Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018

Questions for Anne Driscoll, Health Statistician and Lead Author of “Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018.”

Q: Why did you decide to focus on infant mortality rates in the Appalachia and Delta region?

AD: These two regions are interesting to me because although they are very different in terms of history, geography and population but they are similar in that both have higher poverty rates and worse health outcomes including infant mortality rates (IMRs). In addition, there are official, congressionally-mandated definitions of which counties belong to each region which made it possible to be precise in our definition of each region for the analyses.

Q: Can you summarize how the infant mortality data varied by age and race?

AD: Infants of women in the youngest and oldest age groups (under age 20 and age 40 and over) had the highest mortality rates in all three regions (Appalachia, the Delta and the rest of the US). Infants born to women in their early thirties had the lowest mortality rates. In all three regions, infants of non-Hispanic black women had the highest mortality rates.

Q: What is the take home message for this report?

AD: The main question we asked in this report was whether the gap in infant mortality rates between these two regions and the rest of the U.S. changed over the last two decades. Our results support the conclusion that there has been some narrowing in the gap between the Delta and the rest of the US; the gap decreased from 2.9 deaths per 1,000 births to 2.2. Another way to think of this is that the gap was about one quarter smaller in 2017-2018 than it was in 1995-1996. During the study period, rates did not start declining in the Delta until 2005-2006.

In contrast, the gap between Appalachia and the rest of the US hasn’t narrowed. That is, IMRs have declined in both regions over the last 20 years but since they declined at about the same rate the gap between them didn’t close. In both 1995-96 and 2017-18, IMRs in Appalachia were 0.9 deaths per 1,000 births higher than in the rest of the country. Thus, while the gap between Appalachia and the rest of the US has been smaller than that between the Delta and the rest of the country, it hasn’t narrowed.

Q: Why do you think infant mortality rates have dropped in the Appalachia, Delta, and rest of U.S.?

AD: IMRs have declined for a variety of reasons. Other research has shown that more advanced and effective medical interventions for at-risk infants, particularly for premature infants, have helped lower the mortality rate. In addition, Medicaid is more widely available for pregnant women which allows low-income women to access timely and adequate prenatal care.

Another change which we show in our report is the decline in births to teens. Infants born to teens are at higher risk of poor outcomes, including death. Our analysis shows that the percent of births to teens declined in all three regions and that this accounted for about a fifth of the decline in IMRs in each region.

Q: Do you have infant mortality data on other regions of the United States during the same time-period?

AD: We calculate and publish IMRs for each state every year. But in terms of regions, the key is to have an ‘official’ definition of the region. One of the factors that made this research project possible was that there is an official definition of each of the two regions we studied. That is, we were able to categorize each county as part of Appalachia, the Delta, or the rest of the US.