Preterm birth deadly

Leading cause of death before age 1 also drives up health care costs

Preterm birth kills Milwaukee babies more readily than all the other causes of infant death combined and a disproportionate number of African-american babies, health officials say.

CONFRONTING OUR INFANT MORTALITY CRISIS

Preterm birth kills Milwaukee babies more readily than all the other causes of infant death combined, kills a disproportionate number of African-american babies, and each year across Wisconsin absorbs hundreds of millions of dollars that might otherwise be used to promote healthy birth outcomes.

That has been the trend for years. According to preliminary data to be released Wednesday by the Milwaukee Health Department, 2014 was no different.

Some 84 Milwaukee babies died before their first birthday in 2014, a year in which the city saw its fewest number of births in decades.

As a raw number, 84 is a big drop in infant death. In 2012, 95 babies died. In 2013, 117 died.

But health officials say it’s critical to dig into the numbers to develop sensible health policies that focus on two of infant mortality’s most vexing issues: prematurity and racial disparity.

“The specific causes of death for each of these 84 babies have not yet been fully analyzed,” Milwaukee Health Commissioner Bevan Baker said.

“But we know from prior experience that the leading cause by far is complications of preterm birth.”

Based on historic trends, about 49 of the babies that died in 2014 died from complications stemming from prematurity.

In comparison, using those trends, fewer that13 died in an unsafe sleep environment.

The death of any child for any reason can be a source of enduring agony. The pain of loss is immeasurable. But the health care cost of prematurity can be calculated. On average, a preterm birth costs 12 times that of an uncomplicated full-term birth, according to the Health Department.

It is, on average, a $50,000 difference— per child— in newborn health care costs alone. That sum does not include the sometimes lifelong medical costs associated with preterm births.

In Wisconsin, where an average of 6,650 preterm babies are born each year, that figure swells to $330 million — enough to cover Gov. Scott Walker’s proposed

budget cuts to the University of Wisconsin System.

In Milwaukee, where an average of 1,100 preemies are born each year, the cost is $55 million.

Mayor Tom Barrett said even a portion of that money would pay dividends were it applied to such preventive efforts as the Nurse-family Partnership, a program that, for $7,500 a birth, provides a nurse to low-income, firsttime mothers. Nurses begin visiting the mothers as early in their pregnancies as possible and continue visitations until their children’s second birthday.

Early access to care helps, but it is not enough.

“While improving access to health care and reducing individual behaviors, such as smoking, are important, we must address this issue more effectively by focusing on the biggest driver of preterm birth: chronic, unmitigated stress, particularly chronic stress from poverty, racism and other sources,” Baker said.

The stress that drives preterm births drives infant mortality.

The infant mortality rate is the number of deaths each year per 1,000 births. In 2014, when 9,984 babies were born, Milwaukee’s overall infant mortality rate was 8.4 deaths per 1,000 births.

The number of babies born in 2014 was lower than in recent years. In 2013, there were 10,021 births and 10,032 in 2012. Milwaukee saw 14,089 births in 1970.

The 2014 rate was a significant improvement over the 2013 rate, which was 11.7, and over the 2012 rate, which was 9.5.

Because of the size of numbers involved, single-year rates tend to bounce up and down. To discern improving and worsening trends and make comparisons among racial and ethnic groups, health experts prefer to average rates in three-year blocks.

The three-year average ending in 2014 showed improvements across the board. But they were slight.

The three-year overall rate dropped from10.2 in 2013 to 9.9. For black children, it dropped from15.6 to15.3. For white children, from 5.5 to 5.2. For Hispanic children, from 5.3 to 4.0.

Health officials say they are pleased with but unable to explain the Hispanic drop. They are troubled by the stubborn black and white disparity.

Black babies in Milwaukee are nearly three times more likely to die during their first year of life than white babies. Barrett, seeking to narrow that gap, has set a goal to reduce the overall three-year average rate to 9.4 by 2017. He has set a goal to reduce the black rate to 12.

Ahealthdepartmentanalysis of the most recent infant mortality trends said the city is unlikely to meet its goal for black infants.

“The racial disparity in birth outcomes remains unacceptable and the rate of improvement remains inadequate,” Barrett said.

“We must continue to do more.”

Barrett serves as co-chair of the Milwaukee Lifecourse Initiative for Healthy Families, a collaborative led by United Way of Greater Milwaukee & Waukesha County.

“Our vision is to eliminate the racial disparity in birth outcomes, ensuring every baby reaches their first birthday,” said Mary Lou Young, United Way’s president and CEO.

“Our greatest opportunity to improve birth outcomes is tofocusonprematurityandon addressing the conditions that lead to premature births.”