Infant Mortality in Miami-Dade County · 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

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

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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?

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5

OverviewAlthough 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.

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

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Co

nce

pti

on

Infant

Mortality &

Morbidity

Pregnancy

8

Co

nce

pti

on

Infant

Mortality &

Morbidity

PregnancyPreconception

9

Co

nce

pti

on

Co

nce

pti

on

Infant

Mortality &

Morbidity

PregnancyPreconception

10

Life Course Perspective

Perinatal Mortality

12

8.1

6.1

3.9

2.1

7.3

4.6

3

1.7

0

1

2

3

4

5

6

7

8

9

Fetal MortalityRate

Infant MortalityRate

Neonatal MortalityRate

PostneonatalMortality RateR

ate

s p

er

1,0

00

Liv

e B

irth

s

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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Years

3-Year Infant Mortality RatesMiami-Dade County, 2005-2014

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


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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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Year

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

Miami-Dade County Broward County

Palm Beach County Hillsborough County


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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Year

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

Miami-Dade County Florida United States


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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Years

3-Year Fetal Mortality RatesMiami-Dade County, 2005-2014

Total Fetal Death Rate Black Fetal Death Rate

White Fetal Death Rate Hispanic Fetal Death Rate


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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Years

3-Year Neonatal Infant Mortality RatesMiami-Dade County, 2005-2014

Total Neonatal IMR Black Neonatal IMR

White Neonatal IMR Hispanic Neonatal IMR (All Races)


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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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Years

3-Year Postneonatal Infant Mortality RatesMiami-Dade County, 2005-2014

Total Postneonatal IMR Black Postneonatal IMR

White Postneonatal IMR Hispanic Postneonatal IMR (All Races)


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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

Pe

rce

nt

of

Live

Bir

ths

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


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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

Rat

e p

er

1,0

00

Liv

e B

irth

s

Years

3-Year Cause Specific Infant Mortality RatesMiami-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)


23Source: 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

Rat

e p

er

1,0

00

Liv

e B

irth

s

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

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Neighborhood Area Analysis

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Group Area Group Area

A South Dade/Homestead H Miami Shores/Morningside

B Kendall IDowntown/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

EBrownsville/Coral Gables/

Coconut Grove M North Miami/North Miami Beach

FCoral Gables/Coconut Grove/

Key Biscayne N Aventura/Miami Beach

G Doral/Miami/Springs/Sunset

A

B

CD

G

J K M

NH

F

EI

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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

0 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

Ne

igh

bo

rho

od

Gro

up

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


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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

0 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

Ne

igh

bo

rho

od

Gro

up

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

Highest Neighborhood Percentages:



• Group K: Opa-Locka/Miami

Gardens/Westview


• Group E: Brownsville/Coral

Gables/Coconut Grove


• Group H: Miami Shores/Morningside

Low Birthweight


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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

0 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

Ne

igh

bo

rho

od

Gro

up

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




• Group K: Opa-Locka/Miami

Gardens/Westview



/Coconut Grove



Preterm Birth


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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

RateX X X X X X

High % of Low Birth

WeightX X X X X X

High % of Preterm

BirthsX X X X X X


• Group B: Kendall

• Group E: Brownsville/Coral Gables/Coconut Grove


• Group I: Downtown/East Little Havana/Liberty

City/Little Haiti/Overtown

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



Highest Neighborhood Rates and Percentages

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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

0 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

Ne

igh

bo

rho

od

Gro

up

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


• Group I: Downtown/East Little Havana/

Liberty City/Little Haiti/Overtown


/Westview


/Coconut Grove


• Group J: Hialeah/Miami Lakes


Unwed Mothers


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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

Ne

igh

bo

rho

od

Gro

up

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







/Coconut Grove

Early Prenatal Care


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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

0 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

Ne

igh

bo

rho

od

Gro

up

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


• 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 D: Coral Gables/Kendall

Illicit Drug Use


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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 MonthX X X X X X

% Current Smoker X X X X X X

%Someone Smokes

at homeX 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 N: Aventura/Miami Beach


Highest Neighborhood Percentages

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

33030)


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

0 10 20 30 40 50

33034

33039

33030

33142

33130

33135

33125

33136

33128

33127

33150

33147

33010

33054

33161

Percent

Zip

Co

de

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


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/Coconut Grove (33142, 33130, 33145)


(33034)


/Liberty City/Little Haiti/Overtown (33010)


/Westview (33167, 33056)


(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

0 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

Co

de

Highest Infectious Syphilis Rate by Zip CodesMiami-Dade County, 2014


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• 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)


(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

0 100 200 300 400

33136

33139

33137

33138

33128

33181

33147

33150

33131

33142

33127

33141

33130

33056

33161

Rate per 100,000 population

ZIp

Co

de

Highest Reported HIV Rate by Zip CodeMiami-Dade County, 2014


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


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

• Group M - North Miami/North Miami Beach

• Group N - Aventura/Miami Beach



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Initial Conclusions

Neighborhoods with increasing social

disadvantage correlated with areas with high

infant mortality rates and other adverse birth

outcomes.


Questions?William M. Sappenfield, MD, MPH, CPH

Work: (813) 974-3746Email: [email protected]

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Documents

Infant Mortality in Miami-Dade County · 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