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

2. 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

3. Nine Bay Area Counties

4. Distribution of African-American Population in the Bay Area Bay Area regional birth data have the statistical power to analyze racial/ethnic disparities

5.  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

6. Rates per 1,000 Source: CA Birth Cohort File, 1999-2001 County and Bay Area Data Collaborative Fetal-Infant Mortality (FIM) Rates, 1999-2001 *

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

8. Racial/Ethnic Disparities: Bay Area Data Collaborative Region Source: CA Birth Cohort File, 1999-2001 6.2 7.7 18.3 7.2 7.3 9.1 6.9 7.6 16.2 7.4 0 2 4 6 8 10 12 14 16 18 20 BlackWhiteHispanicAsian/PIAll Races BADC regionAlameda Fetal-Infant Mortality Rates Per 1,000 fetal deaths + births, 1999-2001

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

10. 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

11. Newborn Care Deaths (Rate) Maternal Care Deaths (Rate) Infant Health Deaths (Rate) 500-1499 grams 1500+ 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

12. 500-1499 grams 1500+ grams BADC Black Distribution and Rates FIM, 1999-2001 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, 1999-2001 Fetal (24 Weeks to Birth) Neonatal (Birth to 27 Days) Postneonatal (28 Days to 1 Year)

13. Newborn Care 281 (1.1) Maternal Care 518 (1.9) Infant Health 288 (1.1) 500-1499 grams 1500+ grams Source: CA Birth Cohort File, 1999-2001 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, 1999-2001

14. BADC Black, All Other FIM Disparities, 1999-2001 Newborn Care Black: 1.1 All 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: 2.8 All Other: 1.1 OR = 2.63 (95% CI 1.99-3.40) Maternal Health/Prematurity Black: 8.1 All Other: 2.9 OR = 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)

15. Newborn Care 3 (1%) Maternal Care 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 Health 130 (58%) Total Excess Deaths= 226 Black Preventable Deaths BADC Region, 1999-2001 Against U.S. White Comparison Group, 1998-2000

16. 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

17. 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

18.  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

19. Successes  High level of commitment  Broad vision  Technical support/capacity building  Resource efficient: time and $  Increased statistical power Bay Area Data Collaborative

20. Lessons learned  How to maintain project momentum  How to support diverse interests  How to manage different priorities Bay Area Data Collaborative

21. Source: CA Birth Cohort File, 1999-2002 Maternal Health/Prematurity Risk Factors Black Fetal-Infant Mortality Trend 1999-2002 PPOR Rate per 1,000

22. White American Indian African American Asian-Pacific Islander Hispanic Bay Area Population Change, 1980-2000