Infant Mortality in Miami-Dade County WILLIAM M. SAPPENFIELD, MD, - - PowerPoint PPT Presentation

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

3

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

Introduction

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

4

5

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.

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

Conception

Infant Mortality & Morbidity

Pregnancy

8

Conception

Infant Mortality & Morbidity

Pregnancy Preconception

9

Conception Conception

Infant Mortality & Morbidity

Pregnancy Preconception

10

Life Course Perspective

Perinatal Mortality

12

8.1 6.1 3.9 2.1 7.3 4.6 3 1.7

1 2 3 4 5 6 7 8 9

Fetal Mortality Rate Infant Mortality Rate Neonatal Mortality Rate Postneonatal Mortality Rate

Rates per 1,000 Live Births Years

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

2006 2013

Source: 2016 Miami-Dade County Infant Mortality Analysis

13

0.0 2.0 4.0 6.0 8.0 10.0 12.0

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

3-Year Infant Mortality Rates Miami-Dade County, 2005-2014

Total IMR Black IMR White IMR Other Race IMR Hispanic IMR (All Races)

Source: 2016 Miami-Dade County Infant Mortality Analysis

14

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 2006 2007 2008 2009 2010 2011 2012 2013

Rate per 1,000 Live Births Year

3-Year Infant Mortality Rates across Florida, 2005-2014

Miami-Dade County Broward County Palm Beach County Hillsborough County

Source: 2016 Miami-Dade County Infant Mortality Analysis

15

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 2006 2007 2008 2009 2010 2011 2012 2013

Rate per 1,000 Live Births Year

3-Year Infant Mortality Rates, Florida & U.S., 2005-2014

Miami-Dade County Florida United States

Source: 2016 Miami-Dade County Infant Mortality Analysis

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

17

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

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

3-Year Fetal Mortality Rates Miami-Dade County, 2005-2014

Total Fetal Death Rate Black Fetal Death Rate White Fetal Death Rate Hispanic Fetal Death Rate

Source: 2016 Miami-Dade County Infant Mortality Analysis

18

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0

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

3-Year Neonatal Infant Mortality Rates Miami-Dade County, 2005-2014

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

Source: 2016 Miami-Dade County Infant Mortality Analysis

19

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 2006 2007 2008 2009 2010 2011 2012 2013

Rate per 1,000 Live Births Years

3-Year Postneonatal Infant Mortality Rates Miami-Dade County, 2005-2014

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

Source: 2016 Miami-Dade County Infant Mortality Analysis

20

Infant Health Factors

0.0 2.0 4.0 6.0 8.0 10.0 12.0 2006 2007 2008 2009 2010 2011 2012 2013

Percent of Live Births

Years

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

Source: 2016 Miami-Dade County Infant Mortality Analysis

21

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)

22

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 2006 2007 2008 2009 2010 2011 2012 2013

Rate per 1,000 Live Births Years

3-Year Cause Specific Infant Mortality Rates Miami-Dade County, 2005-2014

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

23

Source: 2016 Miami-Dade County Infant Mortality Analysis 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2006 2007 2008 2009 2010 2011 2012 2013

Rate per 1,000 Live Births Years

Sudden Unexpected Infant Death (SUID) in Miami-Dade County, 2005-2014

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

Maternal Health Factors

Covered in a later presentation

24

Life Course Perspective

Neighborhood Area Analysis

26

Group Area Group Area

A

South Dade/Homestead

H

Miami Shores/Morningside

B

Kendall

I

Downtown/East Little Havana/ Liberty City/Little Haiti/Overtown

C

Westchester/West Dade

J

Hialeah/Miami Lakes

D

Coral Gables/Kendall

K

Opa-Locka/Miami Gardens/Westview

E

Brownsville/Coral Gables/ Coconut Grove

M

North Miami/North Miami Beach

F

Coral Gables/Coconut Grove/ Key Biscayne

N

Aventura/Miami Beach

G

Doral/Miami/Springs/Sunset

A B C D G J K M N H F E I

27

2.5 2.5 2.58 2.66 3.04 3.22 3.62 3.96 4.34 6.08 6.14 7.58 8.92 2 4 6 8 10 Group D Group G Group F Group C Group H Group N Group J Group B Group E Group M Group A Group K Group I

Rate per 1,000 Live Births Neighborhood Group

5-Year Infant Mortality Rate by Neighborhood Miami-Dade County, 2010-2014

Highest Neighborhood Rates:

• Group I: Downtown/East Little Havana

/Liberty City/Little Haiti/Overtown

• Group K: Opa-Locka/Miami Gardens

/Westview

• Group A: South Dade/Homestead
• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral Gables

/Coconut Grove

• Group B: Kendall

Infant Mortality Rate

Source: 2016 Miami-Dade County Infant Mortality Analysis

28

7.02 7.14 7.5 7.6 7.6 7.64 8.04 8.74 8.76 9.16 10.48 11.78 12.52 2 4 6 8 10 12 14 Group G Group J Group D Group F Group N Group C Group B Group H Group A Group E Group M Group K Group I

Percent Neighborhood Group

5-Year Low Birthweight Percentages by Neighborhood, Miami-Dade County, 2010-2014

Highest Neighborhood Percentages:

• Group I: Downtown/East Little Havana

/Liberty City/Little Haiti/Overtown

• Group K: Opa-Locka/Miami

Gardens/Westview

• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral

Gables/Coconut Grove

• Group A: South Dade/Homestead
• Group H: Miami Shores/Morningside

Low Birthweight

Source: 2016 Miami-Dade County Infant Mortality Analysis

29

8.1 8.66 8.66 8.7 9.04 9.08 9.14 9.64 9.76 10.8 11.2 12.82 13.32 2 4 6 8 10 12 14 Group F Group G Group N Group D Group C Group B Group J Group A Group H Group E Group M Group K Group I

Percent Neighborhood Group

5-Year Preterm Birth Percentages by Neighborhood, Miami-Dade County, 2010-2014

Highest Neighborhood Percentages:

• Group I: Downtown/East Little Havana

/Liberty City/Little Haiti/Overtown

• Group K: Opa-Locka/Miami

Gardens/Westview

• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral Gables

/Coconut Grove

• Group H: Miami Shores/Morningside
• Group A: South Dade/Homestead

Preterm Birth

Source: 2016 Miami-Dade County Infant Mortality Analysis

30

Summary of Neighborhood Findings: Maternal and Child Health Outcomes

Grp A Grp B Grp C Grp D Grp E Grp F Grp G Grp H Grp I Grp J Grp K Grp M Grp N

High Infant Mortality Rate X X X X X X High % of Low Birth Weight X X X X X X High % of Preterm Births X X X X X X

• Group A: South Dade/Homestead
• Group B: Kendall
• Group E: Brownsville/Coral Gables/Coconut Grove
• Group H: Miami Shores/Morningside
• Group I: Downtown/East Little Havana/Liberty

City/Little Haiti/Overtown

• Group K: Opa-Locka/Miami Gardens/Westview
• Group M: North Miami/North Miami Beach

Source: 2016 Miami-Dade County Infant Mortality Analysis

Highest Neighborhood Rates and Percentages

31

21.6 23.7 26.26 37.84 41.84 42.28 43.74 50.7 54.06 58.9 64.56 68.34 77.04 20 40 60 80 100 Group F Group D Group N Group G Group B Group H Group C Group M Group J Group A Group E Group K Group I

Percent Neighborhood Group

5-Year Percent of Unwed Mothers by Neighborhood, Miami-Dade County, 2010-2014

Highest Neighborhood Percentages:

• Group I: Downtown/East Little Havana/

Liberty City/Little Haiti/Overtown

• Group K: Opa-Locka/Miami Gardens

/Westview

• Group E: Brownsville/Coral Gables

/Coconut Grove

• Group A: South Dade/Homestead
• Group J: Hialeah/Miami Lakes
• Group M: North Miami/North Miami Beach

Unwed Mothers

Source: 2016 Miami-Dade County Infant Mortality Analysis

32

76.76 77.88 79.7 79.7 81.74 82.3 83.14 83.28 83.74 84.28 84.8 84.88 86.84 70 75 80 85 90 Group K Group A Group J Group I Group M Group E Group G Group C Group B Group N Group H Group D Group F

Percent Neighborhood Group

Highest 5-Year Percent of Early Prenatal Care by Neighborhood, Miami-Dade County, 2010-2014

Lowest Neighborhood Percentages:

• Group K: Opa-Locka/Miami Gardens/

Westview

• Group A: South Dade/Homestead
• Group J: Hialeah/Miami Lakes
• Group I: Downtown/East Little Havana

/Liberty City/Little Haiti/Overtown

• Group M: North Miami/North Miami Beach
• Group E: Brownsville/Coral Gables

/Coconut Grove

Early Prenatal Care

Source: 2016 Miami-Dade County Infant Mortality Analysis

33

7.2 5.5 5.5 5.4 3.9 3.6 3.4 3.3 2.1 2 1.6 1.5 1.5 2 4 6 8 Group N Group F Group I Group C Group H Group D Group M Group B Group E Group K Group J Group A Group G

Percent Neighborhood Group

Highest Percent of Illicit Drug Use by Neighborhood Miami-Dade County, 2014

Highest Neighborhood Percentages:

• Group N: Aventura/Miami Beach
• Group F: Coral Gables/Coconut Grove

/Key Biscayne

• Group I: Downtown/East Little Havana

/Liberty City/Little Haiti/Overtown

• Group C: Westchester/West Dade
• Group H: Miami Shores/Morningside
• Group D: Coral Gables/Kendall

Illicit Drug Use

Source: 2016 Miami-Dade County Infant Mortality Analysis

34

Summary of Neighborhood Findings: Substance Abuse and Tobacco Use

Grp A Grp B Grp C Grp D Grp E Grp F Grp G Grp H Grp I Grp J Grp K Grp M Grp N

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

• Group C: Westchester/West Dade
• Group D: Coral Gables/Kendall
• Group E: Brownsville/Coral Gables/Coconut Grove
• Group F: Coral Gables/Coconut Grove/Key Biscayne
• Group H: Miami Shores/Morningside
• Group I: Downtown/East Little Havana/Liberty

City/Little Haiti/Overtown

• Group J: Hialeah/Miami Lakes
• Group N: Aventura/Miami Beach

Source: 2016 Miami-Dade County Infant Mortality Analysis

Highest Neighborhood Percentages

35

Highest Neighborhood Percentages:

• Group A: South Dade/Homestead (33034, 33039,

33030)

• Group I: Downtown/East Little Havana/Liberty

City/Little Haiti/Overtown (33136, 33128, 33127, 33150, 33147)

• Group E: Brownsville/Coral Gables/Coconut

Grove (33142, 33130, 33135, 33125)

• Group K: Opa-Locka/Miami Gardens /Westview

(33034)

• Group J: Hialeah/Miami Lakes (33010)
• Group M: North Miami/North Miami Beach (33161)

Poverty

44.6 43.5 42.3 42.1 41.5 40 39.8 39.3 38.6 38.1 34.3 33 32.4 31.4 30.1

10 20 30 40 50

33034 33039 33030 33142 33130 33135 33125 33136 33128 33127 33150 33147 33010 33054 33161

Percent Zip Code

Highest Percent of Poverty by Zip Code Miami-Dade County, 2010-2014

Source: 2016 Miami-Dade County Infant Mortality Analysis

36

Highest Neighborhood Rates:

• Group E: Brownsville/Coral Gables

/Coconut Grove (33142, 33130, 33145)

• Group H: Miami Shores/Morningside

(33034)

• Group I: Downtown/East Little Havana

/Liberty City/Little Haiti/Overtown (33010)

• Group K: Opa-Locka/Miami Gardens

/Westview (33167, 33056)

• Group M: North Miami/North Miami Beach

(33181)

• Group N: Aventura/Miami Beach (33139)

Infectious Syphilis

132.1 114.6 82.9 67.4 57.6 57 34.9 32.8 31.2 28.4 28 26.5 25.7 25.3 24.9 20 40 60 80 100 120 140 33128 33139 33136 33132 33138 33137 33167 33142 33056 33130 33181 33133 33145 33147 33126

Rate per 100,000 population Zip Code

Highest Infectious Syphilis Rate by Zip Codes Miami-Dade County, 2014

Source: 2016 Miami-Dade County Infant Mortality Analysis

37

Highest Neighborhood Rates:

• Group E: Brownsville/Coral Gables /Coconut

Grove (33142, 33130, 33145)

• Group H: Miami Shores/Morningside (33137,

33138)

• Group I: Downtown/East Little Havana /Liberty

City/Little Haiti/Overtown (33136, 33128, 33147, 33150, 33127)

• Group K: Opa-Locka/Miami Gardens /Westview

(33056)

• Group M: North Miami/North Miami Beach

(33181, 33161)

• Group N: Aventura/Miami Beach (33139, 33141)

HIV Rates

339.3 207.8 156.6 128.7 118.9 106.3 101.1 90.4 88.4 87.4 86.2 82.7 81.1 79.4 74.9

100 200 300 400

33136 33139 33137 33138 33128 33181 33147 33150 33131 33142 33127 33141 33130 33056 33161

Rate per 100,000 population ZIp Code

Highest Reported HIV Rate by Zip Code Miami-Dade County, 2014

Source: 2016 Miami-Dade County Infant Mortality Analysis

38

Summary of Neighborhood Findings: Sexually Transmitted Diseases

Grp A Grp B Grp C Grp D Grp E Grp F Grp G Grp H Grp I Grp J Grp K Grp M Grp 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

• Group E - Brownsville/Coral Gables/Coconut Grove
• Group H - Miami Shores/Morningside
• Group I - Downtown/East Little Havana/Liberty

City/Little Haiti/Overtown

• Group K - Opa-Locka/Miami Gardens/Westview
• Group M - North Miami/North Miami Beach
• Group N - Aventura/Miami Beach

Source: 2016 Miami-Dade County Infant Mortality Analysis

Highest Neighborhood Rates:

39

Initial Conclusions

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

• utcomes.

Life Course Perspective

Questions?

William M. Sappenfield, MD, MPH, CPH Work: (813) 974-3746 Email: wsappenf@health.usf.edu

41