Infant Mortality: Disparities in the Sunflower State

Key Points

• • The infant mortality rate in Kansas in 2013-2015 was slightly higher than that of the United States (6.2 and 5.9 per 1,000 live births, respectively).
  • Infant mortality has been decreasing overall in Kansas, yet disparities persist among racial and ethnic groups.
  • From 1999-2003 through 2009-2013, non-Hispanic Blacks consistently had the highest rates of infant mortality (13.9-16.7 per 1,000 live births), low birthweight (12.5-13.3) and premature births (12.3-13.1).
  • Hispanics, Any Race were twice as likely to receive inadequate prenatal care than non-Hispanic Whites (33.8 and 14.7 percent, respectively).

This issue brief describes trends and disparities that exist in infant mortality in Kansas. It originates from the Chartbook: Racial and Ethnic Health Disparities in a Changing Kansas, which was published in December 2017 by the Kansas Health Institute (KHI). Data are from the Kansas Department of Health and Environment (KDHE) Office of Vital Statistics, the U.S. Census Bureau’s American Community Survey (ACS), and the ACS Public Use Microdata Sample (PUMS).

Infant mortality rate is defined as the number of deaths of children under age 1 per 1,000 live births. Data in this brief are combined and presented over three five-year time intervals: 1999-2003, 2004-2008 and 2009-2013. These five-year rates are used to reduce the variability that can occur in single years, particularly among smaller population groups.

Statewide, the infant mortality rate was highest for the period 2004-2008 (7.4 per 1,000 live births). The rate in Kansas (6.4) was down for 2009-2013, the most recent five-year period examined (Figure 1). The 2009-2013 rate was 6.4 deaths per 1,000 live births, slightly higher than the U.S. overall rate of 6.0. Although the rate for the next five-year interval is not yet available, the most recent annual estimate in 2016 shows that the infant mortality rate in Kansas continued to decrease to 5.9 in 2016.

Non-Hispanic Asians/Pacific Islanders in Kansas showed the greatest increase in infant mortality rates over the timeframe studied, though the increase could reflect the effect of small numbers for that group. Non-Hispanic Blacks showed the greatest decline in infant mortality rates, followed closely by non-Hispanic Whites, which is similar to national trends.

Over the three five-year time intervals studied, statewide infant mortality (7.0, 7.4 and 6.4 chronologically) was highest for the period 2004-2008. This holds true for all racial and ethnic minority groups, except for non-Hispanic American Indians/Alaska Natives, where low numbers of infant deaths and small population led to high variability in infant mortality rates.

Conditions Associated with Infant Mortality

Several factors contribute to infant mortality, and they vary among ethnic and racial groups. Identified conditions include issues related to birth, such as low birthweight and premature birth; factors related to access to medical care, such as insurance coverage and quality of prenatal care; and socioeconomic factors, including maternal/paternal education levels, employment status, poverty status or income level, and household composition.

Low Birthweight and Premature Birth

Low birthweight and premature birth are the leading causes of infant mortality in the United States. In Kansas, non-Hispanic Blacks had the highest rates of low birthweight across all three five-year time periods studied, ranging from 12.5-13.3 per 1,000 live births (Figure 2). Non-Hispanic Blacks also had the highest rates of prematurity across all three five-year time periods studied, ranging from 12.3-13.1 per 1,000 live births (Figure 2).

Prematurity or low birthweight are responsible for the highest percentage of infant deaths (31.2 percent) among non-Hispanic Blacks in Kansas. In comparison, deaths among non-Hispanic White infants are half as likely to be due to prematurity or low birthweight. Premature births and low birthweights have been identified as contributing factors to higher infant mortality among non-Hispanic Blacks nationwide as well. Higher rates of low birthweight have persisted among non-Hispanic Blacks, regardless of gains made in areas such as advanced education or higher socioeconomic standing. Underlying causes of this disparity are not well understood.

Inadequate Prenatal Care

Inadequate prenatal care is associated with higher infant mortality, and is more common among women under age 20, women who are non-Hispanic Black and Hispanic, Any Race, impoverished women, those lacking health insurance, and those without a high school diploma. In Kansas, women who are non-Hispanic Black, non-Hispanic American Indian/Alaska Native, and Hispanic, Any Race tend to receive less adequate prenatal care than women who are non-Hispanic White. A lack of insurance coverage can reduce access to adequate prenatal care, increasing infant risk of death. During 2011-2015, Hispanic, Any Race had the highest uninsured rate (26.9 percent) in Kansas, and they were twice as likely to receive inadequate prenatal care than non-Hispanic Whites (33.8 and 14.7 percent, respectively) in 2009-2013.

Socioeconomic Factors

Employment status and income are associated with infant mortality. These socioeconomic factors vary between racial and ethnic groups in Kansas. Non-Hispanic Blacks, non-Hispanic American Indians/Alaska Natives, and Hispanics, Any Race in Kansas have the highest rates of poverty, unemployment and low income levels. Lacking a high school diploma, which contributes to higher rates of poverty and unemployment, is highest among mothers who are Hispanic, Any Race in Kansas. Nationwide, Hispanics, Any Race have the highest high school drop-out rate, though that rate has declined dramatically over the last decade.

Linking medical birth records with infant death records for individual mothers and their babies could help identify leading risk factors such as those mentioned above, as well as maternal age, infant gender, live birth order, immigration status, occupation and community of residence. Determining the precise impact of risk factors on infant mortality in Kansas can inform the development of supportive strategies and interventions for mothers and infants, particularly those with higher risk for these adverse outcomes.