Janet Brown, MSc Disparities in Perinatal Outcomes using PPOR: Regional Results for the Bay Area Data Collaborative.

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Presentation transcript:

Janet Brown, MSc Disparities in Perinatal Outcomes using PPOR: Regional Results for the Bay Area Data Collaborative

Additional Authors: Al Abramowitz, MS Ellen J. Stein, MD, MPH, FACOG Anand 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 Area Counties

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

Rates per 1,000 Source: CA Birth Cohort File, County and Bay Area Data Collaborative Fetal-Infant Mortality (FIM) Rates, *

BADC Region and County Fetal-Infant Mortality Rates and 95% Confidence Intervals, 2001

Racial/Ethnic Disparities: Bay Area Data Collaborative Region Source: CA Birth Cohort File, BlackWhiteHispanicAsian/PIAll Races BADC regionAlameda Fetal-Infant Mortality Rates Per 1,000 fetal deaths + births,

 Age at death  Birth weight Parameters Fetal-infant mortality Perinatal Periods of Risk

Newbor n Care Infant Health Maternal Health Prematurity Maternal Care Four “periods of risk” represent potential gaps in maternal and child health systems that lead to fetal-infant mortality

Newborn Care Deaths (Rate) Maternal Care Deaths (Rate) Infant Health Deaths (Rate) grams grams Maternal Health/Prematurity Deaths (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 Risk Analytic Model Age at Death Birth Weight

grams grams BADC Black Distribution and Rates FIM, Newborn Care 25 (1.1) Maternal Health/Prematurity 178 (8.1) Maternal Care 90 (4.1) Infant Health 62 (2.8) 355 total deaths —————————— = 28,160 births + fetal deaths Total FIM Rate= 16.2 per 1,000 Source: CA Birth Cohort File, Fetal (24 Weeks to Birth) Neonatal (Birth to 27 Days) Postneonatal (28 Days to 1 Year)

Newborn Care 281 (1.1) Maternal Care 518 (1.9) Infant Health 288 (1.1) grams grams Source: CA Birth Cohort File, Maternal Health/Prematurity Maternal 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,

BADC Black, All Other FIM Disparities, Newborn Care Black: 1.1 All Other: 1.1 OR = 1.08 (95% CI ) Maternal Care Black: 4.1 All Other: 1.9 OR = 2.12 (95%CI 1.69 – 2.65) Infant Health Black: 2.8 All Other: 1.1 OR = 2.63 (95% CI ) Maternal Health/Prematurity Black: 8.1 All Other: 2.9 OR = 2.84 (95% CI ) Black: 16.2, All Other: 7.0 Total OR = 2.35 (95% CI 2.10 – 2.64)

Newborn Care 3 (1%) Maternal Care 57 (25%) Infant Health 36 (16%) grams grams Fetal (24 Weeks to Birth) Neonatal (Birth to 27 Days) Postneonatal (28 Days to 1 Year) Prematurity/Maternal Health 130 (58%) Total Excess Deaths= 226 Black Preventable Deaths BADC Region, Against U.S. White Comparison Group,

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 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

Source: CA Birth Cohort File, Maternal Health/Prematurity Risk Factors Black Fetal-Infant Mortality Trend PPOR Rate per 1,000

White American Indian African American Asian-Pacific Islander Hispanic Bay Area Population Change,