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Statistics

I. Infant Mortality Rates (1999-2005) for Worcester, MA and the U.S.
(Source: MDPH, WIMRTF, WHSI, and WSWS.org)

Infant Mortality Rate

The Infant Mortality Rate (IMR) of a region is the number of deaths in the first year of life per 1000 live births in a given year. These are the figures for Worcester, the Commonwealth, and the nation since 1990:

Although the number of infant deaths in Worcester are usually between 20-25, the above table demonstrates that year-to-year fluctuations can be quite dramatic based on just a few more or less deaths in any given year.  Hence, we prefer to look at rolling 3-year averages over time..The 3 year rolling averages indicates that Worcester averages an IMR between 8-9, the state of Massachusetts has an average IMR of 5.0, and the US has an average rate of 7.0.

Interpretation of Existing Data:

1. Preponderance of Neonatal Deaths:  Infant deaths are subdivided into Neonatal Deaths (occurring in the first 28 days of life) and Post-Neonatal Deaths (from age 29 days to one year).  In the US, about 66% of infant deaths are neonatal deaths; in Worcester, it is about 75%. This means that ¾ of the babies are dying as neonates who are born too soon and too small to be saved even in the sophisticated Neonatal Intensive Care Unit at UMass Memorial Medical Center. These infants are being born at 20-24 weeks gestation and usually weigh less than 1500 grams.  Premature delivery is usually a reflection of a maternal problem, not an infant problem.

2. Preponderance of Infant Deaths to Black Immigrant Mothers:  Only about 7% of the residents of Worcester are identified as Black, but between 17% and 55% of the infants who died from 2000 to 2006 were born to Black mothers; 50% to 100% of the Black mothers were not born in the US.  (See Table 2 below).  Most of the non-native Black mothers appear to be recent immigrants from West Africa with Ghana being the country most heavily represented.

In the last couple of years, we have observed a trend of increasing infant deaths to women of Hispanic descent, but we have not thoroughly examined this information yet.

3. Absence of Usual High Risk Factors for Prematurity/Low Birth Weight in the Immigrant Mothers:  There are specific factors associated with high-risk pregnancies.  Specifically, mothers who are young (teenagers), poor, uneducated, unmarried, who smoke cigarettes, drink alcohol, or use drugs are at high risk for poor birth outcomes.  We see many of these high risk factors in White, Black, and some Hispanic mothers born in the US.  For example, in the Worcester Healthy Start Initiative, about 64% of the participants are unemployed and about 60% fall below the federal poverty line.  However, the immigrant mothers described above typically do not have the usual high risk characteristics.  In fact, in the immigrant mother population, most are not teens, most have graduated from high school and have jobs, about half receive government assistance, less than a third smoke cigarettes, and very few admit to alcohol or drug use.  

4. Most have had adequate prenatal care:  The absence of prenatal care or late prenatal care is often associated with poor pregnancy outcome.  But, the majority of the Worcester women who have experienced infant deaths have enrolled in prenatal care in the first trimester and have had adequate prenatal care based on standard criteria. 

II. The Response/Strategy of The WHSI (WHSI Target Census Tracts 2008 – 2011)

In 2008, we identified 13 census tracts in Worcester out of 42 with IMRs that are above 10.58 per 1, 000 live births. Out of the 13 census tracts (CTs), 10 are new and were not targeted in the past. The change could be partially explained by demographic shifts/dynamism of the population coupled with changes in the IMR’s of CT’s that were targeted over the previous project cycle. The analysis suggests a new direction in terms of target census tracts for the next project cycle. Of the 13 census tracts there are 3 tiers with the following infant mortality rate:

• 7 Tier II census tracts: 10.58-15.99 per 1,000
• 4 Tier III census tracts: 16.0 – 20.9 per 1,000
• 2 Tier IV census tracts: 21.0 – 25.99 per 1,000

All 13 census tracts that we will be targeting have higher infant mortality rates for all races than the city’s average of 8.25 per 1,000. Four of them have double the city’s rate (8.23/1000), with two census tracts having almost 3 times the city’s average for the same period (2003-2005) and 5 times the State’s average of 4.9/1000. Analyzing the data by race shows a very wide disparity in the IMRs. In two of the identified CT’s the IMR for Whites 0.00. In the same two CT’s the rate was 50.00/1000 live births for Blacks. One of the two CT’s had a rate of 21.74/ 1,000 for Hispanics. Further, whereas the IMR for the city’s black population is 18.38/1000, the rate for four of our target census tracts is between 47.62/1000 and 74.63/1,000. This is between 4 to 7 times the Black IMR rate for the state (which is11.20/1000). The data suggests a great need for services that will contribute to bringing down the astronomical rates in the identified census tracts. In this project cycle, WHSI will focus its outreach efforts and direct more of its new resources towards women and children living in those census tracts. We will target churches, restaurants, barber shops, ethnic markets, Laundromats, businesses, community agencies, and other institutions where the target population frequents within these census tracts.

III. A Comparison of 2006 Birth Indicators of Worcester, WHSI, and MA

• Significantly fewer WHSI babies are dying compared to all babies in Worcester even though WHSI participants are high risk for adverse birth outcomes. From 2000 – 2006, the average Infant Mortality Rate for WHSI participants is 5.0 compared to the city’s rate of 8.1 per 1,000 live births.
• The Worcester Healthy Start Initiative participant infant mortality rate (IMR) is significantly lower than the IMR for the whole city of Worcester, MA. 
• From 1999 – 2006, the activities of the WHSI contributed to the drop in IMR for Blacks in Worcester from 27/1000 to 15.53/1000 live births.
• Since 2000, the program has enrolled more than 8,000 mostly high risk women and connected them to comprehensive primary care and community resources.
• There is overwhelming demand for the psychosocial support services of our case managers who are limited in number because of funding limitations. More outreach workers and case managers are needed to help alleviate infant mortality and health disparities in our communities.