What went right? factors associated with a dramatic decline in infant mortality in an urban population

In 2011, the infant mortality rate (IMR) in Shelby County (Memphis), Tennessee dropped to the lowest levels in its history: 9.6 deaths per 1,000 live births. This represents a 30% decline from 13.8 /1,000 in 2006 in a county where 32% of children live in poverty. In the same time period, the teen birth rate declined 23%. In 2006, Tennessee's Governor and Shelby County's Mayor convened a community summit, followed by a large-scale community initiative. The state contributed $3.75 million to fund community-based initiatives focused on reducing infant mortality. This research aims to identify factors associated with the observed decline in IMR. Birth certificate files were linked to death certificate files for 2006-2010 birth cohorts. Descriptive analysis comparing the 2010 cohort to 2006 was used to identify potential factors. Statistical methods will be applied to assess factors driving the decline in IMR. Preliminary analysis shows that although there was not an appreciable decrease in preterm births or low birth weight (LBW) births, the survival rate improved. Among babies born preterm, there were 77.2 infant deaths /1,000 births in 2006, compared to 53.1 in 2010. Similarly, among babies born with LBW, the IMR fell from 93.5 to 62.7. The IMR for teen moms fell from 18.8 to 10.9. African Americans experienced the largest decline (34%) in IMR of any race. Further analysis determining the statistical significance of these and other factors (prenatal care, maternal education, zip code, BMI, plurality, etc) will be presented to assist programs in targeting interventions.