A County-Level Collaboration to Reduce Infant Mortality: Cradle Cincinnati

We sought to implement and determine the efficacy of Cradle Cincinnati-a county-level collective impact collaborative established to reduce the infant mortality rate (IMR) of Hamilton County, Ohio. We hypothesized that the reduction in the IMR of Hamilton County was attributable to the work of Cradle Cincinnati.

Cradle Cincinnati, conceptualized in the early 2000s and iteratively implemented in the ensuing decades, emphasizes stakeholder engagement, data-driven learning, and community-led strategies to address infant mortality. To determine efficacy, we employed augmented synthetic control methodology to create a synthetic Hamilton County unexposed to Cradle Cincinnati using county-level data from Ohio in the years 2007 to 2023, with change in county-level IMR in the real Hamilton County compared to a synthetic unexposed Hamilton County as the outcome of interest.

Hamilton County IMR decreased from 11.1 (per 1000 livebirths) in 2008 to 5.5 in 2023. Real Hamilton County IMR progressively decreased over time compared to that of a synthetic Hamilton County unexposed to Cradle Cincinnati, reaching statistical significance in 2021 and 2023 (change in deaths per 1000 live births: -2.5 [95% CI: -5.1 to -0.3] and -4.4 [95% CI: -6.6 to -2.0], respectively).

Cradle Cincinnati significantly reduced infant mortality in a large urban Ohio county, with the greatest improvements emerging nearly a decade after implementation. A county-level focus offers potential to reduce the disproportionately high and racially disparate IMR in the United States.