April 1996, Vol. 30, No. 2 

Missouri’s infant death rate reached a record low for the fourth consecutive year in 1995, the state’s health director announced today. According to Dr. Coleen Kivlahan, Director of the Missouri Department of Health, 7.4 infants died per 1,000 live births last year. That compares with a rate of 8.1 in 1994 and 10.2 ten years ago.

Kivlahan said infant mortality decreases were greater for African-American babies than for white babies. The black infant death rate dropped by 18 percent from 16.4 to 13.4 per 1,000 live births while the white infant death rate decreased by 3 percent from 6.6 to 6.4. But the black infant death rate was still more than double the white rate (see Table 1).

"Missouri’s contribution to family planning and prenatal care, along with the excellent medical care available in the state, are paying off in healthier babies," Kivlahan said. "However, I am disturbed that the infant death rate among African Americans is still twice that of the white rate. We need to continue targeting our efforts to improve the health of African-American babies."

The overall decrease in infant mortality reflects improvements in both neonatal (infants less than 28 days of age) and postneonatal (infants 28 days to one year) deaths. The neonatal mortality drop from 6.5 to 4.6 per 1,000 live births from 1985 to 1995 reflects improved survivability of premature babies while the postneonatal decline from 3.7 to 2.8 per 1,000 live births primarily reflects recent reductions in sudden infant death syndrome (SIDS) deaths. In 1995 there were 74 SIDS deaths compared with 88 in 1994 and 120 in 1993.

"Research has shown us that simply putting babies to sleep on their backs or sides can make SIDS deaths 30-50 percent less likely," Kivlahan said. "While not every SIDS death can be prevented this way, the drop in SIDS deaths in 1995 could be attributed in part to Missourians getting the Back to Sleep message."

Another factor in decreasing infant deaths is a continued reduction in mothers with inadequate prenatal care. In 1995, 12.4 percent of mothers obtained an inadequate level of prenatal care compared with 13.6 percent in 1994 and 17.1 percent in 1985. Inadequate prenatal care is defined as care beginning after the first four months of pregnancy, or having less than a recommended number of prenatal care visits during the pregnancy.

"We have made steady improvement in the past few years in our efforts to ensure that Missouri babies are born healthy," Kivlahan said.

Provisional 1995 data shown in Table 2 also demonstrate continued improvement in several key family planning indicators. For example:

• The spiraling increase in out-of-wedlock births has apparently been halted. Last year 23,320 babies were born out-of-wedlock, compared with 23,845 in 1994 and 24,320 in 1993. For the first time since 1976, the percentage of out-of-wedlock births declined, to 32.0 percent in 1995 from 32.5 percent the year before.
• Abortions continued to decline. Abortions decreased by 3.6 percent in 1995 with 13,611 Missouri pregnancies aborted. From 1993 to 1995, abortions decreased 12 percent.
• Short birth-spacing (spacing between births less than 18 months) decreased from 4,923 in 1994 to 4,300 in 1995. The percentage of short birth-spacing decreased from 12.0 percent of second or higher order births in 1994 to 10.6 percent in 1995. The number of births to African Americans with short spacing decreased by over 30 percent in 1995 and by more than half since 1993.
• Births to teens also decreased in 1995, but had increased slightly in 1994. The number of births to teen mothers was 10,490 in 1995 or 3 percent less than the 10,794 in 1994.

Kivlahan credits additional funding for family planning by the Missouri General Assembly as a major factor in these improvements. In fiscal year 1994 an initial $500,000 in general revenue funds was allocated for family planning and this was increased to $1.3 million in 1995 and in 1996.

"Giving women access to family planning services is leading to healthier babies and mothers in Missouri," Kivlahan said. "Family planning efforts also have contributed to fewer unplanned pregnancies and a dramatic reduction in abortions.

"I commend Governor Mel Carnahan and the Missouri General Assembly for their thoughtful approach in tackling some very serious problems that can stem from unplanned pregnancies," Kivlahan added.

In another positive finding, Kivlahan said homicide declined dramatically in 1995.

Homicides dropped by 24 percent and went from the 9th leading cause of death in 1994 to the 12th leading cause of death in 1995.

Total mortality increased slightly in 1995 as approximately 54,000 Missourians died compared with 53,611 in 1994. The three leading causes of death (heart, cancer, stroke) all increased slightly in 1995 with cancer showing the largest increase (2.1 percent). The number of cancer deaths has increased by 14 percent since 1985. Chronic obstructive pulmonary disease, the fourth leading cause of death, decreased for the first time since 1990. Deaths due to pneumonia/influenza and accidents both showed little change.

There were 12 maternal deaths in 1995. While the number is still relatively small, it represents the highest level in 20 years.

Communicable disease data for 1995 show the following:

• Reports of early syphilis (primary, secondary and early latent) decreased from 1,694 cases in 1994 to 1,090 in 1995, a 36 percent decrease. Reports of congenital syphilis also decreased 36 percent from 72 cases in 1994 to 46 cases in 1995. Gonorrhea continues to decrease with 11,302 cases reported in 1995 compared to 12,553 reported in 1994, a decrease of 10 percent.
• In 1995, there were 63 reported cases of pertussis (whooping cough), an increase from the 45 cases reported in 1994. Provisional data for 1995 indicate that 5 cases of Haemophilus influenzae Type b (Hib) meningitis were reported to the Department of Health in children under 5 years, compared to 8 cases in 1994. Two cases of measles were reported in 1995, compared to 161 cases in 1994 and 3 cases of tetanus were reported to the state Department of Health, one of which was in an unimmunized 3-year-old. There were no reported cases of rubella, diptheria or polio. All these diseases can be prevented through vaccination.
• With data still provisional, hepatitis A accounts for 21.5 percent of approximately 6,100 communicable diseases reported to the Bureau of Communicable Disease Control in 1995. Hepatitis A increased more than 100 percent from 619 in 1994 to 1,312 in 1995 with most of the increase in the Kansas City metro area (47 in 1994 to 708 in 1995). Because of intense surveillance and follow-up investigations of contacts, the metropolitan Kansas City area saw a dramatic decrease in hepatitis A cases during the last weeks of 1995. It is now down to usual level of 5 cases per week.
• Hepatitis B has been moving downward since 1990 when there were 633 cases reported. There were 438 cases in 1995, a reduction of 30.8 percent.
• Meningococcal disease (bacterial meningitis) increased significantly in Jasper, Newton and McDonald counties with a rate of 9.3 per 100,000 population (14 cases) in 1995. A rate of approximately 1/100,000 would normally be expected in the USA. There were 63 cases of meningococcal meningitis statewide, an increase of 31 percent from 1994 when there were 43 cases reported and an increase of 85 percent over the 5-year median of 34.
• For the first time in two years, Missouri’s tuberculosis (TB) cases declined. In 1995, 245 new tuberculosis cases were reported, for a case rate of 4.6 per 100,000 population. This represents a 6 percent decrease from 1994 when 260 cases were reported, matching Missouri’s all-time low reported cases in 1992. While tuberculosis cases declined in St. Louis City from 41 to 40, St. Louis County from 42 to 35, and Springfield-Greene County from 14 to 10, increases were noted in Kansas City from 39 to 43. This represents the third year in a row that Kansas City has seen an increase in TB. The outstate areas of Missouri accounted for 117 (48 percent) cases and saw an overall decline of 11 cases. Whites accounted for 135 (55 percent) of all reported tuberculosis cases in 1995, followed by African Americans with 83 (34 percent), Asians with 22 (9 percent) and Hispanics with 5 (2 percent). This represents a 26 percent increase in TB cases among African Americans from 67 in 1994.

LIVE BIRTHS totaled 5,843 in February compared with 5,821 in February 1995. After adjusting for a longer reporting period in 1996, the birth rate decreased from 14.3 to 13.8 per 1,000 population between the two periods. Cumulative births for the 12 months ending with February show a slight decrease from 74,312 to 73,508.

DEATHS increased in February as 4,518 Missourians died compared with 4,336 one year earlier. Cumulative deaths for the 2- and 12-month periods ending with February also show increases.

The NATURAL INCREASE for Missouri in February was 1,325 (5,843 births minus 4,518 deaths). The rate of natural increase declined for all three periods shown in the table below.

MARRIAGES and DISSOLUTIONS OF MARRIAGE both decreased for all three periods shown below. The marriage to divorce ratio for the 12 months ending with February was 1.64 compared to 1.74 in 1995.

INFANT DEATHS decreased slightly in February as 48 Missouri infants died compared with 50 in February 1995. The infant death rate for the 12 months ending with February was 7.2 per 1,000 live births compared with 8.2 for the 12 months ending with February.