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