Infant Death Rate Reaches New Low in State

TIMES MEDICAL WRITER

The infant death rate in California declined to its lowest rate ever in 1993, 6.8 deaths per 1,000 live births, according to the Department of Health Services.

The actual number of infants who died in 1993 during the first year of their lives was 3,970, the lowest since 1915, when the state's population was only 2.9 million, slightly larger than the current population of San Diego County. There were 584,483 live births during 1993, according to data released by the department Wednesday.

"Over the past five years, the infant death rate has declined consistently, from 8.5 (per thousand) in 1989 to 6.8 this past year," said Gayle Wilson, wife of the governor, who released the figures with state Health Director Kim Belshe. "Preventive health care and education are working."

However, the infant death rates in Los Angeles and Orange counties increased somewhat in 1993. The Los Angeles County rate went from 7.2 per thousand to 7.3, and the rate in Orange County increased from 5.4 to 5.9. The latter increase, although apparently large, most likely represented a statistical correction from the preceding year, when the Orange County rate dropped dramatically, said Dr. Rugmini Shaw, chief of the state department's maternal and child health branch. "I wouldn't consider that significant," Shaw said.

Neither Los Angeles County nor Orange County health officials had seen the new report and declined comment.

One disturbing note in the report was the infant death rate for African Americans. Although the rate dropped from 16.7 to 15.5 deaths per thousand, it remained more than twice the rate for whites of 6.2 per thousand. That ratio has remained more or less constant since 1989. The rate for Latinos remained constant at 6.4 per thousand.

"While the infant death rate among African Americans remains unacceptably high, I am encouraged by the rate's decline," Belshe said.

A 1991 report by a blue-ribbon committee appointed by Gov. Pete Wilson attributed the disparity in death rates to "long-term deplorable conditions in the African American community," including poverty, unemployment, substandard housing, single-parent households and lack of access to medical care.

The California rate was the lowest among the 10 largest states in 1993, and was well below the U.S. rate of 8.3 per thousand.

Gayle Wilson attributed the decreases in death rates, in part, to BabyCal, a multimedia campaign to encourage pregnant women to seek prenatal care and avoid alcohol, tobacco and drugs. The state has also provided special funds to improve birth outcomes for black mothers-to-be in selected areas.

But Dr. Irwin Silberman, director of family health programs at the Los Angeles County Department of Health Services, recently attributed the bulk of the decline to the expansion in Medi-Cal services, which gave more women access to care. He also noted that more physicians had agreed to accept Medi-Cal patients, which lessened the burden on public facilities.

The death rate decline has been steady. In 1970, the California rate was 17.2 deaths per thousand, and in 1950 it was 24.9.

Among the 38 largest counties in California, the rate ranged from a low of 4 per thousand in San Mateo County to 11.8 in Mendocino County. The number of deaths in the other counties was too small for reliable measurements.

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