1. Women’s Healthcare in Georgia
Senate Women's Adequate Healthcare
Study Committee
September 14, 2015
Brenda Fitzgerald, M.D.
Commissioner and State Health Officer
Georgia Department of Public Health

2. # 50 In 2013 Maternal Mortality Georgia Ranks nationally
Georgia continues to rank at the bottom in terms of our overall maternal mortality rate. We are pleased that our legislature has supported our commitment to changing this fact by formally establishing a maternal mortality review committee.
For the past year, this team has met on a quarterly basis to review the cases of these women who died either as part of their pregnancy or within the months following the birth of their babies.
nationally
AWHONN 2013

3. Maternal Mortality
The death of a woman during pregnancy or up to one year after delivery
Pregnancy-related death is a death during or within one year of pregnancy that was caused by a complication of pregnancy
Pregnancy-associated death is the death of a woman from any cause while she is pregnant or within one year of pregnancy

4. Maternal Mortality Case Reviews
122 cases
60 pregnancy-associated deaths
25 pregnancy-related deaths
37 not pregnant
The Maternal Mortality Review Committee started reviewing cases in January, 2013.
Cases reviewed were deaths occurring in 2012.
The committee meets quarterly.
Now summarizing findings and experience for year one of this committee.
In 2014, the committee had its first quarter meeting reviewing the first maternal deaths of 2013.
We are also strengthening the reporting process through improved reporting forms and education to providers on what and how to report.

5. Leading Causes of Pregnancy-Associated Death
Number of deaths

6. Leading Causes of Pregnancy-Related Death
Number of deaths

7. Georgia Infant Mortality 2002-2006
5,743 babies in Georgia died before their first birthday
Georgia’s Infant Mortality Rate was percent higher than national average
All live births grouped by one-mile squares, based on location of mothers’ residency at delivery
Six significantly increased clusters of higher mortality rates identified
The leading causes of death identified by cluster

8. Georgia Infant Mortality Clusters 2002-2006
We wanted to take a more targeted approach to addressing IM
Based on location of mother’s residency at delivery, all live births were grouped by one-mile squares
Six significantly increased clusters of higher mortality rates were identified across the state
The red arrows point to the highest risk areas for infant mortality during the period studied ( )

9. Georgia Infant Mortality Clusters 2002-2006
Atlanta Area
Augusta Area
Columbus Area
Macon
Area
Savannah Area
Valdosta Area
11.8
15.1
15.8
14.7
13.3
17.5
Georgia IMR = 8.4 deaths per 1,000 live births

10. Leading Causes of Infant Death by Cluster
Congenital malformations, chromosomal abnormalities 2 3
Newborn affected by maternal complications of pregnancy
Respiratory distress of newborn 1
Short for gestational age, LBW, not otherwise classified
Sudden infant death syndrome
Top 3 causes of infant death by cluster. In most cases, prematurity/LBW was the number one cause.
All cluster share the following leading causes of death:
Short for gestational age, LBW, not otherwise classified, and
congential malformations, chromosomal abnormalities. 10

11. Infant Mortality Reduction Strategic Plan (2012–2016)
Objective 1: Strengthen the Regional Perinatal System
Objective 2: Develop targeted educational campaigns
Objective 3: Develop external collaborations to support initiatives
RPC standards of care
Tobacco Cessation
Early Elective Deliveries
17-Hydroxy P Registry
Safe Sleep
1115 Waiver Utilization to Improve Birth Spacing & Conception Planning
Fetal/Infant mortality review committee
Breastfeeding and Baby-Friendly Hospitals & Businesses
Maternal mortality review committee
Community-based home visitation programs
LARC Placement
Perinatal Quality Collaborative

12. Obstetric Care Provider Shortage
38 Georgia counties with NO OB services
20 Georgia counties with a deficit of OB services

14. Telehealth Goals Increase access to care
Address Georgia’s health challenges
Infant mortality
Oral health
Obesity and associated diseases
Connect Georgians with specialized care that may not exist in every community, i.e. monitoring of a high-risk pregnancy
Increase capacity at DPH sites statewide

15. GA Early Elective Deliveries
Reduced 39-week elective deliveries
Public and private collaboration
Georgia Hospital Association
March of Dimes
GA OB/GYN Society
GA Chapter of American Academy of
Pediatrics
2009: 65%

16. Georgia Early Elective Deliveries
Quarter
Rate
1Q12
7.83%
2Q12
6.32%
3Q12
5.81%
4Q12
4.60%
1Q13
3.51%
2Q13
3.11%
3Q13
3.35%
4Q13
1.88%*
1Q14
1.05%
2Q14
1.1%
3Q14
1.15%
4Q14
1.11%
* As of October 1, 2013 Medicaid in Georgia no longer pays for early elective deliveries
Source: Georgia Hospital Association

17. Georgia Early Elective Deliveries
2015
% of Hospitals Reporting
January
0.76%
87%
February
0.63%
80%
March
0.44%
84%
April
0.62%
74%
May
0.79%
59%
Georgia has been under the national 2% standard for the past 21 months
Source: Georgia Hospital Association

18. Georgia Infant Mortality Rate America’s Health Rankings
Georgia IMR
U.S. Rank
2012
7.7 44
2013
6.93 34
2014
6.6 31
48% DECREASE SINCE 1990
Source: America’s Health Rankings 2014

19. Cardiovascular Disease in Georgia
Cardiovascular Disease (CVD) includes: heart disease, stroke, hypertension, atherosclerosis, and other diseases of the arteries or heart muscle
Cardiovascular Disease in Georgia
CVD is the leading cause of death
29 women die each day from CVD
4,012 women die annually from heart disease
2,185 women die annually from stroke
Source: BRFSS 2013

20. Cost of Cardiovascular Disease in Georgia
$6.1 billion annually
$4.2 billion for heart disease
Average charge per heart-related hospitalization $45,700
$940 million for strokes
Average charge per stroke-related hospitalization $39,453

21. Obesity in Georgia 3 million Georgians are obese
Georgia's adult obesity rate is 30%, up from 10% in 1990
66% of adults are either overweight or obese
73% males
59% females
Obesity in women has increased 2.2% since 2011

22. Cost of Obesity in Georgia
$2.5 billion annually
Direct healthcare costs
Lost productivity
Disability
Death
Estimated $10.8 billion by 2018 if
obesity rate continues to increase
Average hospital stay for obese
individuals is 60% longer than for
healthy weight individuals

23. Obesity in Georgia Interventions
Promote and adopt healthy eating habits
Increase physical activity
Increase access to healthy food and physical activity in work place
GA Shape
Power Up for 30

24. Diabetes in Georgia
Diagnosed diabetes is 9.7% compared to prevalence of undiagnosed diabetes at 6.5%
Between prevalence of diabetes increased from 6.8% to 9.7%
11.7% of Georgia women are diagnosed with diabetes
Gestational diabetes during pregnancy causes increased blood sugar levels and risk of complication for mother and baby

25. Diabetes in Georgia DISTRICT TOTAL % FEMALE %
7-0 West Central (Columbus)
15.9
20.4
3-3 Clayton (Morrow)
14.5
16.7
9-2 Southeast (Waycross)
13.9
16.2
6-0 East Central (Augusta)
15.1
15.4
9-1 Coastal (Savannah)
11.8
15.2
1-1 Northwest (Rome)
13.5
8-2 Southwest (Albany)
11.6
14.4
3-5 DeKalb
11.0
8-1 South (Valdosta)
13.3
5-1 South Central (Dublin)
9.3
13.2
4-0 La Grange
12.2

26. Cost of Diabetes in Georgia
$5.1 billion annually
$3.3 billion direct medical cost
$1.8 billion loss of productivity and sick days
Does not account for undiagnosed diabetes or those with prediabetes

27. Diabetes in Georgia Interventions
Increase the number of accredited Diabetes Self-Management Education (DSME) sites in the state
Increase the number of telehealth sites offering DSME programs
Educate providers on the importance of referring patients DSME and diabetes prevention programs

28. Tobacco Use in Georgia Women 2011-2013
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

29. Health Effects of Tobacco Use
Early death
Cancer
Women who smoke are 26 times more likely than non-smokers to develop lung cancer
Risk factor for cancer of the cervix, ovary, colon, kidney
Increased risk of heart disease and stroke
Lung Damage
Chronic coughing, wheezing, trouble breathing, and long-term lung disease
Reproductive health problems
Trouble getting pregnant
Bleeding, premature birth, and emergency C-section
Miscarriages, stillbirths, and low birth-weight babies

30. Cost of Tobacco Use in Georgia
$5.0 billion annually
$1.8 billion direct medical cost
$3.2 billion loss of productivity and sick days
Tobacco use is the number one preventable cause of death in Georgia

31. Tobacco Use in Georgia Interventions
Establish smoke free policies and social norms
Promote cessation and assist tobacco users to quit
Prevent initiation of tobacco use
Enacting comprehensive smoke free policies
Fund hard hitting mass-media campaigns
Making cessation services fully accessible to tobacco users

32. Georgia Tobacco Quitline
24 hours a day, 7 days a week
English: STOP ( )
Spanish: NO.FUME ( )
Hearing Impaired, TTY Services:

33. Cancer in Georgia 44,000 new cases annually (all sites) 23,000 men
21,000 women
Breast cancer is the leading cause of cancer in Georgia women
6,410 new cases annually
400 new cases of cervical cancer annually

34. Cancer in Georgia 2014 New Cancer Cases Female Breast 7,050
Lung and Bronchus
3,130
Colon and Rectum
2,080
Uterine
1,200
Melanoma
970
Thyroid
850
Non-Hodgkin Lymphoma
810
Ovary
680
Kidney and Renal Pelvis
620
Pancreas
610
Leukemia
480
Cervical
400
All Sites
23,170

35. % of tumors found at this stage
Localized
Regional
Distant
NH Black
52%
37% 9%
NH White
63%
30% 5%

36. Cancer Cost in Georgia $3.7 billion annually Direct medical costs
$243 million annually
Lost productivity and sick days
More than one million days
15,150 cancer deaths in Georgia annually
8,013 males
7,135 females
2012 BRFSS State Summary

37. Alzheimer’s Disease in Georgia
120,000 Georgians currently with Alzheimer’s disease
160,000 Georgians by 2025 with Alzheimer’s disease
63% of Georgians age 65+ with Alzheimer’s disease are women
Women are twice as likely to develop Alzheimer's as breast cancer
12.6% of Georgia women age 45+ reported increased confusion or memory loss in the past year
25% of women in Georgia are caretakers – of those, half are caring for persons with Alzheimer’s disease or dementia!

38. 2014 Alzheimer’s Disease Facts and Figures
In 2014, the costs of caring for seniors with Alzheimer’s and other dementias will total an estimated $214 billion. Most of that – 70 percent ($150 billion) – will be spent by Medicare and Medicaid.

40. Alzheimer’s Disease and Related Dementias Registry
Goals for Registry
Usable data in the preparation and planning for aging population
Identify epidemiological trends
Bring awareness at state level to issues that affect healthy aging
Inform stakeholders for planning and future implementation needs
Improve urban and rural parity
Benefits of a State Alzheimer’s and Related Dementias Registry
It will provide legislators, State planners and administrators, and members of the private sector with accurate data that will enable informed planning for current and future healthcare and social service needs (e.g. nursing home beds, adult day care, etc.).
It will provide a resource for Georgia researchers to secure National Institute for Health (NIH) funding and establish an environment that will attract clinical trial and biotechnology investments, and create new jobs.
It will serve the people of the State of Georgia by guiding efforts to educate the public on Alzheimer's disease and serve as an information clearinghouse on AD for patients and caregivers.
It will further serve Georgians by supporting cutting edge clinical research and biotechnologies that will offer more effective treatments for dementing diseases.