Janet Brown, MSc Disparities in Perinatal Outcomes using PPOR: Regional Results for the Bay Area...
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Janet Brown, MSc Disparities in Perinatal Disparities in Perinatal Outcomes Outcomes using PPOR: Regional Results for using PPOR: Regional Results for the Bay Area Data Collaborative the Bay Area Data Collaborative
Transcript of Janet Brown, MSc Disparities in Perinatal Outcomes using PPOR: Regional Results for the Bay Area...
Janet Brown, MSc
Disparities in Perinatal Outcomes Disparities in Perinatal Outcomes using PPOR: Regional Results for using PPOR: Regional Results for the Bay Area Data Collaborativethe Bay Area Data Collaborative
Additional Authors:Additional Authors:
Al Abramowitz, MSAl Abramowitz, MS
Ellen J. Stein, MD, MPH, Ellen J. Stein, MD, MPH, FACOGFACOG
Anand Chabra, MD, MPHAnand Chabra, MD, MPH
And Special Thanks To:
Jerry A. Sierra
BADC Collaborative
CA Department of Health Services MCAH Branch Epi and Eval Section
Nine Bay Nine Bay Area Area
CountiesCounties
Distribution of African-American Population in the Bay Area
Bay Area regional birth data have the statistical power to analyze racial/ethnic disparities
Present fetal-infant mortality rates for Bay Area counties
Identify health disparities
Identify risk factors using Perinatal Periods of Risk (PPOR) model
Objectives of Presentation
5.6 5.7
6.9 7.2 7.37.7 7.8 8.0 8.1
9.1
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0Rates per 1,000
Source: CA Birth Cohort File, 1999-2001
County and Bay Area Data Collaborative Fetal-Infant Mortality (FIM) Rates, 1999-2001
*
BADC Region and County Fetal-Infant Mortality Rates and 95% Confidence Intervals, 2001
0
2
4
6
8
10
12
Marin Napa Santa Clara San Mateo San
Francisco
Contra
Costa
Sonoma Solano Alameda
Upper and Low er 95% CI for rates per 1,000 births
B A D C R e gi on
7.7
Racial/Ethnic Disparities: Bay Area Data Collaborative Region
Source: CA Birth Cohort File, 1999-2001
6.27.7
18.3
7.2 7.3
9.1
6.97.6
16.2
7.4
02468
101214161820
Black White Hispanic Asian/PI All Races
BADC region Alameda
Fetal-Infant Mortality RatesPer 1,000 fetal deaths + births, 1999-2001
Age at death
Birth weight
Parameters
Fetal-infant mortality
Perinatal Periods of Risk
Perinatal Periods of Risk
Newborn Newborn CareCare
Infant Infant HealthHealth
Maternal Maternal HealthHealth
PrematurityPrematurity
MaternalMaternal Care Care
Four “periods of risk” represent potential gaps in maternal and child health systems that lead to fetal-infant mortality
NewbornCare
Deaths (Rate)
MaternalCare
Deaths (Rate)
Infant Health
Deaths (Rate)
500-1499 grams
1500+ grams
Maternal Health/PrematurityMaternal Health/PrematurityDeaths (Rate)
Fetal(24 Weeks to Birth)
Neonatal(Birth to 27 Days)
Postneonatal(28 Days to 1 Year)
Total Deaths
————— =
Births + Fetal Deaths
Total Fetal Infant Mortality (FIM) Rate per 1,000
Perinatal Periods of RiskAnalytic Model
Age at
Death
Bir
th W
eig
ht
500-1499 grams
1500+ grams
BADC Black Distribution and Rates FIM, 1999-2001
NewbornCare
25 (1.1)
Maternal Health/PrematurityMaternal Health/Prematurity178 (8.1)
MaternalCare
90 (4.1)
Infant Health62 (2.8)
355 total deaths
—————————— =28,160 births + fetal deaths
Total FIM
Rate=16.2 per 1,000
Source: CA Birth Cohort File, 1999-2001
Fetal(24 Weeks to Birth)
Neonatal(Birth to 27 Days)
Postneonatal(28 Days to 1 Year)
NewbornCare
281 (1.1)
MaternalCare
518 (1.9)
Infant Health
288 (1.1)
500-1499 grams
1500+ grams
Source: CA Birth Cohort File, 1999-2001
Maternal Health/PrematurityMaternal Health/Prematurity
768 (2.9)
Fetal(24 Weeks to Birth)
Neonatal(Birth to 28 Days)
Postneonatal(29 Days to 1 Year)
1,855 total deaths
————— =
266,310 births + fetal deaths
Total FIM
Rate=7.0 per 1,000
BADC, All Other, Distribution and Rates FIM, 1999-2001
BADC Black, All Other FIM Disparities, 1999-2001
Newborn Care
Black: 1.1All Other: 1.1
OR = 1.08 (95% CI .72 - 1.63)
Maternal Care
Black: 4.1 All Other: 1.9
OR = 2.12 (95%CI 1.69 – 2.65)
Infant Health
Black: 2.8All Other: 1.1
OR = 2.63(95% CI 1.99-3.40)
Maternal Health/Prematurity
Black: 8.1 All Other: 2.9OR = 2.84 (95% CI 2.41- 3.34)
Black: 16.2, All Other: 7.0 Total OR = 2.35 (95% CI 2.10 – 2.64)
NewbornCare
3 (1%)
MaternalCare
57 (25%)
Infant Health
36 (16%)
500-1499 grams
1500+ grams
Fetal(24 Weeks to Birth)
Neonatal(Birth to 27 Days)
Postneonatal(28 Days to 1 Year)
Prematurity/Maternal HealthPrematurity/Maternal Health130 (58%)
Total Excess
Deaths=226
Black Preventable DeathsBADC Region, 1999-2001
Against U.S. White Comparison Group, 1998-2000
Preventable African American fetal-infant deaths are 1/3 of the excess mortality for the Bay Area
Preventable African American fetal-infant deaths are 1/3 of the excess mortality for the Bay Area
African American births are 7.5% of the total births for the Bay AreaAfrican American births are 7.5% of the total births for the Bay Area
Maternal Health/Prematurity is our opportunity
to reduce African American
fetal and infant deaths
Maternal Health/Prematurity is our opportunity
to reduce African American
fetal and infant deaths
Formed in Nov. 2004, meets bi-monthly, meeting location rotates
Members: MCH directors, medical directors, epidemiologists and others
Purpose Share information Serve as a resource Conduct research
Bay Area Data Collaborative
Successes
High level of commitment
Broad vision
Technical support/capacity building
Resource efficient: time and $
Increased statistical power
Bay Area Data Collaborative
Lessons learned
How to maintain project momentum
How to support diverse interests
How to manage different priorities
Bay Area Data Collaborative
17.016.4 16.6 15.6
7.7
6.2
9.19.1
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1999 2000 2001 2002
Total PPORFIM Rate
Rate Attributed to Maternal Health/ Prematurity
Source: CA Birth Cohort File, 1999-2002
Maternal Health/Prematurity Risk Factors Black Fetal-Infant Mortality Trend
1999-2002
PP
OR
R
ate
pe
r 1
,00
0
White
American Indian
African American
Asian-Pacific Islander
Hispanic
Bay Area Population Change, 1980-2000
