Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
JAMIE SLAUGHTER: So, I’m going to talk to you about infant mortality perinatal periods of risk and racial disparities in the Jackson Metropolitan area. First of all, the infant mortality rate from 1997 through 1999 in the Jackson Metropolitan area was about 10.6 deaths per 1000 live births compared to the U.S. infant mortality rate of 7.2 and this was a difference of about 3.4 deaths per 1000 live births. To further investigate the infant mortality problem in the Jackson Metropolitan area we decided to undergo the perinatal periods of risk approach, which involves major steps. The first being engaging community partners at the beginning of our data process and investigation process. The second is actually mapping out the fetal infant mortality by birth weight and age at death. The third being focusing on reducing the overall fetal infant mortality rate in the community, step for examining the potential opportunity gaps with the populations, and five targeting further investigation and interventions towards those opportunity gaps that were found through the data analysis.
So, in Mississippi and JMA, our community partners were the Mississippi Department of Health, the March of Dimes Jackson Chapter, our Healthy Mothers, Healthy Babies Jackson Metropolitan area Coalition, and there were other MC age organizations at the community level. (Inaudible) infant mortality map (inaudible) age at (inaudible) and by way it breaks up birth weight up into two categories, very low birth weight, 500 grams to 1499 grams, and the other fetal deaths and live births are any other category, which is 1500 grams or more. Age at death is broken into three categories (inaudible) and post neonatal deaths, which creates four categories that have their own risk factors and interventions associated with them. And here are some of the risk factors and problem areas that are associated with these four components. It kind of goes into further depth of the risk factors and intervention areas that are associated with the four components.
Our reference group for the Jackson Metropolitan area consisted of fetal deaths with gestational age greater than 24 weeks and (inaudible) through 500 grams all live births greater than 500 grams. Their age of death was known. The mothers were white, non-Hispanic. They had 13 or more years of education, and were 20 more years old, and the reference group was Mississippi statewide and they were singletons. The fetal infant mortality rate for the reference group was 7.5. The component that contributed the highest was maternal health and prematurity. The Jackson Metropolitan area consists of residence of Hines Madison and Rankin counties, field deaths with gestational age greater than (inaudible) in birth weight greater than or equal to 500 grams. The age of death was known and these were also singletons. Their overall fetal infant mortality rate was 13.3 fetal infant deaths. The component that contributed the highest was maternal health and prematurity, (inaudible) and infant health.
When we compared the JMA population to the reference group, we found that JMA had an excess of 5.8 fetal infant deaths with maternal health contributing the most to the excess. (Inaudible) newborn care category, it’s not highlighted like the others because it didn’t significantly contribute to the excess. Breaking down the Jackson Metropolitan area population by race, the white population had a (inaudible). In comparing to the reference group, you can see that their excess rate was only .2 that’s higher than the reference, and none of the four components in the fetal infant mortality map significantly showed a different (inaudible) the reference group. When looking at blacks we found that their fetal infant mortality rate was 17.6, which is significantly higher than whites or the reference group. If you look at the maternal health and prematurity component, it’s almost eight fetal deaths per 1000 live births. So these numbers (inaudible) and here you can see the comparison to the reference group. Their excess rate is 10.1 fetal deaths. This is higher than the whites overall fetal infant death, and it’s almost twice as high as the excess (inaudible) if you remember it was 5.8, but here there is some good news. If you look at the newborn care component, it’s the difference between the blacks in the reference group, it’s only 0.3. So there was no difference in newborn care. So our opportunity gap (inaudible) for blacks and maternal health and prematurity, maternal care and infant health.
So what we decided to do was to break the black community into two groups by education level. Higher educated blacks were mothers who had 13 or more years of education and then less educated blacks mothers (inaudible) 13 years of education. Higher educated blacks had an infant mortality rate of 13.1. It’s still high, but it’s closer to what the JMA overall population had, and when we compare them to our reference group the excess was 5.6. (Inaudible) the maturity component was the highest contributor, but if you look at the newborn care and infant health components, their contribution is very small, which we thought was very, very significant, very interesting. When we’re looking at less educated blacks (inaudible) overall fetal infant mortality rate is astonishing. It’s 20.5. Their maternal health and prematurity component was 8.5. If you look at the infant health component, it’s 4.8, almost twice as high as (inaudible).
So here’s the comparison of less educated blacks to the reference group, and you cans see the excess rate is 13.0 fetal infant deaths, which is mind blowing. I mean, you know that there’s a difference of disparities existing between races, but it’s just absolutely mind blowing. And again, if you pay attention to the infant health component, their excess rate is 3.2, which is mind blowing, I think, how higher it is in the less (inaudible) educated mothers compared to higher educated blacks. So then what we decided to do was compare less educated blacks to higher educated blacks, and here you can see the results. Less educated blacks had an overall infant morality rate. The excess rate was 7.3 when compared to higher educated blacks. The highest difference between the two groups came in the infant health component, which shows where our opportunity gap (inaudible). So our overall our opportunity gaps in the black community exist in maternal health and prematurity and maternal care for all blacks, but they also our opportunity gap is in infant health for less educated blacks. So using PPOR to identify these areas will help us hone in our resources for further investigation and interventions. So that’s it.