Online Program

Identifying links between infant mortality rate and societal living conditions

Tuesday, November 5, 2013 : 3:10 p.m. - 3:30 p.m.

Maya Mauch, MPH, Department of OB/GYN, University of Massachusetts, Worcester, MA
B. Dale Magee, MD, Department of OB/GYN, Shrewsbury Ob-Gyn/University of Massachusetts, Shrewsbury, MA
Introduction: Infant mortality rate (IMR) has been shown to be a sensitive measure of population health, reflecting socioeconomic status, nutrition, housing, education, employment, and health care. Historical trends in IMR of Worcester, MA, the second largest city in New England, were studied to elucidate possible factors contributing to Worcester's IMR. Methods: 3000 infant death certificates were analyzed in 10-year intervals between 1906 and 2006, including: age of infant, date and cause of death, and mother's birthplace. Results: In 1906, the overall IMR was 143 (per 1000 live births) with 74/1000 due to infectious diseases. By 1936, IMR had dropped significantly to 52/1000, with only 15/1000 due to infection. IMR continued to decrease steadily and by 2006 was 5/1000, with .36/1000 attributable to infection. Conclusions: Worcester's IMR has undergone a dramatic reduction over 100 years, driven in large part by decreases in infectious causes. Interestingly, IMR secondary to infection dropped by 59/1000 from 1906 to 1936 – much higher than the 15/1000 decline during the subsequent era of modern antibiotics and vaccines. Changes in community infrastructure, hygiene, housing, nutrition, and education may well have played a substantial role in these early improvements. This is consistent with previous work demonstrating a sensitive relationship between environment and IMR. This suggests that deteriorations in living conditions during recent difficult economic times could be responsible for current high IMRs among vulnerable subpopulations in Worcester. We propose that interventions addressing societal factors could have the greatest impact in improving Worcester's IMR.

Learning Areas:

Clinical medicine applied in public health

Learning Objectives:
Describe changes in infant mortality rates over 100 years in an urban New England city. Evaluate how infectious causes of infant mortality have decreased in response to changes in societal factors as well as to increased access to antibiotics and vaccines.

Keyword(s): Infant Mortality, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked as project director and/or project manager on several local as well as federally funded grants focusing on HIV prevention in minority communities, immigrant and refugee health, and health disparities among vulnerable populations. A recent interest is how societal factors influence rates of infant mortality within underserved communities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.