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Reducing infant deaths is a specific goal of Governor Rick Snyder’s overall Michigan health and wellness initiative. The initiative includes strategies to address the social determinants of infant mortality, and to improve maternal-preconception health overall. Social determinants can be quantified somewhat using socioeconomic status (SES) measures, a statistic often estimated by combining level of education, occupation, household income or other values associated with economic class. This website displays infant mortality data using one such SES measure, a statistic developed by the Public Health Disparities Geocoding Project.
Can the influence of socioeconomic disparity be detected using reported values from the birth certificate? For example, the source of payment for the delivery is reported. In 2011, 52.5% of women paid for their delivery with private insurance and 45.1% used Medicaid. Because Medicaid enrollment in 2011 includes pregnant women whose household income was 185% of poverty level, the women’s insurance provider could be considered a proxy statistic for estimating the overall preconception poverty level. In practice, however, the source of payment variable is a very poor proxy for SES. Insurance provider data cannot be used to further differentiate women of lower and middle economic classes. Also, it is difficult to determine whether poorer rates indicate the quality of insurance or some additional preconception risk. (See Percent of Live Births and Infant Death Rates by Source of Payment, 2011.)
The education of the mother is reported on the birth certificate, and this variable can be used as an SES indicator. For instance, in 2011, there were twice as many Black mothers without high school degrees as there were White mothers. In 2011, the infant death rate for both races declined as the mother’s level of education increased (See Live Birth Distribution and Infant Death Rates by Education, 2011.) There seems to be a strong connection between educational attainment to infant deaths, and by proxy, economic class. However, educational attainment is correlated with age of mother, and specifically to teen pregnancies. Therefore, the use of mother’s education with regard to natality must be treated with caution; the variable can be a cofounder to statistics related to teen pregnancy, order of birth, and other outcomes indirectly tied to age of mother.
Race is often used as a proxy for SES, but it cannot be used to graduate economic disparity within the same race. Therefore, tables are provided by race and by area-based SES indicator.
This website uses an SES indicator based on the US census tract poverty level, proposed and discussed at the Public Health Disparities Geocoding Project. The method equates tracts to large neighborhoods, and assumes that each person living in a given tract is approximately of the same economic class. The economic class is assumed to be correlated with the number of persons living below the poverty line in a tract. If 20% or more of the persons living in a tract are living below the poverty line, then that tract is considered a poverty area in US Census reports (for example, see Areas with Concentrated Poverty, 2006-2010,) Therefore, those living in tracts where 20% of the persons are below the poverty line, are considered to be the poorest economic class. Those living in tracts where less than 20% of the persons live below the poverty line are considered to have more economic resources--either by employment, community services or better access to care.
The 2000 US Census reports the percent of persons living below the poverty line per census tract. The Michigan Division for Vital Records & Health Statistics (DVRHS) identified the census tracts’ of birth and infant death records by geocoding each record’s individual address.Then, the birth and death records were linked to the tracts from the census to categorize poverty level. The geocoding was conducted for the years between 2000 through 2011. For the 2010 US Census, census tracts were redefined in Michigan, and due to effects of migration and economic conditions, the distribution of births by census tract poverty level changed. For example, between 2007-2009, 30.3% of births were classified as being in the wealthiest census tracts using the 2000 tract and poverty assignments; but according to the 2010 census assignments, 22.1% of births were classified as being in the wealthiest census tracts. According to the 2000 definitions, 16.1% of the live births between 2007-2009 were to residents living in the poorest tracts; and according to the 2010 version, 25.1% were in the poorest tracts.Distribution of Births by Census Tract Poverty