Infant Mortality In Miami-Dade County

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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

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 3

Introduction What is infant mortality and why does it matter to health equity and health disparity? 4

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. 5

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 Pregnancy Infant Mortality & Morbidity 8

Conception Preconception Pregnancy Infant Mortality & Morbidity 9

Conception Conception Preconception Pregnancy Infant Mortality & Morbidity 10

Life Course Perspective

Perinatal Mortality Rates per 1,000 Live Births Perinatal Mortality Rates, Miami-Dade County, 2006-2013 9 8 7 6 5 4 3 2 1 0 8.1 7.3 2006 6.1 2013 4.6 Fetal Mortality Rate 3.9 Infant Mortality Rate 3 Neonatal Mortality Rate 2.1 1.7 Postneonatal Mortality Rate Years Source: 2016 Miami-Dade County Infant Mortality Analysis 12

3-Year Infant Mortality Rates Miami-Dade County, 2005-2014 Rate per 1,000 Live Births 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total IMR Black IMR White IMR Other Race IMR Hispanic IMR (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 13

Rate per 1,000 Live Births 3-Year Infant Mortality Rates across Florida, 2005-2014 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Year Miami-Dade County Palm Beach County Broward County Hillsborough County Source: 2016 Miami-Dade County Infant Mortality Analysis 14

3-Year Infant Mortality Rates, Florida & U.S., 2005-2014 Rate per 1,000 Live Births 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Year Miami-Dade County Florida United States Source: 2016 Miami-Dade County Infant Mortality Analysis 15

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

3-Year Fetal Mortality Rates Miami-Dade County, 2005-2014 Rate per 1,000 Live Births 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2006 2007 2008 2009 Years 2010 2011 2012 Total Fetal Death Rate Black Fetal Death Rate White Fetal Death Rate Hispanic Fetal Death Rate Source: 2016 Miami-Dade County Infant Mortality Analysis 2013 17

3-Year Neonatal Infant Mortality Rates Miami-Dade County, 2005-2014 Rate per 1,000 Live Births 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Neonatal IMR Black Neonatal IMR White Neonatal IMR Hispanic Neonatal IMR (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 18

Rate per 1,000 Live Births 3-Year Postneonatal Infant Mortality Rates Miami-Dade County, 2005-2014 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Postneonatal IMR Black Postneonatal IMR White Postneonatal IMR Hispanic Postneonatal IMR (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 19

Infant Health Factors Preterm Births, Low Birth Weight (LBW), and VLBW Births in Miami-Dade County, 2005-2014 Percent of Live Births 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Preterm Births Total Low Birth Weight (LBW) Total VLBW Births Source: 2016 Miami-Dade County Infant Mortality Analysis 20

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) 21

Rate per 1,000 Live Births 3-Year Cause Specific Infant Mortality Rates Miami-Dade County, 2005-2014 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years 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 22

Sudden Unexpected Infant Death (SUID) in Miami-Dade County, 2005-2014 2.0 Rate per 1,000 Live Births 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 2006 2007 2008 2009 2010 2011 2012 2013 Years Total Non-Hispanic Black Race Non-Hispanic White Race Hispanic Ethnicity (All Races) Source: 2016 Miami-Dade County Infant Mortality Analysis 23

Maternal Health Factors Covered in a later presentation 24

Life Course Perspective

Neighborhood Area Analysis J G C B A K M I N E H D F 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 26

Infant Mortality Rate 5-Year Infant Mortality Rate by Neighborhood Miami-Dade County, 2010-2014 Group I 8.92 Neighborhood Group Group K 7.58 Group A 6.14 Group M 6.08 Group E 3.96 Group J 3.62 Group N Group A: South Dade/Homestead 3.22 Group H Group M: North Miami/North Miami Beach 3.04 Group C 2.66 Group F 2.58 Group G 2.5 Group D 2.5 0 2 Group I: Downtown/East Little Havana /Liberty City/Little Haiti/Overtown Group K: Opa-Locka/Miami Gardens /Westview 4.34 Group B Highest Neighborhood Rates: Group E: Brownsville/Coral Gables /Coconut Grove 4 6 8 10 Group B: Kendall Rate per 1,000 Live Births Source: 2016 Miami-Dade County Infant Mortality Analysis 27

Low Birthweight 5-Year Low Birthweight Percentages by Neighborhood, Miami-Dade County, 2010-2014 Group I 12.52 Group K 11.78 Neighborhood Group Group M Group I: Downtown/East Little Havana /Liberty City/Little Haiti/Overtown 10.48 Group E 9.16 Group A 8.76 Group H 8.74 Group B Group K: Opa-Locka/Miami Gardens/Westview 8.04 Group C 7.64 Group N 7.6 Group F 7.6 Group D 7.5 Group J 7.14 Group G 7.02 0 2 4 6 8 Highest Neighborhood Percentages: Group M: North Miami/North Miami Beach Group E: Brownsville/Coral Gables/Coconut Grove Group A: South Dade/Homestead Group H: Miami Shores/Morningside 10 12 14 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 28

Preterm Birth 5-Year Preterm Birth Percentages by Neighborhood, Miami-Dade County, 2010-2014 Group I 13.32 Group K 12.82 Neighborhood Group Group M 11.2 Group E 10.8 Group H 9.76 Group A 9.64 Group J 9.14 Group B 9.08 Group C 9.04 Group D 8.7 Group N 8.66 Group G 8.66 Group F 2 4 6 8 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 8.1 0 Highest Neighborhood Percentages: 10 12 14 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 29

Summary of Neighborhood Findings: Maternal and Child Health Outcomes High Infant Mortality Rate High % of Low Birth Weight High % of Preterm Births Grp A Grp B X X Grp C Grp D Grp E Grp F Grp G Grp H X Grp I Grp J Grp K Grp M X X X X X X X X X X X X X X X Grp N Highest Neighborhood Rates and Percentages Group A: South Dade/Homestead Group I: Downtown/East Little Havana/Liberty City/Little Haiti/Overtown Group B: Kendall Group E: Brownsville/Coral Gables/Coconut Grove Group K: Opa-Locka/Miami Gardens/Westview Group H: Miami Shores/Morningside Group M: North Miami/North Miami Beach Source: 2016 Miami-Dade County Infant Mortality Analysis 30

Unwed Mothers 5-Year Percent of Unwed Mothers by Neighborhood, Miami-Dade County, 2010-2014 Group I Group K Group I: Downtown/East Little Havana/ Liberty City/Little Haiti/Overtown 68.34 Group E Neighborhood Group Highest Neighborhood Percentages: 77.04 64.56 Group A 58.9 Group J Group K: Opa-Locka/Miami Gardens /Westview 54.06 Group M 50.7 Group C 43.74 Group H 42.28 Group B 41.84 Group G Group E: Brownsville/Coral Gables /Coconut Grove Group A: South Dade/Homestead 37.84 Group N 26.26 Group D Group J: Hialeah/Miami Lakes 23.7 Group F Group M: North Miami/North Miami Beach 21.6 0 20 40 60 80 100 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 31

Early Prenatal Care Highest 5-Year Percent of Early Prenatal Care by Neighborhood, Miami-Dade County, 2010-2014 Neighborhood Group Group F Lowest Neighborhood Percentages: 86.84 Group D 84.88 Group H 84.8 Group N 84.28 Group B Group K: Opa-Locka/Miami Gardens/ Westview Group A: South Dade/Homestead 83.74 Group C 83.28 Group G 83.14 Group E 82.3 Group M 81.74 Group I 79.7 Group J 79.7 Group A 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 77.88 Group K 76.76 70 75 80 85 90 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 32

Illicit Drug Use Highest Percent of Illicit Drug Use by Neighborhood Miami-Dade County, 2014 Group G 1.5 Highest Neighborhood Percentages: Group A 1.5 Group N: Aventura/Miami Beach Neighborhood Group Group J 1.6 Group K Group F: Coral Gables/Coconut Grove /Key Biscayne 2 Group E 2.1 Group B 3.3 Group M Group I: Downtown/East Little Havana /Liberty City/Little Haiti/Overtown 3.4 Group D 3.6 Group H Group C: Westchester/West Dade 3.9 Group C 5.4 Group I 5.5 Group F 5.5 Group N Group H: Miami Shores/Morningside Group D: Coral Gables/Kendall 7.2 0 2 4 6 8 Percent Source: 2016 Miami-Dade County Infant Mortality Analysis 33

Summary of Neighborhood Findings: Substance Abuse and Tobacco Use Grp A % Current Drinker % Illicit Drug Use in Past Month % Current Smoker %Someone Smokes at home X Grp B Grp C Grp D X X X Grp E Grp F Grp G X X X X X Grp H Grp I Grp J Grp K Grp M X X X X X X X X X X X X X X X Highest Neighborhood Percentages Grp N Group H: Miami Shores/Morningside Group C: Westchester/West Dade Group I: Downtown/East Little Havana/Liberty Group D: Coral Gables/Kendall City/Little Haiti/Overtown Group E: Brownsville/Coral Gables/Coconut Grove Group J: Hialeah/Miami Lakes Group F: Coral Gables/Coconut Grove/Key Biscayne Group N: Aventura/Miami Beach Source: 2016 Miami-Dade County Infant Mortality Analysis 34

Poverty Highest Percent of Poverty by Zip Code Miami-Dade County, 2010-2014 33161 30.1 31.4 32.4 33 34.3 38.1 38.6 39.3 39.8 40 41.5 42.1 42.3 43.5 44.6 33054 33010 33147 33150 Zip Code 33127 33128 33136 33125 33135 33130 33142 33030 33039 33034 0 10 20 30 Percent 40 50 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) Source: 2016 Miami-Dade County Infant Mortality Analysis 35

Infectious Syphilis Zip Code Highest Infectious Syphilis Rate by Zip Codes Miami-Dade County, 2014 33126 33147 33145 33133 33181 33130 33056 33142 33167 33137 33138 33132 33136 33139 33128 Highest Neighborhood Rates: 24.9 25.3 25.7 26.5 28 28.4 31.2 32.8 34.9 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) 57 57.6 Group K: Opa-Locka/Miami Gardens /Westview (33167, 33056) 67.4 82.9 114.6 132.1 0 20 40 60 80 100 Rate per 100,000 population 120 140 Group M: North Miami/North Miami Beach (33181) Group N: Aventura/Miami Beach (33139) Source: 2016 Miami-Dade County Infant Mortality Analysis 36

HIV Rates ZIp Code Highest Reported HIV Rate by Zip Code Miami-Dade County, 2014 33161 33056 33130 33141 33127 33142 33131 33150 33147 33181 33128 33138 33137 33139 33136 Highest Neighborhood Rates: 74.9 79.4 81.1 82.7 86.2 87.4 88.4 90.4 101.1 106.3 118.9 128.7 156.6 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) 207.8 339.3 0 100 200 300 Rate per 100,000 population 400 Group M: North Miami/North Miami Beach (33181, 33161) Group N: Aventura/Miami Beach (33139, 33141) Source: 2016 Miami-Dade County Infant Mortality Analysis 37

Summary of Neighborhood Findings: Sexually Transmitted Diseases Grp A Syphilis Rate Gonorrhea Rate Chlamydia Rate HIV Rate AIDS Rate Grp B Grp C X X Grp D Grp E Grp F Grp G Grp H Grp I X X X X X X X X X X Grp J Grp K Grp M Grp N X X X X X X X X X X X X X X X X X X X Highest Neighborhood Rates: Group E - Brownsville/Coral Gables/Coconut Grove Group K - Opa-Locka/Miami Gardens/Westview Group H - Miami Shores/Morningside Group M - North Miami/North Miami Beach Group I - Downtown/East Little Havana/Liberty Group N - Aventura/Miami Beach City/Little Haiti/Overtown Source: 2016 Miami-Dade County Infant Mortality Analysis 38

Initial Conclusions Neighborhoods with increasing social disadvantage correlated with areas with high infant mortality rates and other adverse birth outcomes. 39

Life Course Perspective

Questions? William M. Sappenfield, MD, MPH, CPH Work: (813) 974-3746 Email: wsappenf@health.usf.edu 41

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 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 p

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