1 perinatal periods of risk approach: tarrant county experience anita k. kurian, mbbs, drph division...
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Perinatal Periods of Risk Approach:Tarrant County Experience
Anita K. Kurian, MBBS, DrPHDivision Manager & Chief Epidemiologist
Tarrant County Public Health
ChairpersonResearch & Oversight Committee
Tarrant County Infant Mortality NetworkFort Worth, TX
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Tarrant CountyThe perfect mix of Cowboys and Culture!
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Infant Mortality RatesTarrant County, 1994-2004
Whites Blacks Hispanics All Races
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Infant Mortality Rate
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Infant Mortality Network, Tarrant County
Has been in place for 6 years Collaborative effort
- Tarrant County Public Health
- City of Fort Worth Health Department
- Catholic Charities
- Local Hospitals
- School Districts
- Local Universities
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Data Source
From Tx DSHS…… Live Birth file (500+gms) Infant Death file (500+gms) Linked Infant birth file Fetal death file (24+wks, 500+gms)
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PPOR Phase I
In 2006 with 2001-2003 data Used the birth Cohort file Live births – 80,566; Infant deaths – 421;
Fetal deaths - 219 Data imputations performed for the missing
values using the algorithm based on gestational age
17.4% of infant deaths with unknown birth weights 10% of fetal deaths with unknown birth weights
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*Feto-infant mortality per 1,000 live births & fetal deaths
Infant Health1.7
Newborn Care1.4
Maternal Care1.7
Maternal Health/Prematurity3.1
FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC GROUPS: 2001-2003
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FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC GROUPS: 2001-2003
1.41.31.52.7
1.51.31.52.5
1.71.41.73.1
*Infant Health
*Newborn Care
*Maternal Care
*Maternal Health/ Prematurity
Hispanics
3.62.12.26.0African-Americans
Whites
Tarrant County
Infant Health
Newborn Care
Maternal Care
Maternal
Health/ Prematurity
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Using Reference Group to Calculate Excess Feto-infant Mortality
GroupMaternal Health/
Prematurity
Maternal Care
Newborn Care
Infant Health
Tarrant County 3.1 1.7 1.4 1.7
Excess Rates (Internal) 1.5 0.4 (-0.5) 0.9
Excess Rates (External) 0.9 0.2 0.4 0.5
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GroupMaternal Health/
Prematurity
Maternal Care
Newborn Care
Infant Health
Tarrant County 3.1 1.7 1.4 1.7
White 2.5 1.5 1.3 1.5
African-American 6.0 2.2 2.1 3.6
Hispanic 2.7 1.5 1.3 1.4
Excess Rates: (External Ref group) Tarrant County
0.9 0.2 0.4 0.5
White 0.3 0.0 0.3 0.3
African-American 3.8 0.7 1.1 2.4
Hispanic 0.5 0.0 0.3 0.2
Excess Deaths: Tarrant County
72 16 32 42
White 16 0 11 11
African-American 44 8 13 26
Hispanic 14 0 8 5
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Response to Phase I
Infant mortality summit and meetings
Preconception Health Initiatives WIC – Healthy Kids Need
Healthy Moms
County Hospital District – revised case management protocols
Outreach Programs – Women’s Health Program
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Call to Action
Fetal & infant mortality reviews (FIMR)
Conduct PPOR Phase II analyses
Response to Phase I (cont’d)
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PPOR - Phase II
Target Population: African-Americans
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2001-2003 data Live births – 11,550 Infant deaths - 149 Fetal deaths (24+ weeks) - 60
Data imputations performed for the missing values
17.4% of infant deaths with unknown birth weights
10% of fetal deaths with unknown birth weights
Kitagawa analysis was performed
PPOR – Phase II analyses
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Birthweight-Specific Components For The Absolute Difference In Overall FIMRs Among African-Americans,
Tarrant County, 2001-2003
Birth weight (in grams)
Actual Contribution to Excess Mortality Rates
Birth weightdistribution
FIMR Total
500-749 2.9 -0.6 2.3
750-999 0.8 -0.1 0.7
1,000-1,249 0.5 0.0 0.5
1,250-1,499 0.3 0.2 0.5
Total 4.5 -0.5 4.0
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Study Objective
To identify racial/ethnic differences in risk
factors for VLBW babies in Tarrant County
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Cross-sectional analysis of birth data for Tarrant County – 2001-2004
Outcome of interest - VLBW (yes, no) Risk factors examined –
Plurality (single, multiple) smoking (yes, no) Kotelchuck Index of prenatal care (adequate plus, adequate,
intermediate and inadequate) maternal education (< high school, high school, > high
school) previous preterm birth (yes, no) STD (yes, no) alcohol use (yes, no) pregnancy weight gain (<15 lbs, 15-40 lbs, >40 lbs) maternal age (<20 years, 20-39 years, >=40 years).
Methods
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Adjusted Odds Ratio of characteristics associated with VLBW
OR 95% CI OR 95% CI OR 95% CI
<20 years old 1.14 0.80, 1.62 0.99 0.73, 1.35 1.56* * 1.20, 2.02
20-39 years old
>=40 years old 1.14 0.68, 1.91 0.83 0.36, 1.93 1.69 0.88, 3.26
Single
Multiple 12.97* * * 10.42, 16.15 6.6* * * 4.96, 8.77 10.18* * * 7.61, 13.61
Yes 3.36* 1.32, 8.59 0.55 0.12, 1.47 3.51* 1.19, 10.39
No
Yes 0.33* 0.12, 0.91 0.73 0.40, 1.32 0.41* 0.19, 0.89
No
Yes 0.51* 0.27, 0.96 0.65 0.42, 1.00 0.86 0.45, 1.63
No
Yes 1.52 0.66, 3.48 2.67* 1.10, 6.51 0.82 0.11, 6.36
No
< 15 lbs 2.97* * * 2.32, 3.80 3.21* * * 2.48, 4.15 3.36* * * 2.64, 4.29
15-40 lbs
>40 lbs 0.55* * * 0.43, 0.70 0.99 0.77, 1.28 1.25 0.97, 1.62
Inadequate 8.33* * * 6.23, 11.12 3.96* * * 2.90, 5.41 2.23* * * 2.12, 3.77
Intermediate 5.52* * * 3.98, 7.65 3.13* * * 2.17, 4.52 2.76* * * 1.95, 3.89
Adequate
Adequate Plus 2.80* * * 2.14, 3.65 3.73* * * 2.78, 5.02 2.66* * * 1.99, 3.56*< 0.05, **<0.01, ***<0.001
REFERENCE GROUP REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP
Alcohol Use
Pregnancy Weight Gain
Kotelchuck Index
REFERENCE GROUP
REFERENCE GROUP
REFERENCE GROUP
REFERENCE GROUP
REFERENCE GROUP
REFERENCE GROUP
REFERENCE GROUP REFERENCE GROUP REFERENCE GROUP
Maternal Age
Pluality
Previous Preterm Birth
Pregnancy Anemia
STD
White Black Hispanic
n = 48,232 n = 15,332 n = 38,197
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“Babies Want to LIVE in Tarrant County” campaign
5 Ps for a healthy pregnancy
PREPARE your body by making healthy choices before you get pregnant.
PLAN to see a doctor right away and take prenatal vitamins.
PASS on smoking, drugs and alcohol. PROTECT your baby from environmental
risks and medications that could be dangerous.
PARTICIPATE in local resources for affordable healthcare if you don’t have insurance.
Our Response
http://www.babieswanttolive. org/default.html
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Thanks for Listening