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HomeMy WebLinkAboutIR 7663 ^ ° INFORMAL REPORT TO CITY COUNCIL MEMBERS No.-I-663 December 3, 1992 10 To the Mayor and Members of the City Council C, Subject: INFANT MORTALITY RATE - AN UPDATE OF THE PROBLEM IN FORT WORTH PURPOSE The purpose of this Informal Report is to provide basic information concerning the "much discussed" health statistic - infant mortality rate (IMR); and, to review the IMR in the City of Fort Worth. BACKgROUND IMR is defined as the number of infants born live who die before their first birthday, divided by the number of live births during a period of one year. It is usually expressed per 1,000 live births. An infant is a baby less than 12 months old. Most abortions do not affect the infant mortality rate since 00,11 these are not defined as live births and a birth certificate is not issued. Simply stated, the IMR represents the chance a newborn child has of surviving its first year of life. FACTORS AFFECTING THE IMR, A community's IMR is an important health statistic, an indicator of the overall health status of that community. Complications of low birth weight (LBW) are the main causes of death of infants. Babies weighing less than 5-1/2 pounds at birth are 40 times more likely to die during their first four weeks of life. Infants born prematurely or term babies who did not grow adequately prior to birth comprise this category. Low birth weight has been associated with: Poor prenatal nutrition Maternal illicit drug and alcohol abuse Maternal tobacco use Teenage pregnancy Infectious diseases during pregnancy Genetic factors OFFICIAL RECORD CITY SECRETAIr [ISSUED BY THE CITY MANAGER az — FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7663 December 3, 1992 Page 2 To the Mayor and Members of the City Council 0 Subject: Jeri INFANT MORTALITY RATE - AN UPDATE OF THE PROBLEM IN FORT WORTH Other factors which may cause an infant's demise are: Birth defects Accidents at birth Trauma to the infant Infectious diseases Sudden Infant Death Syndrome (SIDS) Birth Defects may present as malformed organs such as incomplete or improp- erly developed heart, liver, brain, intestines or lungs. Accidents at birth may occur during labor or delivery, resulting in insufficient oxygen to the baby's brain. Trauma to the infant may occur from accidents occurring at delivery or from OW unintentional or intentional injuries. Infectious diseases may affect an infant's viability by occurring during pregnancy (i.e., rubella, syphilis - preventable), leading to birth defects and/or LBW, or by producing respiratory and intestinal (diarrheal) illnesses in the first year of life. SIDS is another major cause of mortality; and, while the causes may include a heterogenous set of conditions, the link of SIDS to poor environment and the reduction of SIDS-related deaths with services to disadvantaged mothers suggests that there is a preventable fraction. FORT WORTH'S IMR IS HIGHEST AMONG MAJOR TEXAS CITIES BUT OTHER CITIES HAVE HIGHER RATES Fort Worth has had the highest infant mortality rate among the six major metropolitan cities in Texas for five of the last seven years. Going back even longer, Fort Worth's infant mortality rate has been the highest among these cities for sixteen of the last twenty-two years. It is, however, not the highest in Texas. Attachment C shows (for 1990) 10 other cities with a higher IMR than Fort Worth, and this list is not comprehensive. But, caution should be used in reviewing this since several of these towns are srr ail in pize aud-their OFFICIAL RECORD CITY SECRETARY IT, WORM To. -ISSUED BY THE CITY MANAGER L 11T.Mk,4 XAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7663 December 3, 1992 00141 To the Mayor and Members of the City Council Page 3 X C, Subject: INFANT MORTALITY RATE - AN UPDATE OF THE PROBLEM IN FORT WORTH IMR's may not be a reliable comparison to other larger communities. Point, in fact, is that Fort Worth's IMR is not the highest in Texas; nor is it the highest in the nation. Attachment D shows Fort Worth's IMR ranking compared to some other major U. S. cities. While these are 1988 statistics, the relative ranking of Fort Worth has not changed through 1990, the most recent year for which rankings are available. IMR 1fi HIGHEST AMONG AFRICAN AMERICAN BABIES Attachment E shows that there is a significant statistical difference in IMR among races and ethnic groups. African American infant mortality rates are considerably higher than Whites or Hispanics. This statistical trend is consistent in Fort Worth as well as other cities in Texas and across the nation. Considering,births in Fort Worth in 1990: a) 1 in every 135 White babies died before its first birthday; b) 1 in every 126 Hispanic babies died before its first birthday; c) 1 in every 49 African American babies died before its first birth- day. INTERVENTIONS TO DECREASE FORT WORTH'S IMR The Public Health Department offers a variety of services to prevent or limit those factors causing infant mortality which are amenable to intervention. In focusing on the major cause of infant mortality, low birth weight, the Health Department provides prenatal care to disadvantaged pregnant women including: screening for diseases tobacco, drug and alcohol abuse counseling and referral adverse social situation intervention appropriate fetal intrauterine growth monitoring Counseling and education is provided and tailored to the needs of the pregnant woman. Appropriate nutrition is monitored and provided through our Women, Infants and Children (WIC) program, if needed. Women are A-4sne reafearred to appropriate support and rehabilitation programs within the "OlkitREWD tobacco, drug and alcohol problems. CITY SECRETARY FT. WORTH, TD. ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS ' FINFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7663 December 3, 1992 To the Mayor and Members of the City Council Page 4 1873 INFANT MORTALITY RATE - AN UPDATE OF THE PROBLEM IN FORT WORTH Other appropriate medical care is provided or referred. Case management is provided, as needed, by our Social Services Section and Public Health Nurses. Caseworkers and community service aides go into the disadvantaged areas of the community in an effort to recruit those pregnant women who most need our services. Although prenatal care has been shown to be effective in reducing IMR, there are many in need who are underserved in Fort Worth. We continue to expand our programs and services as we are able. Birth defects caused by preventable diseases during pregnancy are minimized through early screening and appropriate treatments (i.e., maternal syphilis). Congenital rubella syndrome (involving many organs of the baby) which can cause fetal demise or lead to infant defects, and even death, is averted through proper immunization of women prior to pregnancy. Many of our patients have multiple pregnancies and are vaccinated between them if identified as being without protective antibodies. Genetic counseling is not offered at present. 001*1 We work to reduce motor vehicle trauma through our Car Safety Seat Program. Clients are also educated on home safety and child protection practices during "well baby" visits. Case management is provided when appropriate. Fatal childhood infectious diseases are prevented through an aggressive immunization outreach program. Early Periodic Screening Diagnosis and Treatment (EPSDT) is performed on infants and children, further helping to reduce infant mortality. We are expanding the immunization program and will be establishing not only a fixed site at Town Center Mail but adding to the outreach component as well. Occurrence of SIDS is reduced through pregnancy care, leading to a bigger and healthier infant. Concerted community efforts to improve environmental conditions and provide access to well care impacts positively upon reducing Teen pregnancy rates are reduced through positive modeling and education. The Public Health Department works with the Fort Worth Independent School District to help achieve this. We also will be offering family plan ' . PUS__ to men and women, and will be expanding the Male Adolesc ImMaRICORD Program to help reduce teen pregnancy. CITY SECRETARY FT. WORTH9 TELL ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 7663 December 31 a " 1992 �50)?P�� To the Mayor and Members of the City Council Page 5 10 Subject: INFANT MORTALITY RATE - AN UPDATE OF THE PROBLEM IN FORT WORTH In addition, the Healthy Start Consortium, established in 1991 to seek federal grant funds, continues to address the issue of infant mortality. Under the guidance of its co-chairs, Shirlee Gandy and Commissioner Dionne Bagsby, strategies continue to be developed and implemented. Two of these are an Infant Death Review Board and a community-wide health records system for children. SUMMARY We have defined Infant Mortality Rate and identified many factors in our community contributing to the unacceptably high statistic in Fort Worth; but certainly not the highest in the state. The Public Health Department has been working diligently to intercede for a better outcome. We have explored Low Birth Weight as the prime cause of infant mortality and are working with the TRACS Program (newborn tracking system) at Cook-Fort Worth Children's Owl Medical Center to follow LBW babies for five years. Reducing the Infant Mortality Rate In Fort Worth will continue to be the number one priority of the Health Department. Thanks to the diligent efforts of dedicated Health Department staff, working in concert with the community and the private sector, we are seeing improvement. '--tdB TERRE& City Manager BT:g OMCIAL RECDr"T Off SECRETARY LFT- WORTH, U -ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS INFAN'1' MOIrFALITY 11XrE. The infant mortality rate is the number of infants born live but who subsequently die before their first birthday, expressed as a rate per 1,000 live births per y 0001, Number of infant deaths x 1000/year = meant Number of live births mortality rate Note: abortions do NOT affect the infant mortality rate. r Attachment A OFFICIAL RECORD CIIY SECRf1ARY Fi. WOATN, TEII. lV13Wo Cb uti ,- o T- o h• 9 vi vi of of 6 ao r: O x c r Cy CV Ul CA IR CV '0 U) = ° vi Cri ti to crr: o ow c •" 2 CVv V'.' d.' CC? Cl) d' � ctl CL 2 •> c i5 tD a. r• a o Cy CM 0 � S- 8 W P- r T CCi Ca 6 6 ,0 N X W CO) C? d' C7� > L E 0 t Z% co _ cc; ,.. -� '� CL to w v O Q di tC► hh Cd r• 6 id 1 tti C X '> co 2 � co CD rn rn rn CO rn rn rn a' t�0j� � � T 7"• T T T T T �t � y/ Live births, infant deaths and infant mortality rates in selected Texas cities 1990 City Give births Infant deaths Infant mortality rate Marlin 130 6 46.2 Bridgeport 69 3 43.5 Keller 242 6 24.8 Georgetown 251 5 19.9 Gainesville 269 5 18.6 Waxahachie 393 7 17.8 Nacogdoches 473 7 14.8 Denton 1031 15 14.5 Beaumont 1891 22 11 .6 Longview 1 227 14 10.9 T Dallas 200821 197 9.5 Houston 39,755 369 9. San Antonio 18,794 127 6.8 Austin 8,995 59 6.6 El Paso 13,450 90 6.0 00,11 Source: Texas Dept. of Health, Vital Statistics Division OFFICIAL RECORD Attachment C CITY SECRETARY FT. WORIN, . Infant mortality rates for selected cities 1988 Washington, D. C. 23.2 Detroit 21.0 Baltimore 18.0 Memphis 17.6 Philadelphia 17.5 Cleveland 17.0 Chicago 15.2 Columbus, OH 14.2 Boston 13.9 New York City 13.2 New Orleans 12.7 Indianapolis 12.6 Milwaukee 12.1 Houston 11 .3 Jacksonville, FL 11 .3 Phoenix 10.9 ;�.•,• R,.f i �.;, y i fit,+} .fi'•x<a op" Source: National Center for Health Statistics � RL RECORD , Attachment D CffY SECRETARY FT. WORTH, TEL 0Pk Infant mortality by race in Fort Worth and Texas 1985 - 1990 Fort Worth infant mortality rates (infant deaths per 1 ,000 live births) 1985 1986 1987 1988 1989 1990 Whits 10.4 8.6 7.4 6.5 7.6 7.4 Hispanic 8.7 10.2 9.0 10.9 12.2 7.9 : :>:o:•.ar •j,,:,:,•• .'.- ::::-:d. .. a:.•'A. -r:'.? '•b..•. , ...::iz :. -.=s?:;.ti:.•`•.,.•xh x:.xf:;` :^; . Texas infant mortality rates (Infant deaths per 1,000 live births) 1985 1986 1987 1988 1989 1990 Whits 8.6 8.3 7.9 7.6 7.8 7.0 Hispanic 9.4 8.8 8.4 8.8 8.0 7.0 }1• ..$.a•.. .,. sr..•..Astir .;1:.• r ti,:._:.:::.{, xti :, xjY'<`•1't+:^'t'•';+. 44..- 4 r ^'w'•, i •#• hj•+l,•i•: >..aSt-A•;, '.•rs}i6j ,rJ j Considering births in Fort Worth in 1990: One in every 135 White babies died before its first birthday. . One in every 126 Hispanic babies died before its first birthday. One In every 49 Black babies died before its first birthday. Source: Texas Department of Health, Vital Statistics Division Attachment E OFEICK1 RECORD ��. WORTN, I�X...