1. The impact of academic medical centers on infant mortality rates in five North Carolina counties Timberly Butler, MSII Mentor: Kristen G. Hairston, MD, MPH Maya Angelou Center for Health Equity Wake Forest School of Medicine

2. What is infant mortality (IM)? Death of an infant before their first birthday Top leading causes of death: –Birth defects –SIDS –Prematurity –Complications during pregnancy –Injuries

3. Why is this important? Infant mortality: –illustrates the “health and well-being of a nation” –“factors affecting the health of entire populations can also impact the mortality rate of infants” This research is important because it may help to explain the high rates here in Forsyth County.

4. How do we compare to national and state rates? In 2011: United States rate: 6.1 North Carolina rate: 7.0 –White: 5.3 –African American: 12.7 –Hispanic: 5.0 –Other: 5.0 Forsyth County rate: 7.7 –White: 5.3 –African American: 17.1 –Hispanic: 1.8

5. Why are we looking at the other four counties? Forsyth County versus… –Durham County: home of a private academic institution, like Forsyth –Orange County: home of a public academic institution, unlike Forsyth –Sampson County: rural county located over 70 miles away from academic medical institutions, my home county –Robeson County: another rural county located over 100 miles away from academic medical institutions, also has large Native American population

6. Research questions What are the rates in counties with academic medical institutions vs. those without? What is the funding status of infant mortality community programs? What are the target populations for these programs?

7. Statistical data Source: query system via NC State Center for Health Statistics Rate defined as deaths/births x 1000

13. What resources are available in these counties? Forsyth  Wake Forest Baptist Health  Forsyth County Health Department  Infant Mortality Reduction Coalition  March of Dimes, Winston Salem  NC Baby Love Plus Triad Orange  UNC Health Care  Orange County Health Department Durham  Duke University Medical Center  Durham County Health Department  Welcome Baby  Women’s Health Alliance Durham Women’s Clinic  Durham Connects Sampson  Sampson Regional Medical Center  Sampson County Health Department  Prenatal Care Management (OBCM) Program and Care Coordination for Children (CC4C) Program Robeson  Southeastern Regional Medical Center  Robeson County Health Department  UNCP Healthy Start Corps

14. Comparing the academic medical centers Wake Forest –885 beds, private funding –2012: $50,000 March of Dimes grant to DHP for Centering Pregnancy program UNC –801 beds, public funding –Mainly international efforts Duke –957 beds, private funding –Monthly advice column online

15. Community program survey Out of the 8 programs interviewed… –When asked about funding sources: 6 receive federal funding 2 receive private funding from organizations

16. Community program survey Out of the 8 programs interviewed… –When asked if funding had increased or decreased: 7 said decreased 1 said “level funding”

17. Community program survey Out of the 8 programs interviewed… –When asked about target population: CountyTargetUtilization responses Notes ForsythWomen of childbearing age Women of low socioeconomic status (March of Dimes) Only county with a program specifically for African American women Orangen/a DurhamAny Durham County resident of childbearing age/mom of a newborn Women of low socioeconomic status (required for car seat/crib programs) n/a Sampsonn/a“mostly Latinos, followed by whites, AA’s, and NA’s” Programs offered by county health department Robesonn/a“Tri-racial community” that’s 62% minority: 37% NA, 32% white, 23% black Programs offered by county health department

18. Community program survey Out of the 8 programs interviewed… –Finally, when asked if IM rates were increasing or decreasing: 7 said decreasing –“decreasing, but still above national average” –“downward trend in past several years, but still a ways to go” 1 declined to answer

19. Conclusions Counties with academic medical centers appeared to experience a decline in infant mortality rates, specifically between 2009- 2011. A racial disparity still exists within all counties, with minorities reporting higher rates regardless of location and number of outreach programs. Counties with the highest rates may be more vulnerable to changes in federal funding.

20. Limitations Problems contacting community programs Programs not having information I asked for re: utilization of services, demographics Possible issues with self-reported races, how do those who are biracial identify?

21. Next steps Determine if decrease from 2009-2010 was related to academic medical centers, new legislation, etc. Conduct interviews to see what role physicians play in referring patients to community programs

22. Acknowledgements Dr. Kristen G. Hairston, Wake Forest School of Medicine/Maya Angelou Center for Health Equity Sidney Evans, NC State Center for Health Statistics Debbie Mason, Forsyth County Infant Mortality Reduction Coalition Shelby Weeks, NC Baby Love Plus Triad Brenda Stubbs, March of Dimes, Winston Salem Paula Wright, Durham Connects Cindy Riley, Welcome Baby Kathy Johnson, Sampson County Health Department Kay Freeman, Healthy Start Corps UNC-Pembroke Women's Health Alliance Durham Women's Clinic, CenteringPregnancy

23. Sources CDC, Reproductive Health: Infant Mortality: (http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm) 2011 Infant Mortality Fact Sheet: (http://www.co.forsyth.nc.us/PublicHealth/Documents/2011_IM_fact_sheet.pdf) Map of North Carolina Counties: (http://www2.lib.unc.edu/dc/ncmaps/images/hotcountymap.gif) State Center for Health Statistics Query System, Detailed Mortality Statistics: (http://www.schs.state.nc.us/schs/data/dms/dms.cfm) National Vital Statistics Report: Infant Mortality Statistics from the 2008 Period Linked Birth/Infant Death Data Set: (http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_05.pdf) National Vital Statistics Report: Infant Mortality Statistics from the 2009 Period Linked Birth/Infant Death Data Set: (http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_08.pdf) National Vital Statistics Report: Infant Mortality Statistics from the 2010 Period Linked Birth/Infant Death Data Set: (http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf) National Vital Statistics Report: Infant Mortality Statistics from the 2011 Period Linked Birth/Infant Death Data Set: (http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf) Grant Aims to Reduce Infant Mortality Rate in Forsyth County: (http://www.wakehealth.edu/News- Releases/2012/Grant_Aims_to_Reduce_Infant_Mortality_Rate_in_Forsyth_County.htm) New public-private partnership will improve health care delivery at more than 130 clinics in Malawi: (http://news.unchealthcare.org/news/2011/march/usaidlmrft) DukeHealth.org Health Library, Advice From Doctors: Your Child’s Health: (http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health) UNC Hospitals – Rankings: (http://health.usnews.com/best-hospitals/area/nc/university-of-north-carolina-hospitals- 6360260/details) Wake Forest Baptist Medical Center – Rankings: (http://health.usnews.com/best-hospitals/area/nc/wake-forest-baptist- medical-center-6361700/details) Duke University Medical Center – Rankings: (http://health.usnews.com/best-hospitals/area/nc/duke-university-medical- center-6360355/details) Sampson Regional Medical Center – Rankings: (http://health.usnews.com/best-hospitals/area/nc/sampson-regional- medical-center-6360348/details) Southeastern Regional Medical Center – Rankings: (http://health.usnews.com/best-hospitals/area/nc/southeastern- regional-medical-center-6360950/rankings)