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Core
Indicators Report Health Focus: Mortality
Rate Indicator: Rationale Overall, the United States has seen a decline in infant mortality over the past decade, but the nation still ranks low among other industrialized countries in this area. Efforts to reduce the impact of infant mortality have made some improvement, but more reduction is needed. Infant mortality is the death of an infant in the first year of life. Several factors contribute to infant mortality: congenital defects, respiratory problems, Sudden Infant Death Syndrome (SIDS), multiple births, and problems related to premature birth such as low birth weight. Sudden Infant Death Syndrome or SIDS is a major factor in infant mortality, resulting in one third of all cases. Studies have shown that very low birth weight—3 pounds 8 ounces or less at birth—is a significant factor in infant mortality that contributes to the United States high infant death figures. Premature delivery, maternal drug abuse, or multiple births are determinants for very low birth weight. African-Americans have the highest infant mortality rate among all groups. This finding has been related to poverty and issues regarding access to care. Infants born to women who do not receive adequate prenatal care are subject to low birth weight and have an increased risk of infant mortality.
Measures: Number of infants (per 1,000 live births) who died before their first birthday by race Data Analysis Within the recent 10-year period, the infant mortality rate in St. Joseph County declined 18 percent - from an average of 10.5 during 1988-92 to 8.6 during 1993-97. Comparable rates for the State were 9.9 and 8.6 respectively, for a 12.7 percent decline. While the rest of the State showed a statistically significant decline in total infant mortality rate, however, the decline in St. Joseph County during the period was not significant. The component responsible for the decline in the rest of the State was the white infant mortality rate. Infant mortality has typically been higher for African-Americans in St. Joseph County. The 10-year trend shows a significant decline in rates for this population. Looking at the 1988-92 and 1993-97 periods - the African-American infant mortality rate declined from 21.8 to 16.8 and represented a 23 percent decline on average. Accordingly, while there were statistically significant differences between white and African-American infant mortality rates in 1988-92 and 1993-97 periods, more recent (1995-97) rates show no statistically meaningful differences, due to declines experienced between the 1992-94 and 1995-97 periods.
Focus: Maternal
and Child Health Indicator: Rationale Pregnant teenagers and their unborn infants are at risk for health complications as well as financial hardships. Pregnant teenagers often do not receive the adequate prenatal care needed for a healthy pregnancy; their eating habits tend to be unhealthy; their maternal weight gain is often low; and, their unborn children face the risk of low birth weight—a leading factor in infant mortality. Pregnancy also puts the teenager at risk for health complications. High blood pressure and anemia are frequently seen in teenage pregnancies. Labor difficulties may also be seen. In pregnant adolescents younger than 15, the health risks are greater. Financially, adolescents are not prepared to take on the responsibility of a child. The burden is most often left on the adolescent's parents and/or the government. Most of the families helped by Medicaid, Food Stamps, and Aid to Families with Dependent Children consist of children born to teen mothers. Measures:
Data Analysis Over the 1993-97 period, St. Joseph County recorded nearly 15 percent of all births to teenage women (under 20). This proportion was not significantly different from the rest of the State where 14.2 percent of births were to teenagers. On the basis of their representation in the population, however, the teenage birth rate for St. Joseph County females was significantly higher over that period compared to the rest of the State. For 1993-97, the teenage birth rate for the County was 32 births to females under 20 per 1,000 female population ages 10-19 years of age compared to the rest of the State at a rate of 29.4. Teenage birth rates varied by race. Over the 5-year period, the rate for African-American females was 2.9 times that of white female teenagers. Compared to State rates for this population, St. Joseph County was notably different, both for white (lower) and African-American (higher) females. There were no significant trends in the teenage birth rates for the County in total or any racial group over the five-year period. There was a significant decline in State rates for all teenagers and African-American teenagers between 1993-94 and 1996-97. The total rate for the State declined from 29.7 to 28.9 and the African-American rate declined 60.4 to 53.4. The percent of total births to young teenage females (females 17 and under) was significantly higher in St. Joseph County compared to the rest of the State (6.2% vs 5.2%). This difference was due to higher African-American rates - 15% for the County vs 12.2% for the rest of the State.
Focus: Maternal
and Child Health Indicator: Rationale Because of their immature immune systems, children are one of the more vulnerable segments of the population in terms of illness. Yet many life threatening childhood diseases are preventable if children are fully immunized on a timely basis. In 1996 in the U.S., over three-quarters (77 percent) of children ages 19–35 months received the combined series of recommended vaccines consisting of 4 doses of diphtheria, tetanus, and pertussis (DTP) vaccine, 3 doses of polio vaccine, 1 dose of measles-containing vaccine, and 3 doses of Haemophilus influenzae type b (Hib) vaccine. The Healthy People 2000 goal is for 90 percent of children under 2 years of age to have received the recommended immunization series. Measures: Percentage of two-year old children who are adequately immunized Data Analysis Information from the Indiana State Department of Health on immunization rates for St. Joseph County and the State indicated that in 1998, 52.4 percent of children ages 24 - 35 months of age (at the time of assessment), that is, children born in 1995, were immunized for the 4:3:1:3 vaccination series. These children do not represent all children of this age cohort from the County, but only those who were served at the county health departments. Data from prior years were less reliable. Data is also available on the number and percent of children immunized who are enrolled in day care and Head Start programs. Data for 1997 indicated that, across 31 reporting day care programs and 21 Head Start programs, for children from 24 months to kindergarten age, on average 94 percent of those in St. Joseph County day care programs and 83% in Head Start programs had completed the appropriate series. Data from the INPHO project (Information Network for Public Health Officials) that tracks immunization in a registry (Child Future Immunization Registry) in St. Joseph and surrounding counties indicated that for the year ending December 31, 1998, 73 percent of children 24 - 35 months of age considered "active cases" were adequately immunized. Data were compiled from five sites in St. Joseph County and included 3,858 total cases of which 74 percent were "active." Approximately the same proportion of cases adequately immunized were noted among private pediatric office and non-profit clinic active cases included in the registry. The national goal for immunization is that 90 percent of children at 24 months be adequately immunized.
Overview • Community Capacity •Economic Vitality • Health • Quality of Life |
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Health Indicators |
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John
R. Hagen, Ph.D.
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