Sunday, February 15, 2004

High infant-mortality rate here puzzles health experts

By Matt Leingang
The Cincinnati Enquirer

Amid reports that the national infant-mortality rate jumped in 2002, Hamilton County officials have expressed concern that the increase was even sharper here.

The government reported last week that the U.S. infant-mortality rate had climbed for the first time in more than four decades, in part because more women are putting off motherhood and then having multiple babies via fertility drugs.

Ohio reported 1,153 infant deaths in 2001, for a rate of 7.6 per 1,000 live births. Here's the infant-mortality rates for counties around Greater Cincinnati:
Hamilton: 10.5
Clermont: 4.1
Warren: 4.4
Butler: 8.5
Kentucky (1998 data)
Boone: 6.2
Kenton: 6.5
Campbell: 6.1
Grant: 11.8
Dearborn: 5.8 (average, 1991-2000)
Sources: Ohio Department of Health, Indiana State Department of Health, Kentucky Department for Public Health.
The U.S. Centers for Disease Control and Prevention, in Atlanta, Ga., noted a nationwide jump, from 6.8 deaths per 1,000 births in 2001 to 7.0 deaths in 2002.

But Hamilton County reported 124 infant deaths in 2001 - a rate of 10.5 per 1,000 live births, the latest data available. The statewide average is 7.6.

The 2002 increase in the United States, the first since 1958, could be a one-time blip, the CDC said.

But that's apparently not the case locally, where Hamilton County's infant mortality rate has hovered between 9.8 and 10.5 for much of the past decade, which has local health officials puzzled.

As in the rest of country, women in Hamilton County are delaying motherhood, said Dr. Judith Daniels, medical director of the Cincinnati Health Department. Women who put off motherhood until their 30s or 40s are more likely to have babies with birth defects or other potentially deadly complications.

Also, older women are more likely to use fertility drugs to get pregnant, and such drugs often lead to twins, triplets and other multiple births.

Multiple births carry a higher risk of premature labor and low birth weight - conditions that can endanger babies' lives.

But there are other factors in Hamilton County, including a higher rate of premature births among African-Americans, according to the Hamilton County Child Fatality Review Team, of which Daniels is a member.

African-Americans are disproportionately poor and much of the premature birth risk may be tied to unhealthful conditions and personal behaviors that are common among the poor - including poor nutrition, drug, alcohol and tobacco use or domestic violence.

But that alone doesn't explain the local problem, said Cynthia Yund, epidemiologist with the Hamilton County General Health District.

Other causes of infant death include short gestation, low birth weight, sudden infant death syndrome and birth defects.


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