1. KANSAS INFANT MORTALITY Dennis Cooley MD, FAAP September 2, 2010

2. Infant Mortality Quiz #1 Who has the worst Infant Mortality rate? (2005) Who has the worst Infant Mortality rate? (2005) Cuba Cuba Singapore Singapore Kansas Kansas Poland Poland

3. Infant Mortality Quiz #1 KANSAS

4. Infant Mortality Rates (2005) Singapore- 2.1 Singapore- 2.1 Cuba- 6.2 Cuba- 6.2 Poland- 6.4 Poland- 6.4 Kansas-7.4 Kansas-7.4

5. Countries that have better IMRs than KS Cuba, Faroe Islands, Isle of Man, Italy, New Zealand, Taiwan, San Marino, Greece, Monaco, Ireland, Jersey, United Kingdom, Gibraltar, Portugal, Netherlands, European Union, Luxembourg, Canada, Guernsey, Liechtenstein, Australia, Belgium, Austria, Denmark, Slovenia, Macau, Spain, Switzerland, Germany, Andorra, Czech Republic, Malta, Norway, Finland, France, Iceland, Hong Kong, Japan, Sweden, Singapore, Estonia, Cayman Islands, Slovakia, Poland, Serbia, Cyprus, Lithuania, Croatia …… Central Intelligence Agency, The World Factbook, 2009

6. Infant Mortality Quiz #2 List the states in order of highest African American Infant mortality rates List the states in order of highest African American Infant mortality rates Michigan Michigan Kansas Kansas Mississippi Mississippi District of Columbia District of Columbia

7. Infant Mortality Quiz #2 Michigan-18.3 Michigan-18.3 Kansas-17.6 Kansas-17.6 Mississippi-17.2 Mississippi-17.2 DC-17 DC-17

8. Kansas Ranks 47 th among States for Black Infant Mortality Rate States: Black IMR 05 Rank: Delaware18.950 Michigan18.349 Wisconsin17.748 Kansas17.647 Mississippi17.246 DC*17 Indiana1745 Ohio16.944 North Carolina16.443 Illinois16.443 Colorado16.341 USA13.7 Source: National Center for VS, CDC, 2006

9. IMR trends KS and U.S.A, 1992-2006

10. African American and White Infant Mortality Rates & Ratio, KS Births: 1998-2007

11. Infant deaths by cause of death KS, 2007

12. Births and Deaths by Gestational Age, KS 20005- 2008 Average All Races Pre-term = 9% Pre-term=62% Source: KDHE Premature babies: 60% of deaths!

13. How old are babies when they die? Neonatal deaths (= <28 days old) are more common than post- neonatal deaths in all races and ethnicities Neonatal deaths (= <28 days old) are more common than post- neonatal deaths in all races and ethnicities This distinction is less important today This distinction is less important today LBW and prematurity more important than the age of the baby LBW and prematurity more important than the age of the baby

14. Summary KS IMR is higher than in most other states KS IMR is higher than in most other states Rates are higher in KS than U.S. for all race and ethnic groups Rates are higher in KS than U.S. for all race and ethnic groups Wide disparities by race and ethnicity Wide disparities by race and ethnicity Causes of infant deaths mimic those in other states: Causes of infant deaths mimic those in other states: Prematurity and LBW are key factor Prematurity and LBW are key factor

15. Kansas Infant Mortality Panel Spring 2009 KDHE approached the GCHAC Spring 2009 KDHE approached the GCHAC GCHAC agreed to take the charge GCHAC agreed to take the charge Set up a wide group of experts to look at the problem Set up a wide group of experts to look at the problem June 3, 2009 first meeting June 3, 2009 first meeting

16. Goal of Panel Develop recommendations to improve IMR in the state Develop recommendations to improve IMR in the state Meet over the next year Meet over the next year Preliminary recommendations by December 2009 Preliminary recommendations by December 2009

17. First 6 months Gather Information Gather Information Recommendations Recommendations Prioritize Prioritize

18. Recommendations Completed by end of December Completed by end of December 18 separate recommendations divided 4 groups 18 separate recommendations divided 4 groups Sent to the Secretary of KDHE Sent to the Secretary of KDHE

19. Now What?

20. Successes Legislative success on data collection Legislative success on data collection Met with CDRB Met with CDRB Continued to obtain info on successful programs Continued to obtain info on successful programs Public media event Public media event Met with Kansas SIDS Network Met with Kansas SIDS Network Medicaid 1115 waiver Medicaid 1115 waiver

21. Successes Supported the state in its development of a Genetics Plan Supported the state in its development of a Genetics Plan Successful passage of tobacco legislation Successful passage of tobacco legislation Developing a statewide collaborative for quality improvement at perinatal institutions Developing a statewide collaborative for quality improvement at perinatal institutions Exploring expanding our current Health Start and FIMR community programs in KC and Wichita Exploring expanding our current Health Start and FIMR community programs in KC and Wichita

22. What Next?

23. Another year Support of KDHE the Panel will continue for at least another year Support of KDHE the Panel will continue for at least another year Goal to implement as many of our recommendations as possible Goal to implement as many of our recommendations as possible Continue to gather information on best practices Continue to gather information on best practices

24. Challenges Lack of funding Lack of funding Public awareness Public awareness Best practices- what works and will it work here Best practices- what works and will it work here Keeping up interest among the Panel Keeping up interest among the Panel

25. Final Thoughts