1. 1 Perinatal Periods of Risk Approach: Tarrant County Experience Anita K. Kurian, MBBS, DrPH Division Manager & Chief Epidemiologist Tarrant County Public Health Chairperson Research & Oversight Committee Tarrant County Infant Mortality Network Fort Worth, TX

2. 2 Tarrant County The perfect mix of Cowboys and Culture!

3. 3 Infant Mortality Rates Tarrant County, 1994-2004

4. 4 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

5. 5 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)

6. 6 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

7. 7 *Feto-infant mortality per 1,000 live births & fetal deaths Infant Health 1.7 Newborn Care 1.4 Maternal Care 1.7 Maternal Health/Prematurity 3.1 FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC GROUPS: 2001-2003

8. 8 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 3.6 2.1 2.2 6.0 African-Americans Whites Tarrant County Infant Health Newborn Care Maternal Care Maternal Health/Prematurity

9. 9 Using Reference Group to Calculate Excess Feto-infant Mortality Group Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Tarrant County 3.11.71.41.7 Excess Rates (Internal) 1.50.4(-0.5)0.9 Excess Rates (External) 0.90.20.40.5

10. 10 Group Maternal Health/ Prematurity Maternal Care Newborn Care Infant Health Tarrant County3.11.71.41.7 White2.51.51.31.5 African-American6.02.22.13.6 Hispanic2.71.51.31.4 Excess Rates: (External Ref group) Tarrant County 0.90.20.40.5 White0.30.00.3 African-American3.80.71.12.4 Hispanic0.50.00.30.2 Excess Deaths: Tarrant County 72163242 White16011 African-American4481326 Hispanic14085

11. 11 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

12. 12  Call to Action  Fetal & infant mortality reviews (FIMR)  Conduct PPOR Phase II analyses Response to Phase I (cont’d)

13. 13 PPOR - Phase II Target Population: African-Americans

14. 14  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

15. 15 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 weight distribution FIMRTotal 500-7492.9-0.62.3 750-9990.8-0.10.7 1,000-1,2490.50.00.5 1,250-1,4990.30.20.5 Total4.5-0.54.0

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17. 17 Study Objective To identify racial/ethnic differences in risk factors for VLBW babies in Tarrant County

18. 18  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)  previous preterm birth (yes, no)  STD (yes, no)  alcohol use (yes, no)  pregnancy weight gain ( 40 lbs)  maternal age ( =40 years). Methods

19. 19 Adjusted Odds Ratio of characteristics associated with VLBW

20. 20  “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

21. 21  Honey Child Program - Our Response (cont’d)

22. 22 Thanks for Listening