Epidemiological Justification for Systems-Level Health Policies to Reduce Mississippi Infant Deaths

Introduction: Mississippi’s 2010 and 2011 infant mortality rates (9.7 & 9.4 per 1,000 live births, respectively) remained the highest in the nation. Development of systems-level health policies to reduce infant deaths requires epidemiological justification. The study purpose was to describe characteristics of Mississippi in-hospital infant deaths during 2010-2011, including major medical conditions and any significant disparities.

Methods: The study included 399 in-hospital infant deaths from 2010-2011 Mississippi hospital discharge data. Statistical analyses using SAS 9.3 included descriptive statistics and Chi-square testing. Medical conditions were examined as primary or secondary diagnoses.

Results: A disproportionate number of cases were African American (68.4%), rural residents (66.2%), and Medicaid beneficiaries (74.0%). African-Americans were more likely to have Medicaid (84.3% versus 51.6%, p < 0.001).  Nearly one third of cases (29.3%) died during the first day of life. An additional 13.8% died during the first week. Over 61% of all cases expired during the first month. Over half deaths (58.0%) occurred among infants transferred from another health care facility. Short gestation/low birth weight were the leading morbidities (55.1%). Additional morbidities included congenital anomalies (33.8%), sepsis (22.8%), respiratory distress syndrome (21.1%), and maternal causes (15.3%). Hospital charges for the group exceeded $22 million.

Conclusion: In addition to racial, residential, and socioeconomic disparities, results revealed excess deaths among infants transferred from another facility. Findings confirm the need for better access to high risk health care for mothers and infants. Health policies that revisit previous perinatal regionalization efforts are warranted to improve infant survival rates.

Implications for Public Health: Systems-level changes require epidemiological justification.