Embed Size (px)
Citation preview
Summit County Public Health
Maternal Child Health & Epidemiology/Biostatistics Unit
December 15, 2017
Summit County
Maternal and Infant Health Quarterly Data Report
January – September, 2017
SCPH QUARTERLY BIRTH REPORT, Q3 2017 I
Table of Contents
Introduction.......................………………………………………………………………………………………………...1
Quarterly Highlights……………………………………………………………………………………….………………1
Infant Mortality Surveillance………………………………………………………………………………………………1
Preterm Birth Rates…………...…………………………………………………………………………………………...4
Low Birth Weight Rates……………………………………………………………………………………………………6
Prenatal Care...................................................................................................................................................................7
Pregnancy Spacing.........................................................................................................................................................8
Maternal Smoking Rate..................................................................................................................................................9
Sleep-Related Deaths..................................................................................................................................................10
Akron Data and OEI Hot Spots....................................................................................................................................10
Technical Notes............................................................................................................................................................11
References....................................................................................................................................................................12
List of Tables and Figures
Table 1. Number of infant deaths, Summit County by month, 2016-2017..............................................................1
Figure 1. Summit County infant mortality rate (IMR) by month: Jan 2013 to Sep 2017.........................................2
Figure 2. Summit County neonatal infant mortality rate (NIMR) by month: Jan 2013 to Sep 2017......................3
Figure 3. Summit County infant mortality rates by race and ethnicity, 2016 and five-year average (2012-2016)................................................................................................................................................................................3
Figure 4. Summit County premature birth rate (< 37 weeks gestation) by month: Jan 2013 to Sep 2017..........4
Figure 5. Trend line graph for annual rates of very premature births (< 32 weeks) and extremely premature births (< 28 weeks) in Summit County, 2012-2016.....................................................................................................4
Figure 6. Summit County premature birth rates by race and ethnicity, 2016 and five-year average (2012-2016)................................................................................................................................................................................5
Figure 7. Trend line graph for annual premature birth rate (< 37 weeks gestation) in Summit County and by race, 2012-2016..............................................................................................................................................................5
Figure 8. Summit County low birth weight (< 2500 grams) rate by month: Jan 2013 to Sep 2017.............6
Figure 9. Summit County low birth weight rate by race and ethnicity, 2016 and five-year average (2012-2016)................................................................................................................................................................................6
Figure 10. Trend line graph for annual low birth weight (<2500 grams) birth rate in Summit County and by race, 2012-2016..............................................................................................................................................................7
SCPH QUARTERLY BIRTH REPORT, Q3 2017 II
Figure 11. Summit County rates of prenatal care initiated in the first trimester by race and ethnicity, 2016 and five-year average (2012-2016)......................................................................................................................................7
Figure 12. Trend line graph for rate of prenatal care initiated in the first trimester, in Summit County and by race, 2012-2016..............................................................................................................................................................8
Figure 13. Summit County percentage of births less than 18 months birth to conception interval rates by race and ethnicity, 2016 and five-year average (2012-2016).............................................................................................8
Figure 14. Summit County maternal smoking rates during 2nd or 3rd trimester by race and ethnicity, five-year average (2012-2016)......................................................................................................................................................9
Figure 15. Trend line graph for maternal smoking rates during 2nd and 3rd trimesters in Summit County and by race, 2012-2016.........................................................................................................................................................9
Figure 16. Sleep-related infant deaths in Summit County, 2012-2016..................................................................10
Table 2. Yearly average infant mortality and selected birth outcome rates for the City of Akron, 2012-2016...11
Figure 17. Infant mortality rate map of Summit County and Akron, by cluster, 2007-2016.................................11
Contact Information
If you or your agency would like more information about efforts to improve the health of mothers and infants in Summit County, please visit our website:
https://www.scph.org/maternal-child-health
Or contact: Shaleeta A. Smith, MPH OEI Coordinator/Community Health Supervisor
Summit County Public Health 1867 W. Market Street, Akron, Ohio 44313
Office : 330-926-5629 Cell : 330-217-2938
E-mail: [email protected]
If you have questions about the information in this report, please contact:
Joan Hall, MPH, MSES Maternal and Child Health Epidemiologist
Summit County Public Health 1867 W. Market Street, Akron, Ohio 44313
Office: 330-926-5746 E-mail: [email protected]
SCPH QUARTERLY BIRTH REPORT, Q3 2017 1
Introduction
Infant mortality (IM) is defined as any child death that occurs before the first birthday. On average, the majority of child deaths occur during the first year of life. Infant mortality is a significant public health concern, as it can serve as a crude indicator of the overall health of a community, health disparities existing in a community, and availability and access to health care. 1,2 In 2013, the Ohio Department of Health (ODH) created the Ohio Equity Institute (OEI), a partnership between ODH and nine Ohio counties improve birth outcomes and infant health, reduce infant mortality, and eliminate racial disparities in maternal and child health indicators. Summit County is one of the OEI communities; in 2016, the nine OEI counties accounted for 59% of all infant deaths and 86% of African-American infant deaths. 3
The Maternal and Infant Health Quarterly Report provides current data trends and previous yearly averages in infant mortality and selected birth outcomes in Summit County, and a summary of OEI projects and interventions in the county and in designated infant mortality “hot spots” within the city of Akron. For this initial report, monthly rate will include data going back to 2013. The data used for this report was obtained from ODH, and more detailed information about infant mortality and birth data data can be found in the technical notes section on page 11.
Infant Mortality Surveillance
In 2016, Summit County reported 45 infant deaths, 30 of which resided in the city of Akron. As of September 30, 2017, there were 21 infant deaths in Summit County, and 15 of these were in Akron. Data from 2017 is preliminary, and any rates or counts must be considered provisional until the birth and death data is finalized by ODH.
Infant mortality rates are used to detect trends in infant mortality over time, and to compare the rate of infant death between different population subgroups. In 2016, the infant mortality rate (IMR) for Summit County was 7.6 deaths per 1,000 live births, and IMR in the city of Akron was 11.5 deaths per 1,000 live births. As of September 30, 2017, the provisional IMR was 5.0 in Summit County and 8.2 in Akron.
Table 1. Number of infant deaths, Summit County by month, 2016-2017
2016 2017 January 3 1 February 5 2 March 2 3 April 4 2 May 5 1 June 6 2 July 4 2 August 2 5 September 2 3 October 4 November 6 December 2 Total 45 21
Quarterly Highlights, Q3 2017:
• As of September 30, 2017, the year-to-date provisional rates for infant mortality, neonatal infant mortality, preterm birth, and low birth weight birth were trending lower than in the previous three years
• The 2017 year-to date preliminary total for sleep-related infant deaths was three • The West Akron, Southwest Akron, and Southeast Akron clusters have been identified as “hot
spot” areas for infant mortality in Summit County. Selected zip codes in these clusters (44307, 44320 and 44306) will be areas of focus for OEI interventions
SCPH QUARTERLY BIRTH REPORT, Q3 2017 2
For the past three years (2014 to 2016), the annual county IM rates were similar to the IM rate for Ohio (7.4). As indicated by the red line in Figure 1, the moving two average for the IM rate decreased in 2013, increased through 2014, 2015 and 2016, then displayed a decreasing trend in the past year. The national Healthy People 2020 (HP 2020) goal for the IM rate is 6.0 deaths per 1,000, and is represented by the green line in Figure 1. 4
Figure 1. Summit County infant mortality rate (IMR) by month: Jan 2013 to Sep 2017
Neonatal infant deaths occur in newborns that are less than 28 days old, and approximately 70% of infant deaths occur during the neonatal period. 3 As seen in Figure 2 on page 3, the neonatal infant mortality rates (NIMR) from 2013 -2017 exhibit similar trends as were seen in all Summit County infant deaths. The Healthy People 2020 goal for NIMR is 4.1 deaths per 1,000 live births. 4
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Infa
nt M
orta
lity
Rate
(per
1,0
00 b
irths
)
Monthly IMR HP 2020 Goal (6.0) Yearly Average IMR Rolling 2 year IMR average
IMR Yearly Averages:2013: 5.8 2014: 7.12015: 7.62016: 7.62017 YTD: 5.0
Infant Mortality Rate (IMR)
= # of infant deaths # of live births x 1000
Neonatal Infant Mortality Rate (NIMR)
= # of newborn deaths (< 28 days old) # of live births x 1000
SCPH QUARTERLY BIRTH REPORT, Q3 2017 3
Figure 2. Summit county neonatal infant mortality rate (NIMR) by month: Jan 2013 to Sep 2017
Racial disparities in infant mortality rates continue to persist in Summit County, as indicated in Figure 3. The average IMR for the past five years (2012-2016) in Summit County was 6.8 deaths per 1,000 live births. During this five year period, average IMR’s below the county average were seen in the non-Hispanic (NH) white (4.7), NH Asian (4.9), and Hispanic (3.9) populations, but the NH African-American IMR (13.0) was nearly twice the county average and was 2.8 times higher than the NH white rate. In 2016, the IMR disparity between white and African-American infants was even greater, with the NH black IMR 4.5 times higher than the NH white rate (18.7 and 4.2).
0.00
2.00
4.00
6.00
8.00
10.00
12.00
Neo
nata
l inf
ant m
orta
lity
rate
(dea
ths p
er 1
,000
)
Neonatal IM Rate HP 2020 Goal (4.1) Yearly Average Rolling 2 year average
NIMR Yearly Averages:2013: 3.5 2014: 5.22015: 5.02016: 4.42017 YTD: 2.9
7.66.8
18.7
13.0
4.2 4.7
0.0
3.9
7.7
4.9
0.0
4.0
8.0
12.0
16.0
20.0
2016 2012-2016 average
Infa
nt m
orta
lity
rate
(per
1,0
00)
Summit County NH African-American NH White Hispanic NH Asian
Figure 3. Summit County infant mortality rates by race and ethnicity, 2016 and five-year average (2012-2016)
SCPH QUARTERLY BIRTH REPORT, Q3 2017 4
Preterm Birth Rates
When a birth occurs before 37 weeks gestation, it is considered to be premature. Prematurity is a leading cause of infant death (especially during the first month), and increases the odds of having chronic health conditions and/or developmental delays. It is therefore essential to ensure that as many pregnancies as possible deliver at 37 weeks gestation or later.5,6 The HP2020 goal for preterm birth is 9.4%, and is represented by the green line in Figure 4. From 2013 to 2016, the yearly average rate for preterm birth has increased, but the two-year moving average has shown a decreasing trend since late 2016.
Figure 4. Summit County premature birth rate (< 37 weeks gestation) by month: Jan 2013 to Sep 2017
Babies born earlier than 32 weeks gestation are at even greater risk for death and long-term health and developmental problems.5,6 Births that occur prior to 32 weeks gestation are defined as very premature, and extremely premature births occur prior to 28 weeks gestation. The graph in Figure 5 displays the yearly rates and five-year trends for very premature births and extremely premature births
2.3%
1.7%
2.0% 1.9% 1.9%
0.8%0.7% 0.8%
0.7%1.0%
0.5%
1.0%
1.5%
2.0%
2.5%
2012 2013 2014 2015 2016
% o
f Sum
mit
Coun
ty b
irths
% < 32 Weeks % < 28 Weeks
Five-year averages:< 32 weeks: 1.96%< 28 weeks: 0.81%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
Prem
atur
e bi
rth
rate
% <37 Weeks Gestation HP 2020 Goal (9.4%) Yearly Average Rolling 2 yr Average
Preterm birth rate yearly averages:2013: 9.8% 2014: 10.4%2015: 11.1%2016: 11.8%2017 YTD: 9.3%
Figure 5. Trend line graph for annual rates of very premature births (< 32 weeks) and extremely premature births (< 28 weeks) in Summit County, 2012-2016
SCPH QUARTERLY BIRTH REPORT, Q3 2017 5
for all Summit County births. The very premature birth rate had a small decreasing trend from 2012 to 2016, while there was a slight increase in the rate of extremely preterm births.
As seen in Figure 6, the five-year average preterm birth rate for NH African-American births was 15.5%, which was 60% higher than the preterm birth rate among NH white mothers (9.7%). The preterm birth rate was higher for NH African-American mothers in 2016, which may be associated with the high IMR for infants born to NH African-American mothers during that same year (see Figure 3). The trendline graph in Figure 7 suggests an increasing trend for NH African-American births in the past five years, while prematurity rates for NH white and Summit County appear to be relatively stable..
Figure 7. Trend line graph for annual premature birth rate (< 37 weeks gestation) in Summit County and by race, 2012-2016
11.7%11.0%
17.6%
15.5%
10.2% 9.7%
12.6%
10.5%
8.2%9.3%
0.0%
4.0%
8.0%
12.0%
16.0%
20.0%
2016 2012-2016 average
Prem
atur
e bi
rth
rate
Summit County NH African-American NH White Hispanic NH Asian
Figure 6. Summit County premature birth rates by race and ethnicity, 2016 and five-year average (2012-2016)
11.9%9.8% 10.4%
11.2%11.7%
16.7%
13.6% 14.3% 15.7%
17.6%
10.3%8.8% 9.1%
10.2% 10.2%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
2012 2013 2014 2015 2016
Prem
atur
e bi
rth
rate
Summit County NH African-American NH White
SCPH QUARTERLY BIRTH REPORT, Q3 2017 6
Low Birth Weight Rates
Infants that weigh less than 2500 grams (about 5.5 pounds) at birth are considered to be low birth weight (LBW). Although low birth weight is usually associated with premature birth, other factors may negatively impact fetal growth and development, including congenital defects, maternal complications, and unhealthy maternal behaviors (such as poor nutrition, smoking and/or substance misuse). 7
Figure 8. Summit County low birth weight (< 2500 grams) rate by month: Jan 2013 to Sep 2017
The five-year average low birth weight rate was highest among NH African-American births, at 15.4%, and this was twice as high as the rate seen in NH white births (7.5%) (Figure 9). Trend lines in Figure 10 on page 7 indicate that the low birth weight rate for NH African-American births showed an increasing trend, while the NH white and the county average LBW rates remained relatively unchanged from 2012 to 2016.
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Low
birt
h w
eigh
t rat
e
% Low Birth (<2500 g) Weight Birth HP 2020 Goal (7.8%) Yearly Average Rolling 2 yr Average
Low birth weight birth rate yearly averages:2013: 9.8% 2014: 10.4%2015: 11.1%2016: 11.8%2017 YTD: 9.3%
Figure 9. Summit County low birth weight rate by race and ethnicity, 2016 and five-year average (2012-2016)
9.9% 9.4%
17.6%
15.4%
7.4% 7.5%
12.1%
8.0%9.8% 10.2%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
2016 2012-2016 AVG
Low
birt
h w
eigh
t rat
e
Summit County NH African-American NH White Hispanic NH Asian
SCPH QUARTERLY BIRTH REPORT, Q3 2017 7
Prenatal Care
Initiation of prenatal care during the first trimester is an important part of a healthy pregnancy. Early and adequate prenatal care helps in establishing healthy maternal habits, screening for and addressing potential health issues in the mother and fetus, and improving birth outcomes. 8 The five-year average for first trimester prenatal care was highest among NH whites (76.4%), and NH African-American, Hispanic and NH Asian births had lower five-year rates at 63.8%, 60.4%, and 59.2%, respectively (Figure 11). The trend line graph in Figure 12 indicates that the rate of first trimester prenatal care for Summit County dropped 7% from 2012 to 2016. In addition, all racial/ethnic communities exhibited a downward trend in first trimester prenatal care during the past five years, and the largest decreases were observed in NH African-American (16%) and NH Asian (12.9%) births.
69.8% 72.1%
58.1%63.8%
75.6% 76.4%
60.8% 60.4%56.9% 59.2%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
2016 2012-2016
% P
NC
initi
tate
d in
firs
t trim
este
r
Summit County NH African-American NH white Hispanic NH Asian
Figure 10. Trend line graph for annual low birth weight (<2500 grams) birth rate in Summit County and by race, 2012-2016
9.9%8.5% 9.1% 9.6% 9.9%
15.3%13.2%
15.3% 15.5%
17.6%
7.9%7.1% 7.0%
8.0% 7.4%
0.0%
4.0%
8.0%
12.0%
16.0%
20.0%
2012 2013 2014 2015 2016
Low
birt
h w
eigh
t birt
h ra
te
Summit County NH African-American NH White
Figure 11. Summit County rates of prenatal care initiated in the first trimester by race and ethnicity, 2016 and five-year average (2012-2016)
SCPH QUARTERLY BIRTH REPORT, Q3 2017 8
Pregnancy Spacing
Allowing for a minimum of 18 to 24 months between a previous birth and conception allows a mother’s body to fully recover from birth and prepare for the next pregnancy. 9 As a result, waiting at least a year and a half before trying for the next baby results in improved rates of early prenatal care, reduced risk of prematurity, and reduced risk of low birth weight. The pregnancy interval rate indicates the percentage of
singleton births that were not spaced 18 months between a prior birth and conception.
Based on the five-year average from 2012 to 2016, NH whites had the highest rate of births spaced 18 months or less, at 35.0%. NH African-American mothers had a lower total rate of unhealthy birth intervals (32.2%), but they had the highest rates of births spaced less than six months (9.4%) from the previous birth to conception.
6.6% 9.4%5.8% 7.7%
3.2%
12.2%11.5%
12.7% 10.1%
9.3%
14.8% 11.3% 16.5%13.0%
10.8%
0.0%
10.0%
20.0%
30.0%
40.0%
Summit County NH African-American
NH White Hispanic NH Asian
% o
f pre
gnan
cies
with
< 1
8 m
os in
terv
al
% less than 6 months % 6 up to 12 months % 12 up to 18 months
75.1%
72.0%73.3%
71.2%69.8%69.2%
62.8%
66.0%64.3%
58.1%
77.8% 76.8% 77.2%75.2% 75.6%
65.5%
58.3% 58.8% 59.9% 60.8%
65.3%
55.6%
62.4%
58.4%56.9%
50.0%
55.0%
60.0%
65.0%
70.0%
75.0%
80.0%
2012 2013 2014 2015 2016
% P
NC
in fi
rst t
rimes
ter
Summit County NH African-American NH white Hispanic NH Asian
Figure 12. Trend line graph for rate of prenatal care initiated in the first trimester, in Summit County and by race and ethnicity, 2012-2016
% of pregnancies spaced < 18 months, 5 year average Summit County: 33.5% Hispanic: 30.8% NH African-American: 32.2% NH Asian: 23.3% NH White: 35.0%
Figure 13. Summit County % less than 18 months birth to conception interval rates by race and ethnicity, five-year average (2012-2016)
SCPH QUARTERLY BIRTH REPORT, Q3 2017 9
Maternal Smoking Rate
Smoking during pregnancy has been associated with poor birth outcomes, especially low birth weight and prematurity. 10 Analysis of Summit County birth data indicated that mothers who reported smoking during their second and third trimesters had higher rates of prematurity and low birth weight when compared mothers who never smoked. Summit County mothers who were able to quit smoking at the beginning of
their pregnancy had prematurity and low birth weight rates that were comparable to non-smoking mothers.
NH white mothers had the highest rate (14.5%) of smoking during pregnancy as indicated by the five-year average in Figure 14, followed by NH African-American mothers at 12.5%. Hispanic and NH Asian mothers reported far lower rates of smoking, at 5.2% and 1.4%, respectively. The trend line graph in Figure 15 indicates that the NH white maternal smoking rate decreased by 13.5% from 2012 to 2016 from 2012 to 2016, but the NH African-American smoking rate increased by 5.1%.
14.0%13.5% 13.6%
12.5%
12.0%
11.7%
13.2% 13.0% 12.6%12.3%
15.5%
14.7% 14.9%
13.8%13.4%
10.0%
11.0%
12.0%
13.0%
14.0%
15.0%
16.0%
2012 2013 2014 2015 2016
% sm
okin
g du
ring
2nd
and
3rd
trim
etse
rs
Summit County NH African-American NH White
13.1% 12.5%
14.5%
5.2%
1.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
2012-2016 avg
% sm
okin
g du
ring
2nd
or 3
rd tr
imes
ter
Summit County NH African-American NH White Hispanic NH Asian
Figure 14. Summit County maternal smoking rates during 2nd or 3rd trimester by race and ethnicity, five-year average (2012-2016)
Figure 15. Trend line graph for maternal smoking rates during 2nd and 3rd trimesters in Summit County and by race, 2012-2016
SCPH QUARTERLY BIRTH REPORT, Q3 2017 10
Sleep-Related Deaths
Sleep-related deaths occur when an infant is placed in an unsafe sleeping environment or sleeping position, including: not in a crib, co-sleeping with others, in the presence of blankets, stuffed animals, or pillows, and/or sleeping on the stomach or side. Infant deaths due to Sudden Infant Death Syndrome (SIDS) are also classified as sleep-related. Summit County Public Health works with the ODH and other community to partners to promote the ABC’s of safe sleep: Alone, placed on Back, and in a Crib.11 Sleep-related deaths have generally decreased in the past five years from nine cases in 2012 to five cases in 2016 (Figure 16). The provisional total of sleep-related deaths in 2017 is three, but this may change if additional cases are reported and reviewed.
Figure 16. Sleep-related infant deaths in Summit County, 2012-2016
Akron Data and OEI Hot spots
Akron is the largest city in Summit County, with a population of nearly 200,000. When compared to Summit County, higher IM rates and NIM rates are observed in the city of Akron (Table 2). Higher rates of preterm birth, low birth weight births, and maternal smoking occurred in births to Akron residents, and Akron resident births also had lower rates of initiation of prenatal care in the first trimester. However, Akron mothers with previous births reported slightly lower rates of unhealthy birth spacing than Summit County in 2016 (31.3% and 33.6%, respectively).
Within the city of Akron, several infant mortality “hot spots” have been identified. These areas have the highest infant mortality rates and tend to have higher rates of poor birth outcomes, such as preterm birth and low birth weight. As shown in Figure 17, the clusters with the highest ten-year average (2007-2016) infant mortality rates are West Akron, Southwest Akron, and Southeast Akron. The zip codes which
2017 YTD Sleep-Related deaths:
3
9
76
7
5
0%
5%
10%
15%
20%
25%
0
1
2
3
4
5
6
7
8
9
10
2012 2013 2014 2015 2016
Perc
enta
ge o
f inf
ant d
eath
s
Num
ber o
f dea
ths
% of total infant deaths # of sleep-related deaths
SCPH QUARTERLY BIRTH REPORT, Q3 2017 11
correspond to these clusters (44307, 44320, and 44306) are considered to be areas of the highest priority for interventions that promote infant vitality and maternal health. In addition, a possible emerging hot spot was identified in North/Northwest Akron (44310 zip code) and will be monitored closely.
The local infant mortality collaborative group in Summit County is Every One: Summit County Better Birth Outcomes (SCBBO). SCBBO was formed in 2013, is led by the OEI team at Summit County Public Health, and includes membership from local health care, government, and community agencies. The interventions selected by the Summit County OEI team include:
1. Increasing education and access to progesterone therapy for mothers at risk for premature birth
2. Promoting long acting reversible contraception (LARC) to decrease unplanned pregnancies and promote healthy birth spacing
3. Combatting institutional racism and implicit bias
Future quarterly reports will contain updates on OEI activities, interventions and their impacts.
Table 2. Yearly average infant mortality and selected birth outcome rates for the City of Akron, 2012-2017 (YTD)
IMR NIMR % Preterm (< 37 wks)
% Low Birth Weight
% PNC in 1st Trimester
% Birth to Conception
Interval < 18 mos.
% Smoked 2nd and/or 3rd Trimesters
2012 8.7 5.2 13.7% 12.0% 69.0% 33.2% 20.0%
2013 8.0 5.6 11.6% 10.8% 66.3% 33.6% 20.2%
2014 8.1 5.4 11.2% 10.7% 68.8% 34.4% 19.4%
2015 9.7 6.1 13.1% 11.6% 66.2% 34.0% 18.3%
2016 10.7 5.3 13.5% 12.6% 60.3% 31.3% 19.6% 2017 YTD 8.2 4.3 10.9% 10.4% 60.2% 35.2% 16.6%
Figure 17. Summit County infant mortality rates by census tract cluster, 2007-2016
NR = Not Reported. Stable IM rates can not be calculated in areas with < 10 infant deaths
SCPH QUARTERLY BIRTH REPORT, Q3 2017 12
Technical Notes
Data Sources: The Summit County Public Health Epidemiology/Biostatistics Unit completed all analysis
1. Infant Mortality: ODH data from birth and death certificates were used to count infant deaths and calculate the infant mortality rate. Data from 2016 and earlier are finalized, 2017 data is provisional and will not be finalized until mid-2018.
2. Birth Indicators: ODH Birth certificate data 3. Cause of Infant Death: Sleep-related death information was provided by the Summit County
Child Fatality Review Board.
Data limitations: It is important to note that large annual changes in birth rates, especially for specific racial or ethnic groups, may be due to small overall numbers of births within that population. Caution is warranted in interpreting these findings across subpopulations within the County.
Using the graphs and data in this report: Most of the graphs in this report will offer the following key types of data: the monthly rate, the yearly average of the rate, the two year moving average of the rate, and the Healthy People 2020 goal of the rate (if one exists). In order to protect privacy for birth indicator data, data and rates will be suppressed if there are fewer than 10 individuals in an analysis group. Since there is a great deal of fluctuation in monthly rates, the two year moving average provides a better indication of trends in the data, and includes the 24 months immediately prior to and including the current month. The moving average is subject to change based on new data, especially data from 2017, which has not yet been finalized by the ODH and is considered to be preliminary.
Racial Disparity Graphs: Two types of graphs are used throughout this report to illustrate the differences in infant mortality rates and birth outcomes among the various racial and ethnic groups in Summit County. A comparison graph of the 2016 rate and the five-year average rate (2012-2016) for most indicators includes the county rate and the rates for major racial/ethnic groups. In addition, the trend line graph displays the direction change in the yearly average rates for the county, non-Hispanic white and non-Hispanic African-American populations.
Racial demographics: To determine whether racial disparities exist in Summit County in either infant deaths or birth outcomes, infant death and birth data is also stratified by race and ethnicity. The information on race and ethnicity is based on self-reported data provided by the mothers about themselves; the race/ethnicity of children may be different from those of their mothers. These groups are divided following race categories in the ODH birth data: Non-Hispanic White, Non-Hispanic African American, Hispanic, and Non-Hispanic Asian. The mothers who identify their ethnicity as Hispanic or Latino may belong to any racial group. Although smaller in size, the Hispanic and Asian communities are significant, especially in certain areas throughout Summit County.
For this introductory report, the graphs will include data from 2013, which was the first year of organized infant mortality efforts through the formation of the Ohio Equity Institute (OEI) and Summit County Better Birth Outcomes (SCBBO). Future quarterly reports will contain data from the previous two years.
Healthy People 2020 Goals: Healthy People 2020 (HP 2020) is the most recent version of the Healthy People program, a federal interagency initiative that provides evidence-based 10-year national goals for the improvement of the health of Americans. 4 HP 2020 goals for infant mortality and birth indicators were added to the monthly rate graphs to provide a reference to how Summit County is doing in comparison to national goals. Summit County infant and maternal health indicators typically have not met the HP2020 goals.
SCPH QUARTERLY BIRTH REPORT, Q3 2017 13
Summit County Census Tract Clusters: Based on census tracts from the 2010 census, twenty Summit County clusters were developed to standardize data reporting within Summit County Public Health. The clusters are groupings of census tracts with similar demographic characteristics. Some clusters will follow municipal and/or township boundaries, but for Akron, seven clusters serve as geographical subdivisions of the city.
References
1. State Infant Mortality Collaborative: Infant Mortality Toolkit. State Infant Mortality (SIM) Toolkit: A Standardized Approach for Examining Infant Mortality. N.p., 01 Nov 2013. Web. [insert access date]. <http://www.amchp.org/programsandtopics/data-assessment/InfantMortalityToolkit/Pages/default.aspx>.
2. Reidpath, D.D., & Allotey, P. (2003). Infant mortality rate as an indicator of population health. Journal of Epidemiology and Community Health, 57(5): 344-346. Doi:10.1136/jech.57.5.344.
3. Ohio Department of Health (ODH). (2017). 2016 Ohio Infant Mortality Data: General Findings. Retrieved October 15, 2017 from: https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/OEI/2016-Ohio-Infant-Mortality-Report-FINAL.pdf?la=en
4. Office of Disease Prevention and Health Promotion (ODPHP). Healthy People 2020: Maternal, Infant, and Child Health. Retrieved November 16, 2017 from: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health
5. Centers for Disease Control and Prevention (CDC). Preterm Birth. Retrieved November 8, 2017 from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
6. March of Dimes. Premature Babies. Retrieved November 8, 2017 from: https://www.marchofdimes.org/complications/premature-babies.aspx
7. March of Dimes. Low birthweight. Retrieved November 16, 2017 from: https://www.marchofdimes.org/complications/low-birthweight.aspx
8. Centers for Disease Control and Prevention (CDC). Maternal and Infant Health. Retrieved November 8, 2017 from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/index.html
9. March of Dimes. (2015). Birth Spacing and Birth Outcomes. Retrieved November 30, 2017 from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0ahUKEwim-t7xpoLYAhUm5YMKHZUwCJEQFgg9MAM&url=https%3A%2F%2Fwww.marchofdimes.org%2FMOD-Birth-Spacing-Factsheet-November-2015.pdf&usg=AOvVaw3E6F0dgzk6ZQZBe1M7cOB0
10. Centers for Disease Control and Prevention (CDC). Tobacco Use and Pregnancy. Retrieved November 16 from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/index.htm
11. Ohio Department of Health (ODH). (2017). Infant Safe Sleep. Retrieved 12/5/2017 from: https://www.odh.ohio.gov/safesleep/
