CLEVELAND, Ohio -- Preliminary data on infant deaths last year in Cuyahoga County indicate some good news for the region: the infant mortality rate dropped by 8 percent.
But the improvement was as racially segregated as the county. Infant deaths among white babies plummeted by 45 percent compared to the previous year, while for black babies, there was a slight increase in the infant mortality rate.
The infant mortality rate, defined as the number of infant deaths before the age of 1 per 1,000 live births, was 7.97 for the county in 2017, according to the early data released Tuesday afternoon at a meeting of First Year Cleveland, the city-county infant mortality initiative.
A total of 116 babies in the county died last year before reaching a first birthday. The infant mortality rate for the year might change slightly in the coming months as some infant deaths from the previous year are reported to the county as late as August, and as the number of births is finalized, said Cuyahoga County Board of Health Data Analyst Richard Stacklin, who presented the local data.
The infant mortality rate for white babies was 2.54. For black babies, it was 15.6.
The improvement for white babies has widened an already shocking gap in the odds of survival for the county's smallest residents: For every white baby that died before reaching a first birthday in Cuyahoga County last year, more than six black babies died, nearly double the gap in previous years.
"I've analyzed this data for eight years, and this is the largest disparity I've seen," Stacklin said.
It's an alarming pattern that's showing up in . A 2017 JAMA Pediatrics study found that national progress in bringing down the infant mortality rate for black babies stalled in recent years, while the rate continued to drop for white babies, widening the disparity between the two.
Similarly, after improving for nearly a decade, the rate of babies born at a low birth weight nationwide rose by 2 percent in 2016, according to the annual County Health Rankings & Roadmaps Report by University of Wisconsin Population Health Institute (UHWPI) and the Robert Wood Johnson Foundation.
"The most striking is that there continue to be these very sobering racial disparities in low birth weight, and not just in low birth weight but in birth outcomes in general," said Marjory Givens, UWPHI associate scientist.
In all 50 states, black babies were more likely to be born at low birth weight, defined as less than 5 1/2 pounds, which puts them at immediate risk for a number of life-threatening health problems, including difficulty breathing due to underdeveloped lungs, jaundice, anemia, and infection.
The rate of low birth weight babies in Cuyahoga County was the highest of the state's 88 counties, at 11 percent. The national rate in 2016 was 8.2 percent.
"This is a pattern that's playing out not just in Cuyahoga County and Ohio, but also the nation. It's really a very disturbing pattern and a poor start to life for children of color," Givens said.
What's driving the gap
What's driving the widening racial gap in infant deaths in Cuyahoga County and in many other parts of the country is early, or preterm, births.
For more than 20 years, preterm birth, or delivery prior to 37 weeks gestation, has been the biggest contributor to infant deaths in the county and city of Cleveland, which have notoriously high rates of early birth. And black women are far more likely (in one recent study four times more likely) to have a baby born very early, between 16 and 22 weeks' gestation.
The majority of low birth weight babies are also premature.
As in previous years, about half of the babies who died in the county last year were born so early that they had little chance of survival. Of the 56 babies lost who were born at 22 weeks gestation or less, the vast majority (more than 4 in 5) were black babies.
"This is the very large gap that caused that large disparity that we saw in 2017," Stacklin said. Typically about 60 percent of infant deaths in the county in any given year are caused by prematurity, he said. "It's unacceptable."
It's also the primary target for local efforts to reduce racial disparities in infant deaths and drive down the area's infant mortality rate overall.
First Year Cleveland has set a goal of reducing the region's racial disparity in infant deaths as part of its three-year strategic plan and has set aside 0,000 from its operating budget for three action teams which will:
"The disparity is something that we will not sleep at night until we address," said FYC Executive Director Bernadette Kerrigan.
Part of the group's plan to reduce infant deaths among black families includes increasing access to evidence-based programs that help reduce infant deaths.
The Ohio Department of Health announced Tuesday it is awarding 0,000 in federal funding to it's Cuyahoga County Help Me Grow partners, as well as MetroHealth's Nurse Family Partnership to increase home visiting services to women during pregnancy.
The Ohio Department of Health is making infant death certificate information available to Cuyahoga County public health officials on a monthly basis to allow them to more quickly analyze trends.
First Year Cleveland has said it plans to publish the monthly data on its newly launched website, firstyearcleveland.org.