Infant mortality report, 2017

Infant Mortality Report
Learn more about infant mortality at: dph.georgia.gov/infant-mortality

Infant Mortality Report
2

INFANT MORTALITY REPORT | Introduction
Learn more at: dph.georgia.gov/infant-mortality

A S D E F I N E D B Y T H E W O R L D H E A LT H O R G A N I Z AT I O N, the infant mortality rate (IMR) is the number of deaths that occur in the first year of life per 1,000 births. IMR is a measure of how well a society ensures the health of its people, particularly
its women and children. In 2017,Georgia's IMR was 7.2 per 1,000 live births; 932 Georgia infants died before their first birthday.

DATA OVERVIEW
From 2008 to 2017, 9,707 Georgia infants died before their first birthday
Between 2013 and 2017, prematurity was the leading cause of infant deaths
in Georgia
The infant mortality rate among Black, non-Hispanic infants is 2 times higher than White, non-Hispanic or Hispanic
Between 2013 and 2017, over half of infant deaths occurred within the first 6 days of life

| F I GU R E 1 Infant Mortality Rate in Georgia, 2008-2017

IMR (per 1,000 live births)

9

8

8.0

7

6

5

4

3

2

1

0 2008

7.5 2009

6.3 2010

6.8

6.7

2011

2012

7.2 2013

7.7

7.8

7.4

Healthy People 2020

2014

2015

2016

7.2 2017

R E D U C I N G T H E I N FA N T M O R TA L I T Y R AT E is a priority nationally and in Georgia. From 2008 to 2017, Georgia did not

achieve the Healthy People 2020 target of 6 infant deaths per 1,000 live births. Over that decade, Georgia's infant mortality

rate fluctuated between 6.3 and 8.0 deaths per 1,000 live births.

GEORGIA INFANT MORTALITY REPORT 3

INFANT MORTALITY | by Race/Ethnicity

| FIGURE 2 Infant Mortality by Race/Ethnicity

WHITE,

NH IMR:

5.4

infant deaths
PER 1,000 LIVE BIRTHS

BLACK, NH IMR:
12.2
infant deaths
PER 1,000 LIVE BIRTHS

The infant mortality rate among Black, non-Hispanic infants is twice that of White, non-Hispanic or Hispanic infants. This racial disparity mirrors the national trend.

4 GEORGIA INFANT MORTALITY REPORT

GEORGIA INFANT MORTALITY REPORT

INFANT MORTALITY | by Race/Ethnicity

LEADING CAUSES1 OF INFANT DEATH BY RACE/ETHNICITY
The top five causes of death are the same for White, non-Hispanic and Black, non-Hispanic infants. However, Black, non-Hispanic infants are disproportionately impacted by each of these causes, especially prematurity.
| F I GU R E 3 The Top Five Causes of Death in White, Non-Hispanic and Black, non-Hispanic Infants, Georgia, 2013-2017

Prematurity

4.2

10.0

Sudden Infant Death Syndrome

2.4 3.6

Respiratory Conditions

2.6 3.5

Newborn A ected by Maternal Complications of Pregnancy

1.0 2.9

Cardiovascular Disorders

2.1 2.6

1 Causes of death include underlying or immediate causes and are not mutually exclusive. Infants may have more than one cause of death indicated. The denominator for the percentages calculated are all the causes of death, not the number of infants. The numerator includes each time the respective cause of death was indicated.

0.0

2.0

4.0

White, non-Hispanic

6.0

8.0

10.0

Black, non-Hispanic

12.0

GEORGIA INFANT MORTALITY REPORT 5

INFANT MORTALITY | Infancy Period

INFANCY PERIOD
The first year of an infant's life is characterized by many physiologic changes and developmental milestones. The early neonatal period indicates the time between birth and six days of life, the late neonatal period indicates time between 7 and 27 days, and the post neonatal period indicates time between 28 and 364 days.
| F I GU R E 4 Infant Deaths by Infancy Period, Georgia, 2013-2017

More than half of infant deaths occur during the first six days of life.

EARLY
NEONATAL

LATE
NEONATAL

POST
NEONATAL

2,597
53.5
PERCENT

626
12.9
PERCENT

1,629
33.6
PERCENT
Total of 4,852 infant deaths

6 GEORGIA INFANT MORTALITY REPORT

INFANT MORTALITY | Infancy Period

LEADING CAUSES OF INFANT DEATH BY INFANCY PERIOD
The top three conditions underlying or leading to the immediate cause of death in infants by infancy period reflect the unique risks infants experience over the course of the first 12 months of life.

| F I GU R E 5 The Top Three Causes of Death in the Early Neonatal Infancy Period

Cause of Death Prematurity Respiratory conditions Newborn affected by maternal complications of pregnancy

% 26.7 9.8 8.6

| F I GU R E 6 The Top Three Causes of Death in the Late Neonatal Infancy Period

Cause of Death

%

Respiratory conditions

9.5

Cardiovascular disorders

9.0

Birth-related infections

7.5

| F I GU R E 7 The Top Three Causes of Death in the Post Neonatal Infancy Period

Cause of Death

%

Sudden infant death syndrome

15.5

Suffocation

9.4

Other causes of death, unspecified

4.2

Prematurity comprises over one-fourth of the early neonatal causes of death.
Respiratory conditions and cardiovascular disorders each make up about one in ten late neonatal causes of death.
Sudden infant death syndrome (SIDS) is the most common post neonatal cause of death.

More than half of infant deaths occur during the first six days of life. Prematurity, respiratory conditions and cardiovascular disorders, along with sudden infant death syndrome (SIDS) are the most common causes of infant mortality in early, late and post neonatal infancy periods, respectively.

INFANT MORTALITY | Excess Infant Deaths

G E O G R A P H I C D I S T R I B U T I O N O F E XC E S S I N FA N T D E AT H S (excess infant mortality rate by county)
A positive excess infant mortality rate denotes counties with a higher infant mortality rate than the reference group. The excess infant mortality rate by county was calculated by comparing the observed infant mortality rate for each county to the infant mortality rate for a reference group (see Appendix A).

The Georgia counties with the highest excess infant mortality rate between 2012 and 2016 are concentrated in the southern region of the state.
,
| F I GU R E 8 Excess Infant Mortality Rate by County of Residence, Georgia, 2012-16

Dade

Catoosa

Walker Whit eld

Murray

Fannin Gilmer

Towns Union

Rabun

Habersham White

Chattooga

Gordon

Pickens

Lumpkin

Stephens

Floyd

Dawson

Banks Franklin

Hall

Bartow

Cherokee Forsyth

Hart

EXCESS IMR
-3.1 - 0.0 0.4 - 2.8

Jackson Madison

Elbert

Polk Haralson

Cobb Paulding
Douglas Fulton

Gwinnett DeKalb

Barrow Clarke

Walton

Oconee

Oglethorpe

Wilkes

Rockdale

Lincoln

Carroll

Clayton

Newton

Morgan

Greene Taliaferro

Columbia

Heard

Coweta

Fayette

Henry

Spalding Butts

Jasper

Putnam

McDu e Warren
Hancock Glascock

Richmond

2.9 - 5.7 5.9 - 9.4 10.3 - 15.0

Troup

Pike Meriwether

Lamar Monroe

Baldwin Jones

Je erson Washington

Burke

Upson

Harris Muscogee

Talbot

Bibb Crawford

Taylor

Peach

Wilkinson Twiggs

Johnson

Jenkins Emanuel

Screven

Marion Chattahoochee

Macon

Houston Bleckley

Laurens

Treutlen

Candler Bulloch

E ngham

Schley

Stewart Webster

Sumter

Quitman

Terrell Randolph

Lee

Clay

Calhoun

Dougherty

Dooly

Pulaski

Crisp

Wilcox

Turner

Dodge

Montgomery

Wheeler

Toombs

Evans

Telfair

Tattnall

Ben Hill

Je Davis Appling

Long

Bryan Liberty

Chatham

Worth

Irwin Tift

Co ee

Bacon

Wayne

McIntosh

Early Miller

Baker Mitchell

Colquitt

Berrien Cook

Atkinson

Pierce

Ware

Brantley

Glynn

Seminole Decatur

Grady

Thomas

Brooks

Lanier Lowndes

Clinch

Charlton

Camden

Echols

Between 2012 and 2016, if all counties in Georgia had the same infan$t mortality rate as the reference group, 2,680 infant deaths could have been prevented in Georgia.

INFANT MORTALITY | Public Health Programs

CenteringPregnancy CenteringPregnancy, an innovative model of group prenatal care that integrates physical assessment with extensive health education and group support, has been demonstrated to improve several important pregnancy outcomes including preterm birth.
| P R I O R I T Y Implement CenteringPregnancy programs
in two additional public health districts.
FAMILY PLANNING The DPH Family Planning program supports the healthcare needs of women and assists them with planning the number, timing and spacing of their children.
| P R I O R I T Y Increase long-acting reversible
contraceptive access and utilization.

group socialization experiences to improve health outcomes, home and child safety, school readiness, family safety, and family economic self-sufficiency.
| P R I O R I T Y Ensure evidence-based home visits
MATERNAL AND NEONATAL LEVELS OF CARE DESIGNATIONS Maternal and Neonatal Levels of Care Designations designate hospitals according to the level of care they provide for mothers and infants. The designations ensure mothers and infants receive care in the closest facility that is most appropriate for their level of risk.
| P R I O R I T Y Increase the number of hospitals that have
achieved a designation

GEORGIA 5-STAR HOSPITAL INITIATIVE The Georgia 5-STAR Hospital Initiative was developed to encourage hospitals to take steps toward becoming breastfeeding-friendly. Birthing hospitals are recognized for implementing evidence-based maternity care practices that promote and support breastfeeding with one star for every two breastfeeding-friendly steps completed.
| P R I O R I T Y Increase the number of birthing hospitals
that implement recommended steps to increase successful breastfeeding initiation and duration.
GEORGIA PERINATAL QUALITY COLLABORATIVE (GAPQC) GaPQC is a network of over 30 organizations led by DPH that are working to establish and maintain a robust statewide perinatal data and quality improvement system that engages stakeholders in evidenced based practice improvements.
| P R I O R I T Y lncrease the number of hospitals that
implement quality improvement projects for maternal and neonatal care.
HOME VISITING Home Visiting offers support and comprehensive services to at-risk families through home visits and

PERINATAL CASE MANAGEMENT (PCM) PCM services are available to assist Medicaid eligible pregnant woman in gaining access to needed medical, nutritional and other services to improve maternal and infant health outcomes.
| P R I O R I T Y Ensure deliveries occur at risk-appropriate
facilities.
PERINATAL REGIONALIZATION There are six perinatal regions throughout Georgia, and each has one regional perinatal center. Services provided include high-risk maternal and neonatal medical care, medical transportation, perinatal consultation, and developmental clinics for infants born preterm, low birth weight, and at risk for neurological disorders.
| P R I O R I T Y Ensure deliveries occur at risk-appropriate
facilities.
SAFE TO SLEEP CAMPAIGN The Safe to Sleep Program coordinates statewide public health interventions intended to protect infants from sudden infant death syndrome and other sleep-related causes of death.
| P R I O R I T Y Prevent sleep-related infant deaths.
GEORGIA INFANT MORTALITY REPORT 9

INFANT MORTALITY | Appendix A
EXCESS INFANT MORTALITY RATE CALCULATION
A reference group must be identified to calculate the excess infant mortality rate. Typically, a subpopulation with a low infant mortality rate is identified within the geographic area of interest. The reference group used in this report was selected based on guidance from subject matter experts. The reference infant mortality rate
was calculated using the following maternal characteristics: 1| Georgia resident, 2| White, non-Hispanic, 3| 25 to 29 years of age, and 4| higher than a high school
education. Approximately 2,680 excess infant deaths occurred over a 5-year period (2012-16). The infant mortality rate of the reference group was 3.2 infant deaths per 1,000 live births (2012-2016 birth cohort). The excess infant mortality rate and the excess infant deaths are calculated based on the infant mortality rate of the reference group; see the following formulas:
EXCESS INFANT MORTALITY RATE
IMR -- IMRREF
EXCESS INFANT DEATHS
Observed number of infant deaths -- expected number of infant deaths = Observed number of infant deaths -- (number of births * IMREF /1,000)
10 G EO RGI A I N FA NT M O RTA L I T Y R E P O RT

INFANT MORTALITY | Appendix B

APP. B | INFANT MORTALITY MEASURES BY COUNTY OF RESIDENCE, GEORGIA, 2012-2016

County

Number of Births

Number of Infant Deaths

Infant Mortality Rate

Excess Infant Mortality Rate

Excess Infant Deaths

Appling

1,276

8

6.3

3.2

3

Atkinson

634

2

*

**

0

Bacon

754

6

8

4.9

3

Baker

161

1

*

**

0

Baldwin

2,259

24

10.6

7.5

16

Banks

969

8

8.3

5.2

4

Barrow

5,219

26

5

1.9

9

Bartow

6,532

53

8.1

5.0

32

Ben Hill

1,143

18

15.7

12.6

14

Berrien

1,200

10

8.3

5.2

6

Bibb

10,809

154

14.2

11.1

119

Bleckley

660

7

10.6

7.5

4

Brantley

1,086

8

7.4

4.3

4

Brooks

1,017

9

8.8

5.7

5

Bryan

2,561

16

6.2

3.1

7

Bulloch

4,343

37

8.5

5.4

23

Burke

1,605

22

13.7

10.6

16

Butts

1,300

14

10.8

7.7

9

Calhoun

257

2

*

**

1

Camden

4,000

25

6.3

3.2

12

Candler

705

5

7.1

4.0

2

Carroll

7,327

39

5.3

2.2

15

Catoosa

3,689

13

3.5

0.4

1

Charlton

597

1

*

**

0

Chatham

19,904

151

7.6

4.5

88

Chattahoochee

1,162

7

6

2.9

3

Chattooga

1,443

11

7.6

4.5

6

Cherokee

14,026

64

4.6

1.5

19

Clarke

6,856

45

6.6

3.5

23

Clay

173

1

*

**

0

Clayton

21,207

177

8.3

5.2

110

Clinch

504

9

17.9

14.8

7

Cobb

47,043

288

6.1

3.0

139

Coffee

2,955

27

9.1

6.0

17

Colquitt

3,280

25

7.6

4.5

14

Columbia

8,684

69

7.9

4.8

41

Cook

1,091

8

7.3

4.2

4

Coweta

8,183

41

5

1.9

15

Crawford

634

7

11

7.9

5

Crisp

1,471

25

17

13.9

20

APP. B | INFANT MORTALITY MEASURES BY COUNTY OF RESIDENCE, GEORGIA, 2012-2016

County

Number of Births

Number of Infant Deaths

Infant Mortality Rate

Excess Infant Mortality Rate

Excess Infant Deaths

Dade

843

8

9.5

6.4

5

Dawson

1,176

11

9.4

6.3

7

Decatur

1,831

19

10.4

7.3

13

DeKalb

55,043

396

7.2

4.1

222

Dodge

1,175

13

11.1

8.0

9

Dooly

548

4

*

**

2

Dougherty

6,416

97

15.1

12.0

76

Douglas

8,702

64

7.4

4.3

36

Early

672

11

16.4

13.3

8

Echols

322

4

*

**

2

Effingham

3,783

34

9

5.9

22

Elbert

1,121

8

7.1

4.0

4

Emanuel

1,571

15

9.5

6.4

10

Evans

785

5

6.4

3.3

2

Fannin

1,005

11

10.9

7.8

7

Fayette

4,248

28

6.6

3.5

14

Floyd

5,907

43

7.3

4.2

24

Forsyth

11,421

44

3.9

0.8

8

Franklin

1,329

9

6.8

3.7

4

Fulton

62,569

436

7

3.9

239

Gilmer

1,582

6

3.8

0.7

1

Glascock

138

0

0

-3.1

0

Glynn

4,889

35

7.2

4.1

19

Gordon

3,477

17

4.9

1.8

6

Grady

1,724

12

7

3.9

6

Greene

823

3

*

**

0

Gwinnett

57,943

365

6.3

3.2

182

Habersham

2,512

15

6

2.9

7

Hall

12,768

68

5.3

2.2

27

Hancock

350

3

*

**

1

Haralson

1,689

13

7.7

4.6

7

Harris

1,426

11

7.7

4.6

6

Hart

1,378

12

8.7

5.6

7

Heard

648

4

*

**

1

Henry

11,911

84

7.1

4.0

46

Houston

10,124

78

7.7

4.6

46

Irwin

504

4

*

**

2

Jackson

3,928

22

5.6

2.5

9

Jasper

843

4

*

**

1

Jeff Davis

1,046

14

13.4

10.3

10

Jefferson

1,037

13

12.5

9.4

9

Jenkins

496

5

10.1

7.0

3

APP. B | INFANT MORTALITY MEASURES BY COUNTY OF RESIDENCE, GEORGIA, 2012-2016

County

Number of Births

Number of Infant Deaths

Infant Mortality Rate

Excess Infant Mortality Rate

Excess Infant Deaths

Johnson

454

2

*

**

0

Jones

1,517

14

9.2

6.1

9

Lamar

999

4

*

**

0

Lanier

702

1

*

**

-1

Laurens

3,205

33

10.3

7.2

22

Lee

1,782

10

5.6

2.5

4

Liberty

7,317

60

8.2

5.1

36

Lincoln

393

3

*

**

1

Long

1,359

10

7.4

4.3

5

Lowndes

7,974

79

9.9

6.8

53

Lumpkin

1,490

7

4.7

1.6

2

McDuffie

1,455

12

8.2

5.1

7

McIntosh

600

3

*

**

1

Macon

682

5

7.3

4.2

2

Madison

1,703

12

7

3.9

6

Marion

443

7

15.8

12.7

5

Meriwether

1,270

12

9.4

6.3

8

Miller

331

0

0

-3.1

-1

Mitchell

1,339

16

11.9

8.8

11

Monroe

1,380

13

9.4

6.3

8

Montgomery

481

6

12.5

9.4

4

Morgan

932

4

*

**

1

Murray

2,506

3

*

**

-4

Muscogee

15,385

170

11

7.9

121

Newton

6,618

43

6.5

3.4

22

Oconee

1,679

12

7.1

4.0

6

Oglethorpe

779

2

*

*

0

Paulding

9,379

55

5.9

2.8

25

Peach

1,474

12

8.1

5.0

7

Pickens

1,524

12

7.9

4.8

7

Pierce

1,189

3

*

**

0

Pike

806

2

*

**

0

Polk

2,788

19

6.8

3.7

10

Pulaski

441

2

*

**

0

Putnam

1,162

9

7.7

4.6

5

Quitman

124

2

*

**

1

Rabun

759

5

6.6

3.5

2

Randolph

414

4

*

**

2

Richmond

14,719

164

11.1

8.0

117

APP. B | INFANT MORTALITY MEASURES BY COUNTY OF RESIDENCE, GEORGIA, 2012-2016

County

Number of Births

Number of Infant Deaths

Infant Mortality Rate

Excess Infant Mortality Rate

Excess Infant Deaths

Rockdale

4,948

62

12.5

9.4

46

Schley

246

1

*

**

0

Screven

875

8

9.1

6.0

5

Seminole

484

8

16.5

13.4

6

Spalding

4,085

40

9.8

6.7

27

Stephens

1,575

10

6.3

3.2

5

Stewart

220

4

*

**

3

Sumter

1,926

12

6.2

3.1

5

Talbot

262

0

0

-3.1

0

Taliaferro

74

0

0

-3.1

0

Tattnall

1,371

13

9.5

6.4

8

Taylor

435

5

11.5

8.4

3

Telfair

648

6

9.3

6.2

3

Terrell

596

4

*

**

2

Thomas

2,887

24

8.3

5.2

14

Tift

2,858

22

7.7

4.6

13

Toombs

1,977

19

9.6

6.5

12

Towns

431

3

*

**

1

Treutlen

389

2

*

**

0

Troup

4,556

38

8.3

5.2

23

Turner

574

1

*

**

0

Twiggs

471

5

10.6

7.5

3

Union

820

4

*

**

1

Upson

1,631

11

6.7

3.6

5

Walker

3,727

24

6.4

3.3

12

Walton

5,280

31

5.9

2.8

14

Ware

2,423

19

7.8

4.7

11

Warren

272

3

*

**

2

Washington

1,178

5

4.2

1.1

1

Wayne

1,982

9

4.5

1.4

2

Webster

116

0

0

-3.1

0

Wheeler

319

3

*

**

1

White

1,327

4

*

**

0

Whitfield

6,948

31

4.5

1.4

9

Wilcox

454

7

15.4

12.3

5

Wilkes

528

5

9.5

6.4

3

Wilkinson

517

2

*

**

0

Worth

1,286

10

7.8

4.7

5

TOTALS

650,672

4,798

2,680

*The infant mortality rate is not calculated for counties with 1-4 infant deaths **The excess infant mortality rate is not calculated for counties with 1-4 infant deaths

dph.georgia.gov

MATERNAL AND CHILD HEALTH 2 P E AC H T R E E ST R E E T, 1 1 T H F LO O R ATLANTA, GEORGIA, 30303-3142