Disparities in Perinatal Outcomes

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Disparities in Perinatal Outcomes using PPOR
Regional Results for the Bay Area Data
Collaborative
Janet Brown, MSc
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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
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Nine Bay Area Counties
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Bay Area regional birth data have the statistical
power to analyze racial/ethnic disparities
Distribution of African-American Population in
the Bay Area
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Objectives of Presentation

• Present fetal-infant mortality rates for Bay
  Area counties
• Identify health disparities
• Identify risk factors using Perinatal Periods of
  Risk (PPOR) model

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County and Bay Area Data Collaborative
Fetal-Infant Mortality (FIM) Rates, 1999-2001
Rates per 1,000

Source CA Birth Cohort File, 1999-2001
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BADC Region and County Fetal-Infant Mortality
Rates and 95 Confidence Intervals, 2001
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Racial/Ethnic Disparities Bay Area Data
Collaborative Region
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Fetal-Infant Mortality Rates
18.3
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Per 1,000 fetal deaths births, 1999-2001
16.2
16
14
12
9.1
10
7.7
7.6
7.4
7.3
7.2
6.9
8
6.2
6
4
2
0
Black
White
Hispanic
Asian/PI
All Races
BADC region
Alameda
Source CA Birth Cohort File, 1999-2001
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Parameters
Perinatal Periods of Risk

• Age at death
• Birth weight

Fetal-infant mortality
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Perinatal Periods of Risk
Four periods of risk represent potential gaps
in maternal and child health systems that lead to
fetal-infant mortality
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Perinatal Periods of Risk
Analytic Model
Age at Death



Maternal Health/Prematurity Deaths (Rate)

500-1499 grams
Birth Weight
Newborn Care Deaths (Rate)
Maternal Care Deaths (Rate)
Infant Health Deaths (Rate)
1500 grams
Total Fetal Infant Mortality (FIM) Rate per
1,000
Total Deaths Births Fetal
Deaths
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BADC Black Distribution and Rates FIM, 1999-2001
Maternal Health/Prematurity 178 (8.1)

500-1499 grams
355 total deaths 28,160 births
fetal deaths
Newborn Care 25 (1.1)
Maternal Care 90 (4.1)
Infant Health 62 (2.8)
1500 grams
Total FIM Rate16.2 per 1,000
Source CA Birth Cohort File, 1999-2001
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BADC, All Other, Distribution and Rates FIM,
1999-2001



Maternal Health/Prematurity768 (2.9)

500-1499 grams
1,855 total deaths 266,310 births
fetal deaths
Newborn Care 281 (1.1)
Maternal Care 518 (1.9)
Infant Health 288 (1.1)
Total FIM Rate7.0 per 1,000
1500 grams
Source CA Birth Cohort File, 1999-2001
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BADC Black, All Other FIM Disparities, 1999-2001


Maternal Health/Prematurity Black 8.1 All
Other 2.9 OR 2.84 (95 CI 2.41- 3.34)
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 (95CI 1.69 2.65)
Infant Health Black 2.8All Other 1.1 OR
2.63(95 CI 1.99-3.40)
Black 16.2, All Other 7.0 Total OR 2.35
(95 CI 2.10 2.64)
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Black Preventable Deaths BADC Region, 1999-2001
Against U.S. White Comparison Group, 1998-2000



Prematurity/Maternal Health 130 (58)

Newborn Care 3 (1)
Maternal Care 57 (25)
Infant Health 36 (16)
Total Excess Deaths226
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African American births are 7.5 of the total
births for the Bay Area
Preventable African American fetal-infant deaths
are 1/3 of the excess mortality for the Bay Area
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Maternal Health/Prematurity is our opportunity
to reduce African American fetal and infant
deaths
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Bay Area Data Collaborative

• 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

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Bay Area Data Collaborative

• Successes
• High level of commitment
• Broad vision
• Technical support/capacity building
• Resource efficient time and
• Increased statistical power

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Bay Area Data Collaborative

• Lessons learned
• How to maintain project momentum
• How to support diverse interests
• How to manage different priorities

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Maternal Health/Prematurity Risk Factors Black
Fetal-Infant Mortality Trend1999-2002
PPOR Rate per 1,000
Source CA Birth Cohort File, 1999-2002
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Bay Area Population Change, 1980-2000
American Indian
Asian-Pacific Islander
White
African American
Hispanic
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