KANSAS INFANT KANSAS INFANT MORTALITYMORTALITYDennis Cooley MD, FAAPDennis Cooley MD, FAAP

September 2, 2010September 2, 2010

Infant Mortality Quiz Infant Mortality Quiz #1#1

Who has the worst Infant Mortality rate? Who has the worst Infant Mortality rate? (2005)(2005) CubaCuba SingaporeSingapore KansasKansas PolandPoland

Infant Mortality Quiz Infant Mortality Quiz #1#1

Infant Mortality RatesInfant Mortality Rates(2005)(2005)

Singapore- 2.1Singapore- 2.1

Cuba- 6.2Cuba- 6.2

Poland- 6.4Poland- 6.4

Kansas-7.4Kansas-7.4

Countries that have better IMRs Countries that have better IMRs than KSthan KS

Cuba, Faroe Islands, Isle of Man, Italy, New Cuba, Faroe Islands, Isle of Man, Italy, New Zealand, Taiwan, San Marino, Greece, Monaco, Zealand, Taiwan, San Marino, Greece, Monaco, Ireland, Jersey, United Kingdom, Gibraltar, Ireland, Jersey, United Kingdom, Gibraltar, Portugal, Netherlands, European Union, Portugal, Netherlands, European Union, Luxembourg, Canada, Guernsey, Luxembourg, Canada, Guernsey, Liechtenstein, Australia, Belgium, Austria, Liechtenstein, Australia, Belgium, Austria, Denmark, Slovenia, Macau, Spain, Denmark, Slovenia, Macau, Spain, Switzerland, Germany, Andorra, Czech Switzerland, Germany, Andorra, Czech Republic, Malta, Norway, Finland, France, Republic, Malta, Norway, Finland, France, Iceland, Hong Kong, Japan, Sweden, Iceland, Hong Kong, Japan, Sweden, Singapore, Estonia, Cayman Islands, Slovakia, Singapore, Estonia, Cayman Islands, Slovakia, Poland, Serbia, Cyprus, Lithuania, Croatia ……Poland, Serbia, Cyprus, Lithuania, Croatia ……

Central Intelligence Agency, The World Factbook, 2009

Infant Mortality Quiz Infant Mortality Quiz #2#2

List the states in order of highest African List the states in order of highest African American Infant mortality ratesAmerican Infant mortality rates MichiganMichigan KansasKansas MississippiMississippi District of ColumbiaDistrict of Columbia

Infant Mortality Quiz Infant Mortality Quiz #2#2

Michigan-18.3Michigan-18.3

Kansas-17.6Kansas-17.6

Mississippi-17.2Mississippi-17.2

DC-17DC-17

Kansas Ranks 47Kansas Ranks 47thth among States for Black among States for Black Infant Mortality Rate Infant Mortality Rate

States:States: Black IMR 05Black IMR 05 Rank:Rank:

Delaware 18.9 50

Michigan 18.3 49

Wisconsin 17.7 48

Kansas 17.6 47

Mississippi 17.2 46

DC* 17

Indiana 17 45

Ohio 16.9 44

North Carolina 16.4 43

Illinois 16.4 43

Colorado 16.3 41

USA 13.7

Source: National Center for VS, CDC, 2006

IMR trendsIMR trendsKS and U.S.A, 1992-2006KS and U.S.A, 1992-2006

African American and White Infant African American and White Infant Mortality Rates & Ratio, KS Births: Mortality Rates & Ratio, KS Births:

1998-20071998-2007

1.4 2.1 1.93.1 2.5 2.5 2.4 2.7 2.8 2.9

2.1

0

5

10

15

20

25

Rat

es a

nd

Rat

io

White NH

Black NH

Ratio

Infant deaths by cause of Infant deaths by cause of deathdeath

KS, 2007KS, 2007

Births and Deaths by Gestational Age, Births and Deaths by Gestational Age, KS 20005-2008 AverageKS 20005-2008 Average

All RacesAll Races

Pre-term = 9%Pre-term = 9% Pre-term=62%Pre-term=62%

Source: KDHE

Premature babies: <10% of births, BUT >60% of deaths!

How old are babies when How old are babies when they die?they die?

Neonatal deaths (= Neonatal deaths (= <28 days old) are <28 days old) are more common than more common than post-neonatal deaths post-neonatal deaths in all races and in all races and ethnicitiesethnicities

This distinction is This distinction is less important todayless important today LBW and prematurity LBW and prematurity

more important than more important than the age of the baby the age of the baby

SummarySummary KS IMR is higher than in most other statesKS IMR is higher than in most other states

Rates are higher in KS than U.S. for all race and Rates are higher in KS than U.S. for all race and ethnic groupsethnic groups

Wide disparities by race and ethnicityWide disparities by race and ethnicity Causes of infant deaths mimic those in Causes of infant deaths mimic those in

other states:other states: Prematurity and LBW are key factorPrematurity and LBW are key factor

Kansas Infant Kansas Infant Mortality PanelMortality Panel

Spring 2009 KDHE approached the GCHACSpring 2009 KDHE approached the GCHAC

GCHAC agreed to take the chargeGCHAC agreed to take the charge

Set up a wide group of experts to look at Set up a wide group of experts to look at the problemthe problem

June 3, 2009 first meetingJune 3, 2009 first meeting

Goal of PanelGoal of Panel

Develop recommendations to improve IMR Develop recommendations to improve IMR in the statein the state

Meet over the next yearMeet over the next year

Preliminary recommendations by December Preliminary recommendations by December 20092009

First 6 monthsFirst 6 months

Gather Information Gather Information

RecommendationsRecommendations

PrioritizePrioritize

RecommendationsRecommendations

Completed by end of DecemberCompleted by end of December

18 separate recommendations divided 4 18 separate recommendations divided 4 groupsgroups

Sent to the Secretary of KDHESent to the Secretary of KDHE

Now What?Now What?

SuccessesSuccesses

Legislative success on data collectionLegislative success on data collection

Met with CDRB Met with CDRB

Continued to obtain info on successful Continued to obtain info on successful programsprograms

Public media eventPublic media event

Met with Kansas SIDS Network Met with Kansas SIDS Network

Medicaid 1115 waiverMedicaid 1115 waiver

SuccessesSuccesses

Supported the state in its development of a Supported the state in its development of a Genetics Plan Genetics Plan

Successful passage of tobacco legislationSuccessful passage of tobacco legislation

Developing a statewide collaborative for Developing a statewide collaborative for quality improvement at perinatal institutions quality improvement at perinatal institutions

Exploring expanding our current Health Start Exploring expanding our current Health Start and FIMR community programs in KC and and FIMR community programs in KC and WichitaWichita

What Next?What Next?

Another yearAnother year

Support of KDHE the Panel will continue for Support of KDHE the Panel will continue for at least another yearat least another year

Goal to implement as many of our Goal to implement as many of our recommendations as possiblerecommendations as possible

Continue to gather information on best Continue to gather information on best practicespractices

ChallengesChallenges

Lack of fundingLack of funding

Public awarenessPublic awareness

Best practices- what works and will it work Best practices- what works and will it work herehere

Keeping up interest among the PanelKeeping up interest among the Panel

Final ThoughtsFinal Thoughts