 • Group N: Aventura/Miami Beach Group J 1.6 Group K 2 • Group F: Coral Gables/Coconut Grove Group E 2.1 /Key Biscayne Group B 3.3 Group M 3.4 • Group I: Downtown/East Little Havana Group D 3.6 /Liberty City/Little Haiti/Overtown Group H 3.9 • Group C: Westchester/West Dade

NeighborhoodGroup Group C 5.4 Group I 5.5 • Group H: Miami Shores/Morningside Group F 5.5 • Group D: Coral Gables/Kendall Group N 7.2

0 2 4 6 8 Percent

Source: 2016 Miami-Dade County Infant Mortality Analysis 33 Summary of Neighborhood Findings: Substance Abuse and Tobacco Use Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp A B C D E F G H I J K M N

% Current Drinker X X X X X X % Illicit Drug Use in X X X X X X Past Month % Current Smoker X X X X X X %Someone Smokes X X X X X X at home

Highest Neighborhood Percentages • Group H: Miami Shores/Morningside • Group C: Westchester/West Dade • Group I: Downtown/East Little Havana/Liberty • Group D: Coral Gables/Kendall City/Little Haiti/Overtown • Group E: Brownsville/Coral Gables/Coconut Grove • Group J: Hialeah/Miami Lakes • Group F: Coral Gables/Coconut Grove/Key Biscayne • Group N: Aventura/Miami Beach

Source: 2016 Miami-Dade County Infant Mortality Analysis 34 Highest Percent of Poverty by Zip Code Poverty Miami-Dade County, 2010-2014 Highest Neighborhood Percentages: 33161 30.1 33054 31.4 • Group A: South Dade/Homestead (33034, 33039, 33010 32.4 33030) 33147 33 33150 34.3 • Group I: Downtown/East Little Havana/Liberty 33127 38.1 33128 38.6 City/Little Haiti/Overtown (33136, 33128, 33127, 33136 39.3 33150, 33147)

33125 39.8 Zip Code Zip 33135 40 • Group E: Brownsville/Coral Gables/Coconut 33130 41.5 Grove (33142, 33130, 33135, 33125) 33142 42.1 33030 42.3 • Group K: Opa-Locka/Miami Gardens /Westview 33039 43.5 (33034) 33034 44.6 • Group J: Hialeah/Miami Lakes (33010) 0 10 20 30 40 50 Percent • Group M: North Miami/North Miami Beach (33161)

Source: 2016 Miami-Dade County Infant Mortality Analysis 35 Highest Infectious Syphilis Rate by Zip Codes Infectious Syphilis Miami-Dade County, 2014

33126 24.9 Highest Neighborhood Rates: 33147 25.3 33145 25.7 • Group E: Brownsville/Coral Gables 33133 26.5 /Coconut Grove (33142, 33130, 33145) 33181 28 33130 28.4 • Group H: Miami Shores/Morningside 33056 31.2 (33034) 33142 32.8

33167 34.9 • Group I: Downtown/East Little Havana Zip Code Zip 33137 57 /Liberty City/Little Haiti/Overtown (33010) 33138 57.6 33132 67.4 • Group K: Opa-Locka/Miami Gardens 33136 82.9 /Westview (33167, 33056) 33139 114.6 33128 132.1 • Group M: North Miami/North Miami Beach (33181) 0 20 40 60 80 100 120 140 Rate per 100,000 population • Group N: Aventura/Miami Beach (33139)

Source: 2016 Miami-Dade County Infant Mortality Analysis 36 HIV Rates Highest Reported HIV Rate by Zip Code Miami-Dade County, 2014 Highest Neighborhood Rates: 33161 74.9 • Group E: Brownsville/Coral Gables /Coconut 33056 79.4 33130 81.1 Grove (33142, 33130, 33145) 33141 82.7 • Group H: Miami Shores/Morningside (33137, 33127 86.2 33142 87.4 33138) 33131 88.4 33150 90.4 • Group I: Downtown/East Little Havana /Liberty

33147 101.1 City/Little Haiti/Overtown (33136, 33128, 33147, ZIp Code ZIp 33181 106.3 33150, 33127) 33128 118.9 33138 128.7 • Group K: Opa-Locka/Miami Gardens /Westview 33137 156.6 (33056) 33139 207.8 33136 339.3 • Group M: North Miami/North Miami Beach 0 100 200 300 400 (33181, 33161) Rate per 100,000 population • Group N: Aventura/Miami Beach (33139, 33141)

Source: 2016 Miami-Dade County Infant Mortality Analysis 37 Summary of Neighborhood Findings: Sexually Transmitted Diseases Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp Grp A B C D E F G H I J K M N Syphilis Rate X X X X X X Gonorrhea Rate X X X X X X Chlamydia Rate X X X X X X HIV Rate X X X X X X AIDS Rate X X X X X X X

Highest Neighborhood Rates: • Group E - Brownsville/Coral Gables/Coconut Grove • Group K - Opa-Locka/Miami Gardens/Westview • Group H - Miami Shores/Morningside • Group M - North Miami/North Miami Beach • Group I - Downtown/East Little Havana/Liberty • Group N - Aventura/Miami Beach City/Little Haiti/Overtown

Source: 2016 Miami-Dade County Infant Mortality Analysis 38 Initial Conclusions

Neighborhoods with increasing social disadvantage correlated with areas with high infant mortality rates and other adverse birth outcomes.

39 Life Course Perspective Questions?

William M. Sappenfield, MD, MPH, CPH Work: (813) 974-3746 Email: [email protected]