It’s rare to run across facts from an anti-vaccine proponent, so it shocked me when I found out this one was true:
According to a 2010 CDC report on infant mortality, Mississippi led the USA with 9.62 infant deaths per 1,000 live births (1). Gleefully, anti-vaxxers point out multiple references showing Mississippi also leads the nation in vaccinating children, with rates at or better than 99.9% overall. For example see references (2) and (3).
As a scientist, I’m forced to concede facts, and here we have one: the state with the best vaccination record is also losing children at the highest rate.
So what’s the problem here? Are vaccinations failing to protect the children of Mississippi as the anti-vaccination forum post claimed? Or, worse yet, are vaccinations somehow harming the children?
Well, as is often the case, just because someone is throwing a fact out at you, it doesn’t mean they’re being honest. I’ve always found this to be true of the anti-vaccination crowd, so I did a bit of research. My suspicions were confirmed, and what’s really happening in Mississippi is obvious.
Comparing Apples to Oranges
The problem is that Mississippi children are dying at birth, before they ever have a shot at vaccination (no pun intended). Or, they’re dying from causes that couldn’t be helped by a vaccine. For example, how do you vaccinate a child in the womb against a parent who smokes (smoking causes pre-mature birth, which leads to higher infant mortality)?
According to a 2013 Mississippi Infant Mortality Report (4), pre-term birth complications are the leading causes of infant death. Birth defects account for 19.1% of deaths, low birth weight/prematurity 15.2%, Sudden Infant Death Syndrome (SIDS) 10.6%… accidents, maternal complications, respiratory distress, and infections present at birth are all in the top 10 – none possibly preventable (or caused by) vaccines.
Let’s say this again because it’s the point anti-vaxxers intentionally choose to ignore: Mississippi infants are dying before they ever live long enough to get vaccinated.
Another major contributor to infant mortality in Mississippi is socioeconomic conditions. According to the same report (4), poor and un-insured women, teens, and African-American women are more likely to lose babies due to pre-term births. For example, there are 14.1 pre-term births for white Mississippian women vs. 20.6 for blacks per 1,000 live births. As pointed out two paragraphs earlier, pre-term birth complications are the leading cause of infant death in this state.
Why am I harping on about social and economic conditions in a discussion of infant mortality rates in Mississippi? Well, we know they’re a contributor to higher infant mortality. Guess which is the poorest state in the USA? Yes, it’s Mississippi (5). How do you vaccinate a child against a mother’s lack of access to proper pre-natal care?
The socioeconomic study is reinforced by a CDC study (6) that shows infant mortality rates nationwide for black women are more than twice those for white women. Why would this matter for infant mortality in Mississippi? According to the 2010 U.S. Census, Mississippi has the highest percentage of African-Americans in the United States (7).
Last but not least, exposure to cigarette smoke is known to have an effect on low birthweight, which in turn increases the risk of infant mortality (4). A 2013 Gallup poll places Mississippi third in the nation when it comes to addiction to cigarette smoking, behind only Kentucky and West Virginia (8). No wonder so many children are dying. How do you vaccinate a child against a parent who smokes?
So now we know why so many children are dying in Mississippi, and anti-vaccine nutters are comparing apples to oranges when quoting infant mortality and vaccination rates for the state.
But let’s not stop there – let’s compare vaccinated Mississippi children against unvaccinated children in other states.
Comparing Apples to Apples
Before poorly informed anti-vaccination campaigners started making their rounds, measles was a disease that was considered beaten. Now, thanks to unvaccinated children, it’s on the comeback, and people are dying (12).
In the news recently, the three states with the highest number of measles outbreaks were Ohio , California , and New York City  (9). How do OH, CA, and NY compare to well-vaccinated Mississippi when it comes to MMR (Measles-Mumps-Rubella) vaccinations? If you’re anti-vaccine lady whose quote opened this article, you’re not going to like the answer: Ohio, California, and New York lag Mississippi by 3 to 7 percent in vaccination levels (9). And that lady needs to sit down now and hold on to her seat:
How many measles cases have been reported in highly vaccinated Mississippi? In the last decade, there has been one confirmed case of measles in the Magnolia State.
To drive the point home, most of the 288 measles cases reported in the USA this year have been in unvaccinated persons or those with unknown vaccination status (9). So Mississippi is clearly doing a great job, once the child lives long enough to get vaccinated.
If the anti-vaccine lady is still seated, she should stay there, because it gets worse.
Measles isn’t the only example for which we have hard evidence. In 2012, the largest Chickenpox outbreak in the USA hit Vigo County in Indiana (11). 84 cases were reported in a county that usually sees less than 10 per year. Chickenpox can cause serious problems for older children and adults and is extremely contagious.
In 2012, the state of Indiana reported 469 cases of Chickenpox. Mississippi reported only 11 (13). Not surprisingly, Indiana ranks very poorly compared to Mississippi – approximately 7% less of the Indiana population is vaccinated against Chickenpox (3). Again, when you look at the facts, Mississippi’s vaccination programs are working, while states with poor vaccination records are suffering the consequences.
When reading anti-vaccination posts in online forums and on Facebook, it’s best to keep an old saying in mind:
“Figures don’t lie, but liars figure”
The quote has been attributed to various sources including Mark Twain, but regardless of who said it, the truth behind the Mississippi vaccination/infant mortality myth is nothing more than a phenomenon with a fancy name of false or illusory correlation: you simply take two numbers that have nothing to do with each other, and convince your audience that there’s a relationship between them.
I’ll close by a fun example of false correlation that everyone can understand, courtesy of the Spurious Correlation Generator at http://www.tylervigen.com: Did you know that taking anti-diabetic drugs is directly linked to your chances of drowning in a fishing boat accident?
Hey, anti-vaccine believers, the numbers don’t lie!
(1) CDC Infant Deaths Per 1,000 Live Births, By State: 2010
(2) Advisory Board Company Daily Briefing – States With the Best – and Worst – Vaccine Coverage (August 2013)
(3) CDC MMWR Vaccination Coverage Among Children in Kindergarten –USA, 2012-13 School Year
(4) Mississippi Department of Health and Vital Statistics
(5) State & County Quick Facts, United States Census Bureau
(6) Recent Declines in Infant Mortality in the United States, NCHS Data Brief, April 2013 http://www.cdc.gov/nchs/data/databriefs/db120.pdf
(7) Historical Census Statistics on Population Totals By Race, U.S. Census Bureau http://www.census.gov/population/www/documentation/twps0056/twps0056.html
(8) Gallup Well-Being: In U.S., Smoking Rate Loest in Utah, Highest in Kentucky http://www.gallup.com/poll/167771/smoking-rate-lowest-utah-highest-kentucky.aspx
(9) CDC Morbidity and Mortality Weekly Report
(10) Mississippi Morbidity Report, Vol 24, No. 12. Dec 2008
(11) Largest Chickenpox Outbreak in the U.S. Hits Vigo County in Indiana (Huffington Post 11/27/2012)
(12) World Health Organization “Measles”
(13) CDC Morbidity and Mortality Weekly Report, Summary of Notifiable Diseases – United States 2012