Maternal & Child Health Epidemiology:

An Overview of Selected Data Systems

Data Users ConferenceNovember 17, 2004

Presented by Susan Nalder, EdD, MPH, CNMMCH Epidemiology Program Manager

New Mexico Department of Health

MCH Epidemiology, Population Based

Uses data variety of data and data sources covering population characteristics, health status by natality, mortality, morbidity and injury, healthy & health risk behaviors, access to and use of primary preventive care

Hand-out shows kinds of data used to monitor this population

Presentation will focus on PRAMSSpecial mention of selected projects

MCH Epidemiology, Population Based

National Survey of Children with Special Health Care Needs:Federal MCH-B and NCHSNew Mexico sample 751Data collected in 2001; reported in 2002Used SLAITS methodology – need to use STATA or combination of SAS+SUDAANData files and data reports may be accessed: www.cdc.gov/slaitsData report: www.cdc.gov/nchs/slaits.htm

MCH Epidemiology, Population Based

National Survey of Child Health:Federal MCH-B and NCHSNew Mexico sample ~2,000Data collected in 2004Data files available early 2004Used SLAITS methodology – need to use STATA or combination of SAS+SUDAANData files and data reports will be posted: www.cdc.gov/slaits

MCH Epidemiology, Population Based

NM Child Fatality Review and NM Maternal Mortality ReviewData bases developed and in testing 2004; reviews ongoing since 1996Reports are at www.doh.state.nm.usProgram contact:Anne Worthington, MPHAnne.Worthington@doh.state.nm.ustel 505-476-8888

MCH Epidemiology, Population Based

Comprehensive MCH data and information available through the Title V MCH Block Grant program

Over 60 indicators of health status and access to/use of care

www.mchb.hrsa.govOnline data; can see NM data and any other state

A

Pregnancy Risk Assessment and Monitoring System

P M S R

From Data to ActionNM Pregnancy Risk

Assessment Monitoring System

AcknowledgementsThe NM PRAMS team

– Ssu Weng, MD, MPH, PRAMS Epidemiologist– Dorin Sisneros, PRAMS Operations Manager

– Eirian Coronado, MA, PRAMS Coordination and Epidemiology

The PRAMS Sample Source - The team in the NM Office of Vital Records and Health Statistics

The Telephone Follow-up- The team in the Survey Unit, Division of Epidemiology & Response

The CDC PRAMS Team- Nedra Whitehead, PhD, NM PRAMS Advisor

Funding Support and TA

The Title V Maternal & Child Health Block Grant (1995 to present)

The PRAMS Project in the Program Services Branch, Division of Reproductive Health, Centers for Disease Control & Prevention in Atlanta (1996-present)

The Medicaid Program, NM Human Services Department (1998 to present)

The Family Preservation & Support Project, Prevention & Intervention, NM Children, Families and Youth Department (1995-1999)

PRAMS is a multi-state, ongoing surveillance project

(32 states)

The Purpose of NM PRAMS

•To improve the health of New Mexico’s mothers, infants and families

The Purpose of NM PRAMS

• To reduce significant disparities in maternal, infant and family health measures: – Disparities: geographic areas, age, race or

ethnicity, education, poverty, families with Medicaid paid services

– Measures: health status, healthy & health risk behaviors, exposure to stressors, access to/use of health & health related services

The Purpose of NM PRAMS• To produce data and information, and

foster its use for – Strategic analysis with local

groups, translation of data to action

– Informed Policy– Informed decisions about programs,

selection of evidence-based services– Education of policy makers,

providers, present and future mothers & fathers, and the public

– Monitoring and reporting status and trends over time

About NM PRAMS

• A multi-year, population-based surveillance system

• Monitors over 100 selected behaviors and experiences of mothers and infants that occurred before, during or after a pregnancy & live birth … against a background of socio-demographic, economic and cultural characteristics

About NM PRAMS

• Preconceptional Period ~ up to 12 months before pregnancy– Health insurance before pregnancy– Use of multivitamins– Height & Weight, BMI calculations– Intention of pregnancy– Tobacco, Alcohol, Physical Abuse– Knowledge about Emergency

Contraceptive Pill

About NM PRAMS

• Pregnancy– When knew she was pregnant– Prenatal care, including barriers– Payor of care– Health education received (11

topics)– HIV testing– Oral health services– Services including WIC and 11

supportive services– Prenatal health problems

(diabetes, pregnancy related, injuries)

About NM PRAMS

• Pregnancy & Delivery– Experience of feeling treated

unfairly when getting health care

– Prenatal hospitalizations– Tobacco, alcohol, physical

abuse– Life stressors (13 topics)– Payor of care for delivery– Length of stay after delivery

About NM PRAMS

• Post-Partum to ~2 months– Post partum check up– Use of family planning method(s)– Barriers to using family planning– Supportive services (11 kinds)– Working or in school, or at home– Depression– Food security for the family– Household utilities

About NM PRAMS

• Early Infancy to ~2 months– Hospitalization or NICU after

delivery– Infant feeding

• Several questions about breastfeeding

– Second hand smoke exposure– Infant sleep position– Well child care– Infant car seat– Home visiting services– Family support for infant’s care

More About NM PRAMS

• The Sample: random selection from NM live birth registration files

IN: NM Residents, live birth in NM, singleton-triplet

Excluded: Non-resident, Resident but out of state birth, adoption

• Timing: 2-6 months post-partum• Method: mailed survey with

telephone follow-up

Data collectionUp to 3 mailings

Telephone interview for non-responders

Recall bias minimized– Mailed 2-6 months after delivery

More About NM PRAMS, 1997-2000

• 1997-2000 Sample Design: stratified sample, oversampled low birth weight & Native Americans

• Statewide, 8,182 sampled; 5,711 responded, 70% response rate

• 2001-Present, the Sample Design: stratified sample, oversampled by Health District

PRAMS Reports Mother’s Residence by Public Health Districts

• District I Urban: Bernalillo, Torrance, Valencia, and zip codes for Bernalillo town & Rio Rancho

• District I Rural: Sandoval (excludes Bernalillo town & Rio Rancho zip), McKinley, San Juan, Cibola

• District II: Colfax, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, Union

• District III: Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, Socorro

• District IV: Chaves, Curry, DeBaca, Eddy, Guadalupe, Lea, Lincoln, Quay, Roosevelt

More on the PRAMS

• Statewide Estimates and Other Analysis: Selected characteristics of the mothers are associated with outcomes, behaviors or other findings.

• Age Groups• Race and Ethnicity• Education Levels• Marital Status• Any Previous Live Birth• Residence by Public Health District• Public Assistance• Payor of Care and I.H.S.

– PNC & Delivery, Delivery Only

Point estimateAnalysis weights

• Each respondent “speaks” for about 12 other women

Not selected for sample or who

did not respond• Weighting process complex

•Done by CDC PRAMS•See PRAMS reports on DOH website

Potential bias from

• Less than 100% response – about 30% do not participate

• Mail survey: appeals to more educated women, but many less-advantaged women participate

• Phone respondents vs. mail• Recall (2-6 months after birth)• Self-report by respondent

NM PRAMS

• Annual Surveillance Report– Detailed reporting >20 topics– Multi-year reporting >20 topics

• Special Reports– Teen report– Medicaid report– Topics of interest

NM PRAMS

• Use of PRAMS by outside researchers– CDC PRAMS working on a public

use data set … – NM PRAMS, qualified researchers

may propose an analysis project and obtain data, a process is in place

email us at nmprams@doh.state.nm.usErian Coronado, MA, PRAMS Coordinator

Tel: 505-475-8895Ssu Weng, MD, MPH, PRAMS Epidemiologist

Tel: 505-476-8892Susan Nalder, EdD, MPH PRAMS Director

Tel: 505-476-8890Maternal and Child Health Epidemiology Program

Family Health BureauNM Department of Health2040 South Pacheco St, Santa Fe, NM 87505

Contact information for NM PRAMS