ALAMEDA COUNTY MATERNAL AND INFANT …ALAMEDA COUNTY MATERNAL AND INFANT HEALTH INDICATORS Alameda County Public Health Department Health Care Services Agency October 2018 Kiko Malin,

ALAMEDA COUNTY MATERNAL AND INFANT HEALTH INDICATORS

Alameda County Public Health DepartmentHealth Care Services Agency

October 2018

Kiko Malin, Jill Miller, Lisa Goldberg and Misha Taherbhai.Alameda County Public Health Department.

Key Questions

1. Who is giving birth in Alameda County?

2. How healthy are moms, newborns, and infants in Alameda County and what health inequities exist?

3. How healthy are young children and women of child bearing age in Alameda County and what inequities exist?

4. How has Alameda County been doing over time and within different communities?

5. How is Alameda County doing compared to Healthy People 2020 (HP2020) and within California?

2

Types of Data Presented3

Count: Number of events or cases at a given point in time.

Counts are used to look at the magnitude of the health event within a population.

22,148

21,414

19,572 19,551

18,000

19,000

20,000

21,000

22,000

23,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Nu

mb

er o

f B

irth

s

In 2016, there were

19,551 births in

Alameda County.


Percentage: Share of events over the population that can be

affected at a given point in time. Percentages are used to compare populations of different sizes for example comparing different

races/ethnicities or age groups.10-19 years 2.1%

20-34 years 69.9%

35-49 years 27.9%

In 2016, 27.9% of births

where to women 35-49

years of age.


Rate: measure of a health event in a specific population over a set time

period.

Rates are used to compare populations of different sizes or over different time periods.

15.315.0

14.8 14.7

14.2 14.3 14.414.5

14.0

13.5

12.712.4

12.612.3

12.512.3

12.1

11

12

13

14

15

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016Bir

th R

ate

(# b

irth

s/1

,00

0 p

op

ula

tio

n)

The Alameda County

birth rate went from

15.3 births per 1,000

population in 2000 to

12.1 in 2016.

Ratio: a relationship between two numbers indicating how many

times the first number contains the second. Ratios are used to show health disparities or to compare outcomes across different groups.

8.6%

5.9% 5.8% 5.8%5.4%

4.8%4.1%

0%

2%

4%

6%

8%

10%

12%

AfricanAmerican

Asian PacificIslander

Multirace All Races Latino White

Perc

enta

ge L

ow

& V

ery

Low

Bir

th

Wei

ghts

(%

)


In 2016, the percentage of low birth weight births among African

Americans was 2.1 times the percentage of low birth weight births

among whites.

Determining Baby’s Race/Ethnicity 7

The Birth Certificate allows mothers to select up to 3 race groups and Latino/Hispanic ethnicity

Mother’s race/ethnicity determines baby’s race/ethnicity.

Race/Ethnicity is mutually exclusive (one category per mother & baby).

Race Categories

African American NH

American Indian NH

Asian NH

Pacific Islander NH

White NH

Multirace NH- More than 1 of the above

Hispanic/Latino Ethnicity-Any Race

Mexican

Chicano

Puerto Rican

Cuban

Central/South American

Declined to State (DTS) Race/Ethnicity

Mother’s Race/Ethnicity not included on baby’s birth certificate

“Refused to State” or “Unknown”

8

▪ Births

▪ Age

▪ Non US–Born Moms

▪ First-Time Moms

▪ Medi-Cal & WIC Births

▪ Recent Data

▪ Trends

▪ Race/Ethnicity

▪ Location/Place

Who is giving birth in Alameda County?

Birth Trend in Alameda County, 2000-2016

Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.

9

22,148

21,414

19,572 19,551

18,000

19,000

20,000

21,000

22,000

23,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Nu

mb

er o

f B

irth

s

Annual Birth Rate Trend in Alameda County, 2000-201610


15.3

15.014.8

14.7

14.2 14.3 14.414.5

14.0

13.5

12.7

12.412.6

12.312.5

12.312.1

11

12

13

14

15

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Bir

th R

ate

(Bir

ths

per

1,0

00

po

pu

lati

on

)

Birth Rate Trend by Race/Ethnicity, 2000-201611


0

2

4

6

8

10

12

14

16

18

20

22

24

2000-02 2002-04 2004-06 2006-08 2008-10 2010-12 2012-14 2014-16

Bir

th r

ate

(Bir

ths

per

1,0

00

po

pu

lati

on

)

PacIsl

Hisp/Lat

Asian

All Races

AfAm/Black

White

Multirace

AmerInd

6,162

5,126

4,513

1,5851,344

618

170 330

1000

2000

3000

4000

5000

6000

Asian Latino White Black/ AfricanAmerican

Other/Unknown Multirace Pacific Islander American Indian

Nu

mb

er o

f B

irth

s

Number of Births by Race/Ethnicity, 201612

Source: CAPE, with data from Alameda County Vital Statistics files, 2016.

19,551 Births

Birth Rate by Race/Ethnicity, 201613


13.913.5 13.4

12.1

9.2 9.0 8.67.9

0

2

4

6

8

10

12

14

16

18

Latino Pacific Islander Asian All Races AfricanAmerican

Multirace White AmericanIndian

Bir

th r

ate

(B

irth

s p

er 1

,00

0 p

op

ula

tio

n)

Birth Rate by City/Place, 2014-201614


6.56.5

7.28.1

10.210.4

10.811.6

11.912.012.112.212.312.3

12.813.0

13.413.6

14.414.915.015.0

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

Piedmont

Sunol

Berkeley

Pleasanton

Remainder of County

Castro Valley

Alameda

Fairview

San Leandro

San Lorenzo

Livermore

Emeryville

Alameda County

Union City

Albany

Fremont

Oakland

Newark

Hayward

Dublin

Ashland

Cherryland

Percentage of Births by Alameda County Hospital, 2008-201615


0%

5%

10%

15%

20%

25%

30%

2008 2009 2010 2011 2012 2013 2014 2015 2016

Perc

enta

ge o

f A

nn

ual

Bir

ths

Alta Bates (Berkeley)

Kaiser Hayward/San Leandro

Washington (Fremont)

Kaiser Oakland

Highland General (Oakland)

ValleyCare (Pleasanton)

St Rose (Hayward)

Eden (Castro Valley)

Home Births

Source: CAPE, with data from Alameda County Vital Statistics files, 2000 and 2016

Percentage of Total Births by Age Category, 2000 & 201616

10-19 years 7.8%

20-34 years 73.4%

35-49 years 18.8%

2000 Births

10-19 years 2.1%

20-34 years 69.9%

35-49 years 27.9%

2016 Births

17.7

12.3

8.3

5.6

4.1

2.8

1.2

0

5

10

15

20

Latino Black/AfricanAmerican

All Races Multirace PacificIslander

White Asian

Teen

Bir

th R

ate

(Bir

ths

per

1,0

00

fem

ales

age

s1

5-1

9 y

ears

)

Teen Birth Rate by Race/Ethnicity, 201617


415 Teen Births

Teen Birth Rate Trend by Race/Ethnicity, 2000-201618


0

10

20

30

40

50

60

70

2000-02 2002-04 2004-06 2006-08 2008-10 2010-12 2012-14 2014-16

Teen

Bir

th R

ate

(Bir

ths

per

1,0

00

fem

ales

age

s 1

5-1

9

year

s)

Hisp/Lat

PacIsl

AfAm/Black

All Races

Multi

White

Asian

19

52.8%

48.2% 47.7%

44.0%40.9%

34.9%

30.3% 30.0%

0%

10%

20%

30%

40%

50%

60%

Multirace White Asian All Races Black/ AfricanAmerican

Latino AmericanIndian

PacificIslander

Perc

enta

ge o

f Fi

rst

Tim

e M

om

s

Percentage of First Child Births (First-time Moms) by Race/Ethnicity, 2016

20


8,594 First Child Births

81.6%

54.5%52.1% 50.0%

20.5%17.7%

11.0%

0%

20%

40%

60%

80%

100%

Asian Latino Pacific Islander All Races White Black Multirace

Perc

enta

ge o

f B

irth

s

Percentage Births to Non US-born Mothers by Race/Ethnicity, 201621


9,777 non US-born Mom Births

Top 5 Countries of Mothers’ Birth, 201622

Asian

Ranking CountryNumber live

births 1 India 1,8182 China 1,277

3 US 1,133

4 Philippines 556

5 Other 343

6 Vietnam 315

Source: Alameda County Vital Statistics files, 2016.

Latino

Ranking CountryNumber live

births 1 US 2,3292 Mexico 1,857

3 El Salvador 333

4 Guatemala 313

5 Other 191

0%

10%

20%

30%

40%

50%

60%

2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16

Perc

enta

ge o

f M

edi-

Cal

Bir

ths

Hisp/Lat

AfAm/Black

AmerInd

PacIsl

All Races

Multirace

Asian

White

Percentage of Medi-Cal Births* by Race/Ethnicity, 2000-2016

23

Source: CAPE, with data from Alameda County Vital Statistics files, 2000-2016.*Medi-Cal births are underestimates due to missing data

2016 Medi-Cal Births Range: 4,890-6,516.

0%

20%

40%

60%

80%

100%

2008 2009 2010 2011 2012 2013 2014 2015 2016

Perc

enta

ge S

har

e o

f M

edi-

Cal

Bir

ths Highland General

(Oakland)

St Rose (Hayward)

Alta Bates (Berkeley)

ValleyCare (Pleasanton)

Eden (Castro Valley)

Washington (Fremont)

Home Births

Kaiser Oakland

Kaiser Hayward/SanLeandro

Percentage Share of Medi-Cal Births* within each Alameda County Hospital, 2008-2016

24


*Medi-Cal births are underestimates due to missing data2016 Medi-Cal Births Range: 4,890-6,516.

Percentage of WIC Participant Births by Race/Ethnicity, 2008-2016

25


0%

10%

20%

30%

40%

50%

60%

70%

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16

Perc

enta

ge o

f W

IC P

arti

cip

ant

Bir

ths

Hisp/Lat

AfAm/Black

AmerInd

PacIsl

All Races

Multirace

Asian

White

26

▪ Prenatal Care

▪ Premature Birth

▪ Low Birth Weight

▪ Infant Deaths

▪ Fetal Deaths

▪ Recent Data

▪ Trends

▪ Race/Ethnicity

▪ Compared to HP2020 & California

How healthy are moms & newborns in Alameda County?

Percentage of Medi-Cal Prenatal Care* by Race/Ethnicity, 2008-2016

27


*Medi-Cal prenatal care visits are underestimates due to missing data.

0%

10%

20%

30%

40%

50%

60%

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16

Perc

enta

ge o

f M

edi-

Cal

Pre

nat

al C

are

Hisp/Lat

AfAm/Black

AmerInd

PacIsl

All Races

Multirace

Asian

White

Percentage of First Trimester Prenatal Care by Race/Ethnicity, 2016

28

17,265 1st Trimester Entry into Prenatal CareSource: CAPE, with data from Alameda County Vital Statistics files, 2016.

76.5%

85.2% 87.2%89.4% 91.5% 91.7% 92.8% 93.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pacific Islander AfricanAmerican/

Black

Latino All Races White Asian Multirace AmericanIndian

Perc

enta

ge o

f 1

st T

rim

este

r P

ren

atal

Car

e

75.7%

67.6%

77.3%

60%

65%

70%

75%

80%

85%

90%

95%

100%

2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16

Perc

enta

ge o

f 1

st T

rim

este

r En

try

into

Pre

nat

al C

are

Asian

White

Multirace

All Races

AmerInd

AfAm/Black

Hisp/Lat

PacIsl

Percentage of First Trimester Prenatal Care Trend by Race/Ethnicity, 2000-2016

29


93.8%92.8%

89.0%88.0%

76.9%

91.9%

88.2%

83.8%

87.9%

77.7%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Asian White Black/African American Hispanic/Latino Pacific Islander

Perc

enta

ge 1

st T

rim

este

r P

ren

atal

Car

eUS born Non-US born

Percentage of First Trimester Prenatal Care by Race/Ethnicity for US versus Non-US Born Mothers, 2012-2016

30


75.4%

69.8% 69.6% 68.8%66.7% 65.7% 65.3%

56.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Asian White All Races Multirace AmericanIndian

AfricanAmerican/

Black

Latino Pacific Islander

Perc

enta

ge A

deq

uat

e/A

deq

uat

e P

us

PN

C

Percentage of Adequate/Adequate Plus Prenatal Care by Race/Ethnicity, 2016

31

13,607 Adequate/Adequate Plus Prenatal CareSource: CAPE, with data from Alameda County Vital Statistics files, 2016.

Percentage of Adequate/Adequate Plus Prenatal Care by Race/Ethnicity, 2008-2016

32


66.1%67.6%

58.9%

40%

50%

60%

70%

80%

90%

100%

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16

Perc

enta

ge A

deq

uat

e/A

deq

uat

e P

lus

Pre

nat

al C

are

Asian

White

Multirace

All Races

AmerInd

AfAm/Black

Hisp/Lat

PacIsl

77.7%

74.5%

65.3%

70.8%

57.9%

80.6%

69.5%

60.6%

67.1%

61.0%

50%

60%

70%

80%

Asian White Black/African American Hispanic/Latino Pacific Islander

Perc

enta

ge A

deq

uat

e P

ren

atal

Car

e US born Non -US born

Percentage of Adequate Prenatal Care by Race/Ethnicity for US versus non-US Born Mothers, 2012-2016

33


8.4% 8.2%

7.1%6.8%

6.6% 6.5%

5.5%

0%

2%

4%

6%

8%

10%

AfricanAmerican/ Black

Multirace Pacific Islander Latino All Races Asian White

Perc

enta

ge P

rete

rm b

irth

(<3

7 w

eeks

ges

tati

on

al a

ge)

Percentage Singleton Premature Births by race/ethnicity, 201634

1.5 times

1,229 Premature BirthsSource: CAPE, with data from Alameda County Vital Statistics files, 2016.

14.0%

9.5%

7.4%

5.2%

0%

2%

4%

6%

8%

10%

12%

14%

2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16

Perc

enta

ge o

f P

rem

atu

re B

irth

s (<

37

wee

ks g

esta

tio

nal

ag

e)

AfAm/Black

Asian

All Races

Multirace

PacIsl

Hisp/Lat

White

Percentage of Singleton Premature Births Trend by Race/Ethnicity, 2000-2016

35


1.8 times

1.9 times

1,229 Singleton Premature Births (2016)

10.6%

7.3% 7.5%7.1%

5.3%

4.1%

6.8%

4.2%

6.6%

7.6%

5.3%

8.6%

0%

2%

4%

6%

8%

10%

12%

Black/AfricanAmerican

MultiRace Asian Hispanic/Latino White Pacific Islander

Perc

enta

ge P

rem

atu

re B

irth

s (%

)US born Non US-born

Percentage Singleton Premature Births by Race/Ethnicity for US versus non US Born Mothers, 2012-2016

36


8.6%

5.9% 5.8% 5.8%5.4%

4.8%

4.1%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Black/ AfricanAmerican

Asian Pacific Islander Multirace All Races Latino White

Perc

enta

ge L

ow

Bir

th W

eigh

t B

irth

s (<

2,5

00

gra

ms)

Percentage Singleton Low Birth Weight (LBW) Births by race/ethnicity, 2016

37

2.1 times

1,027 LBW BirthsSource: CAPE, with data from Alameda County Vital Statistics files, 2016.

10.3%

9.2%

3.6% 3.8%

0%

2%

4%

6%

8%

10%

12%

2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16

Perc

enta

ge o

f Lo

w B

irth

Wei

ght

Bir

ths

(<2

,50

0 g

ram

s)

AfAm/Black

Asian

All Races

Multirace

Hisp/Lat

White

Percentage of Singleton, Low Birth Weight Births Trend by Race/Ethnicity, 2000-2016

38


2.4 times

2.8 times

9.9%

7.0%

5.5%5.0%

3.7%

2.1%

4.9%

6.1%

4.1%4.8%

4.0%

7.0%

0%

2%

4%

6%

8%

10%

12%

Black/AfricanAmerican

Asian MultiRace Hispanic/Latino White Pacific Islander

Perc

enta

ge L

ow

Bir

th W

eigh

t B

irth

s (<

2,5

00

gra

ms)

US born Non-US born

Percentage Singleton Low Birth Weight by Race/Ethnicity for US versus non-US Born Mothers, 2012-2016

39


Number of Infant Deaths in Alameda County, 2000-2016

40


101

132

90

97

109 106

90

105

89

78

94

80

73

86

75 75

67

60

80

100

120

140

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Nu

mb

er o

f In

fan

t D

eath

s

4.9 4.9

4.6

4.94.9

4.8

4.5

4.3 4.3 4.3 4.3

4.2

4.04.1

3.7

3.5

3.7

3.9

4.1

4.3

4.5

4.7

4.9

2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16

Infa

nt

Mo

rtal

ity

Rat

e (

dea

ths

per

1,0

00

live

bir

ths)

Infant Mortality Rate Trend in Alameda County, 2000-2016

41


1.2 decrease (24 fewer deaths)

African American 22.1% (16)

Latino 28.6% (21)

Asian 16.6% (12)

White 18.9% (14)

Multirace 10.6% (8)

Pacific Islander 1.8% (1)

Other/Unknown 1.4% (1)African

American 8.6% (1,679)

Latino 26.8% (5,234

Asian 30.8% (6,006)

White 23.1% (4,503)

Multirace 3.0% (582)

Pacific Islander 1.0%

(192)

Other/Unknown 6.6% (1,320 )

Percentage of Births v. Infant Deaths by Race/Ethnicity, 2014-2016

42

Births=19,517 Infant Deaths= 72


Infant Mortality Rate by Race/Ethnicity, 2014-2016


43

Average Annual Number Infant Deaths = 72

9.5

3.9 3.7

3.0

2.0

0

2

4

6

8

10

African American/Black

Latino All Races White Asian

Infa

nt

Mo

rtal

ity

Rat

e (d

eath

s p

er 1

,00

0 li

ve b

irth

s)3.2 times

10.6

11.7

9.3

10.210.8

12.011.7

9.5

8.17.6

8.9

10.4

11.4 11.6

9.5

0

2

4

6

8

10

12

14

2000-02 2002-04 2004-05 2006-08 2008-10 2010-12 2012-14 2014-16

Infa

nt

Mo

rtal

ity

Rat

e (d

eath

s p

er 1

,00

0 li

ve b

irth

s)

AfAm/Black

Hisp/Lat

All Races

White

Asian

Infant Mortality Rate Trend by Race/Ethnicity, 2000-201644


3.2 times

2.8 times

6.6

2.8 2.51.9

1.3

3.0

1.11.2

1.2

0.7

0

2

4

6

8

10

12

African American/Black

Latino Alameda County White Asian

Infa

nt

Dea

th R

ate

(dea

ths

per

1,0

00

live

bir

ths)

Neonatal Death Rate Post-neomatal Death Rate

Neonatal and Post-Neonatal Infant Mortality Rates by Race/Ethnicity, 2014-2016


45

Neonatal Deaths= 30 per yr; Post-neonatal Deaths=14 per yr.

Leading Causes of Infant Death in Alameda County, 2012-2016

Cause 5-Yr Total Number Percent

All Other Perinatal Conditions 116 30.9%

Congenital Abnormalities 91 24.2%Perinatal Conditions- Short Length of Gestation and Low Birth Weight Disorders 43 11.4%

Neonatal Medical Conditions 35 9.3%

Sudden Infant Death Syndrome (SIDS) 33 8.8%Perinatal Conditions - Maternal Pregnancy, Labor, and Delivery complications 28 7.4%

Infectious Diseases 14 3.7%

All Other Infant Diseases 11 2.9%

Accidents or Assault 5 1.3%Total 376 100%


46

SIDS 17.8%

Neonatal Conditions 4.4%

Perinatal-maternal

pregnancy labor and delivery

complications 6.7%

Perinatal- short gestation and lbw disorders 13.3%

All other perinatal conditions 32.2%

Congenital abnormalities

18.9%

All Other Causes 6.7%

SIDS 5.9% Neonatal Conditions

10.8% Perinatal-maternal

pregnancy labor and delivery

complications 7.7%

Perinatal- short gestation and lbw disorders

10.8%

All other perinatal

conditions 30.4%

Congenital abnormalities

25.9%

All Other Causes 8.4%

Percentage of Infant Deaths by Cause of Death African Americans v. All Other Race/Ethnic Groups, 2012-2016

47

All Other Race/Ethnic Groups* =286 Deaths Black/African Americans= 90 Deaths


*All Other Race/Ethnic Groups include: White, Hispanic/Latino,Multirace, Pacific Islander, and Unknown/Other.

Number of Fetal Deaths in Alameda County, 2008-201648


141

124

116

93

103

115 111

66

106

60

80

100

120

140

2008 2009 2010 2011 2012 2013 2014 2015* 2016

Nu

mb

er o

f Fe

tal D

eath

s

*2015 Fetal Deaths may be underreported.

Fetal Mortality Rate in Alameda County, 2008-2016

49


6.7

6.16.0

4.9

5.3

6.0

5.6

3.4

5.4

2.0

3.0

4.0

5.0

6.0

7.0

2008 2009 2010 2011 2012 2013 2014 2015* 2016

Feta

l Mo

rtal

ity

Rat

e (F

etal

Dea

ths

per

1,0

00

live

b

irth

s +

feta

l dea

ths)

*2015 Fetal Death Rate may be an underestimate.

15.314.7

13.512.6

11.8

10.210.8

0

2

4

6

8

10

12

14

16

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16

Feta

l Mo

rtal

ity

Rat

e (f

etal

dea

ths

per

1,0

00

live

bir

ths

+ fe

tal d

eath

s

AfAm/Black

All Races

Hisp/Lat

Asian

White

Fetal Mortality Rate Trend by Race/Ethnicity, 2009-201650


2.7 times

3.4 times

*2015 Fetal Death Rate may be an underestimate.

Fetal and Infant Mortality Rates by Race/Ethnicity, 2014-2016


51

Fetal Deaths=94; Infant Deaths=72.

10.8

4.8 4.6 4.1 4.1

9.5

3.7 3.93.0

2.0

0

5

10

15

20

African American/ Black All Races Latino White Asian

Infa

nt

and

Fet

al M

ort

alit

y R

ates

Fetal Mortality Rate Infant Mortality Rate

Comparisons: Infant Health Indicators52

Indicator HP2020 California Alameda County AC Ranking

1st Trimester Prenatal Care

77.9% or more

83.3% 89.1% 2/56

Adequate/Adequate Plus Prenatal Care

77.6% or more

77.9% 73.3% 38/56

Breastfeeding Initiation during early postpartum

81.9% or more

93.8% 97.4% 8/56

Exclusive Breastfeeding3 months after delivery

46.2% 29.1% 34.6% ―

Sources: CAPE, with data from Alameda County Vital Statistics files, 2014-2016.Healthy People 2020.California Department of Public Health (CDPH) 2018 County Health Profiles. California Department of Public Health In-Hospital Breastfeeding 2018.Maternal and Infant Health Assessment (MIHA), 2013-2015.

Comparisons: Infant Health Indicators53

Indicator HP2020 California Alameda County AC Ranking

Teen Births ― 17.6/1000 10.2/1000 7/52

Premature Births 11.4% or less 8.5% 6.6%* ―

Low Birth Weight 7.8% or less 6.8% 7.1%* 42/52

Very Low Birth Weight 1.4% or less 1.2% 1.2% ―

Infant Mortality Rate6.0/1000 or

fewer4.6/1000 3.7/1000 ―

Sources: CAPE, with data from Alameda County Vital Statistics files, 2014-2016. Healthy People 2020. California Department of Public Health (CDPH) 2018 County Health Profiles.

*Low Birth Weight and Premature Births in this table are based on all births not just singleton births.

54

▪ SIDS & Safe Sleep

▪ Breastfeeding

▪ Recent Data

▪ Race/Ethnicity

How healthy are infants in Alameda County?

SIDS Deaths in Alameda County

55

Over the last five years, in Alameda County there was an average of 7 SIDS cases per year.


The Percentage of SIDS cases in Alameda County, 2012-2016

5 -Year Total

The trend shows a slight decrease in SIDS rates over time that is not statistically significant (p=0.07)

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

SID

S D

eath

s p

er 1

,00

0 li

ve b

irh

ts

White 15.2%

African American

48.5%

Asian/Pacific …

Latino 9.1%

Multirace 18.2%

2.0

1.5

1.3

1.5

1.71.6

1.9 1.9

0.24 0.22 0.26 0.30 0.29 0.30 0.260.20

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2005-2009 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 2011-2015 2012-2016SID

S M

ort

alit

y R

ate

(SID

S d

eath

s p

er 1

,00

0 b

irth

s)

AfAm/Black

All OtherRaces

SIDS Mortality Rate Trend by Race/Ethnicity, 2005-201656


9.3 times8.5 times

All Other Races: White, Asian, Pacific Islander, Multirace, Latinoand American Indian.

+Higher than County Percentage

- Lower than County Percentage

Percentage Placed Infant on Back to Sleep by Race/Ethnicity, 2013-2015

57

Source: Maternal and Infant Health Assessment (MHIA) Survey 2013-2015.

*

92.6%87.6%

83.4%

77.4%

65.6%

0%

20%

40%

60%

80%

100%

White Asian/ Pacific Islander All Races Latino Black/ African American

Perc

enta

ge P

lace

d In

fan

t o

n B

ack

to S

leep

+

-

48.4%

44.0%

37.5% 37.2%

20.6%

0%

10%

20%

30%

40%

50%

Black/ African American Latino Asian/ Pacific Islander All Races White

Perc

enta

ge In

fan

t A

lway

s o

r O

ften

Sh

ared

Bed

Percentage Infant Always or Often Shared Bed by Race/Ethnicity, 2013-2015

58


-



93.8%

88.0%

84.9%82.8% 82.6%

81.2%80.1%

78.1%

50%

60%

70%

80%

90%

100%

AmericanIndian*

White Multirace PacificIslander*

All Races Asian Latino Black/ AfricanAmerican

Perc

enta

ge E

xclu

sive

ly B

reas

tfed

New

bo

rn in

Ho

spit

al

Percentage of Exclusive Early Breastfeeding by Race/Ethnicity, 2016

Source: California Department of Public Health, In-Hospital Breastfeeding, 2016

59

*Breastfeeding data likely an overestimate.

78.9% 78.4%73.5%

70.3%65.3%

51.0%

28.2%

34.6%31.9%

28.9%

0%

20%

40%

60%

80%

100%

White Asian/ Pacific Islander All Races Latino Black/ African American

Perc

enta

ge B

reas

tfee

din

g 3

Mo

nth

s A

fter

Del

iver

y Any Breastfeeding Exclusive Breastfeeding

Percentage Breastfeeding at 3 Months by Race/Ethnicity, 2013-2015

60


-



Reproductive Life Planning61

▪ Unintended Pregnancies

▪ Postpartum Birth Control Use

▪ Family Planning

▪ Recent Data

▪ Race/Ethnicity

Unintended Pregnancies US

In 2011, 45% (2.8 million/6.1 million) pregnancies in the US each year were unintended.

In 2011, 5% of reproductive-age women had an unintended pregnancy each year.

❑Demographic Disparities Teen Moms (15-17 years) & Young Moms (18-24 years)

Poor Women (<200% Federal Poverty Level)

Less than high school education

Single/Cohabitating Moms

Racial/Ethnic Groups

62

Source: Guttmacher Institute. Unintended Pregnancy in the US, Fact Sheet September 2016. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states

Unintended Pregnancies CA

In 2010, 48% of all pregnancies (393,000) in California were unintended.

CA unintended pregnancy rate in 2010: 50 per 1,000 women aged 15–44 years.

In 2010, 42% of unintended pregnancies in California resulted in births; 45% in abortions; the remainder resulted in miscarriages.

In 2010, federal and state government spent $1.8 billion on unintended pregnancies in CA.

63

Source: Guttmacher Institute. State Facts about Unintended Pregnancy in CA, Fact Sheet August 2017. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california

34.8% 34.0%

24.9%16.8% 18.5%

25.2%

9.9%

12.7%

14.0% 9.9%

0%

20%

40%

60%

80%

Black/ African American Latino All Races White Asian/ Pacific Islander

Perc

enta

ge o

f U

nin

ten

tio

nal

Pre

gnan

cy

Unintended Unsure of Pregnancy Intentions

Percentage Unintentional Pregnancy by Race/Ethnicity, 2013-2015

64


Percentage Postpartum Birth Control Use by Race/Ethnicity, 2013-2015

65


89.8%85.8% 85.1% 84.5%

78.1%

0%

20%

40%

60%

80%

100%

Latino All Races Asian/ Pacific Islander White African American

Perc

enta

ge P

ost

par

tum

Bir

th C

on

tro

l Use

Percentage Births <18 Months apart by Race/Ethnicity, 201566

Source: Family Health Outcomes Project (FHOP) Alameda County Databook 2015.

30.9%

23.1% 22.3%21.3%

20.2%

0%

10%

20%

30%

40%

White All Races African American Asian/ PacificIslander

Latino

Perc

enta

ge b

irth

s <1

8 m

on

ths

Ap

art

Unmet Need for Family Planning Services in CA

In 2014, over 2.6 million CA women aged 13-44 years were in need of publicly funded family planning services.

Publicly funded family planning centers in CA served 1.3 million female clients in 2014.

Publicly funded family planning centers in CA helped avert over 321,000 unintended pregnancies in 2010.

This would have resulted in 156,000 unplanned births and 116,00 abortions.

This saved the state and federal government over $1.79 billion.

67

Source: Guttmacher Institute. State Facts about Unintended Pregnancy in CA, Fact Sheet August 2017. https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california

▪ Teen Birth Rate

▪ Infant Mortality Rate

▪ % Low Birth Weight

MCH Indicators by Social Gradient68

11.712.9

15.2

17.4 17.5

13.8

15.6

13.9

12.1

9.8

0

5

10

15

20

25

<5% 5%-9% 10%-19% 20%-29% >=30%

Bir

th R

ate

(bir

ths

per

1,0

00

po

pu

lati

on

)

Neighborhood Poverty Level

Latino

All Races

White

African American

Asian

Birth Rate by Poverty Level and Race/Ethnicity, 2012-201669


Most Affluent Least Affluent

9.3

19.2

28.4

36.2

6.6

16.7

27.3

30.7

0

10

20

30

40

<10% 10%-19% 20%-29% >=30%

Teen

Bir

th R

ate

(Tee

n B

irth

s p

er 1

,00

0 F

emal

e p

op

15

-19

ye

ars)


African American

Latino

All Races

White

Asian

Teen Birth Rate by Poverty Level and Race/Ethnicity, 2012-201670



5.56.2

13.7

16.3

3.1 3.2

5.3

6.5

0

2

4

6

8

10

12

14

16

<10% FPL 10-19 FPL 20-29 FPL >=30 FPL

Infa

nt

Mo

rtal

ity

Rat

e (D

eath

s p

er 1

,00

0 li

ve b

irth

s)


AfricanAmerican

White

All Races

Latino

Asian

Infant Mortality Rate by Poverty Level and Race/Ethnicity, 2012-201671


3.0 times


Social Gradient Takeaways

1. Race and Class (socioeconomic status) are closely connected

The most affluent neighborhoods have high % of Whites and Asians.

The least affluent neighborhoods have high % of Latinos and African Americans.

2. Birth Rates, Teen Birth Rates, and Infant Mortality are associated with neighborhood poverty.

Poorer neighborhoods have Birth Rates compared to more affluent neighborhoods.

Poorer neighborhoods have Teen Birth Rates compared to more affluent neighborhoods, especially for Latino and African American teens.

Infant Mortality with neighborhood poverty, especially for African Americans

The African American IMR in the poorer neighborhoods is 3X the African American IMR in the most affluent neighborhoods.

72

Social Gradient: Key Takeaways

3. Racial/Ethnic Inequities persist when controlling for neighborhood poverty

African Americans in the most affluent neighborhoods have % of premature babies than Whites, Asians and Latinos in the poorest neighborhoods.

African Americans in the most affluent neighborhoods have % of low birth weight babies than Whites, Asians and Latinos in the poorest neighborhoods.

4. Conclusion: Neighborhood poverty does not fully explain poor infant health outcomes. Racism is an underlying cause of maternal and infant health inequities in Alameda County.

73

RACISM MATTERS, NOT BIOLOGY

Source: Camara Jones, American Journal of Epidemiology, 2001

Impacts of Racism on Health74

Improving African American Birth Outcomes

Supporting and strengthening existing programs specifically serving African-American families Black Infant Health

Healthy Start

Focused attention on improved outreach to the African-American community

Introduction of RBA measures that relate more directly to infant mortality

Department-wide Initiative “Turn the Curve on African American IMR.” Next steps include: Awareness campaign

Implicit bias training with providers

Collaborating with partners on housing/financial security

75

How healthy are young children in Alameda County?76

37.8%

32.6%

18.1% 17.3%

11.6%9.5%

5.2%

2.3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

AmericanIndian*

AfricanAmerican

PacificIslander*

Latino All races Multirace White NH Asian

Ch

ildre

n <

6 y

ears

livi

ng

in p

ove

rty

Children 5 years and under Living in Poverty by Race/Ethnicity, 2016

*Data for American Indians and Pacific Islanders is from 5 year census files- 2012-2016.Source: Cape with data from US Census Bureau American Community Survey, 1 year and 5 year files 2016.

77

7.2 times

55.6%54.0%

37.4% 36.8%

33.0%30.7%

18.4%16.8%

0%

10%

20%

30%

40%

50%

60%

AfricanAmerican

Latino Multirace AmericanIndian*

All races Pacific Islander* White NH Asian

Perc

enta

ge o

f C

hild

ren

<6

on

Pu

blic

Insu

ran

ce

Percentage Children 5 Years and under with Public Health Insurance by Race/Ethnicity, 2016

78

Source: Cape with data from IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.

*Data for American Indians and Pacific Islanders is from 5 year files- 2012-2016.

Percentage Children 5 Years and underby Race/Ethnicity, 2016

79

Source: Cape with data from US Census and IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.


37.8%

32.6%

18.1% 17.3%

11.6%9.5%

5.2%2.3%

36.8%

55.6%

30.7%

54.0%

33.0%

37.4%

18.4%16.8%

0%

10%

20%

30%

40%

50%

60%

AmericanIndian*

AfricanAmerican

PacificIslander*

Latino All races Multirace White NH Asian

Perc

enta

ge o

f C

hild

ren

<6 y

ears

Living in Poverty With Public Health Insurance


102.5

38.934.8

25.1

18.0

0

20

40

60

80

100

120

African American All Races Latino Asian/ PacificIslander

White

Ast

hm

a H

osp

ital

izat

ion

Rat

e (#

h

osp

ital

izat

ion

s/1

0,0

00

po

pu

lati

on

0-4

yea

rs)

Asthma Hospitalizations for Children 0-4 years by Race/Ethnicity, 2013-3Q2015

80

Source: CAPE, with data from OSHPD ED Visits, 2013-3Q2015.

HP2020 Objective: 18.2 or less

1,035 Hospitalizations

539.6

259.0

224.5 221.1

145.4

0

200

400

600

African American All Races White Latino Asian/ Pacific Islander

Un

inte

nti

on

al In

jury

Ho

spit

aliz

atio

n R

ate

(#

ho

spit

aliz

atio

ns/

10

0,0

00

po

pu

lati

on

0-4

yea

rs)

Unintentional Injury Hospitalizations for Children 0-4 years by Race/Ethnicity, 2013-2015

81

Source: CAPE, with data from OSHPD Hospitalizations, 2013-3Q2015.

689 Hospitalizations

How healthy are women of child bearing age (15-44 years) in Alameda County?

82

31.6%

19.9%

17.2%

14.5%13.5%

12.2%

9.1% 8.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

AfricanAmerican

AmericanIndian*

PacificIslander*

Latino Multirace All races Asian White NH

Perc

enta

ge w

om

en 1

5-4

4 y

rs li

vin

g in

po

vert

y

Women Living in Poverty by Race/Ethnicity, 201683

3.6 times

*Data for American Indians and Pacific Islanders is from 5 year census files- 2012-2016.Source: Cape with data from US Census Bureau American Community Survey, 1 year and 5 year files 2016.

Percentage Women Uninsured and with Public Health Insurance by Race/Ethnicity, 2016

84

Source: Cape with data from IPUMS USA Integrated files, 1 year file 2016 and 5 year file 2012-2016.

*Data for American Indians, Pacific Islanders, and Multirace is from 5 year files- 2012-2016.

37.9%

29.2%

20.4%

17.2%

12.2%14.0% 13.4%

9.1%7.5%

11.2%

5.5%

31.0%

11.9%

3.6%2.4%

9.5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

AfricanAmerican

Latino All races AmericanIndian*

PacificIslander*

Asian White NH Multirace*

Perc

enta

ge o

f W

om

en 1

8-4

4 y

ears

With Public Health Insurance Uninsured

Percentage Women 15-44 yearsby Race/Ethnicity, 2016

85


*Data for American Indians, Pacific Islanders, and Multirace is from 5 year files- 2012-2016.

31.6%

19.9%17.2%

14.5%12.2%

13.5%

8.7% 9.1%

37.9%

17.2%

12.20%

29.2%

20.4%

9.1%

13.4% 14.0%

0%

10%

20%

30%

40%

50%

AfricanAmerican

AmericanIndian*

Pacific Islander* Latino All races Multirace* White NH Asian

Perc

enta

ge W

om

en 1

5-4

4 y

ears

Living in Poverty With Public Health Insurance

18.9%

11.1%

8.9%7.5% 6.9%

4.2%3.3% 2.9%

0%

5%

10%

15%

20%

25%

30%

Latino AmericanIndian*

AfricanAmerican

All races PacificIslander*

Multirace* Asian White

Perc

enta

ge W

om

en 1

8-4

4 y

ears

wit

h le

ss t

han

HS

Edu

cati

on

Women with Less than High School Education by Race/Ethnicity, 2016

86

6.5 times



Percentage Overweight/Obese Women, 2012-2016

87

Source: Cape with data from California Health Interview Survey (CHIS) pooled data 2012-2016.

73.4%

60.6% 59.4%

48.1%

36.3%

29.6%

0%

20%

40%

60%

80%

Latino African American Multirace All Races White Asian

Perc

enta

ge W

om

en O

verw

eigh

t/O

bes

e (B

MI ≥

25

.0)

Key Takeaways

1. Who is giving birth in Alameda County( AC)?

There has been a in AC births since 2000. (Ave. 19,500 births per year since 2012.)

Asians and Latinos have the largest # of births. Latinos have the highest birth rate.

AC has seen a dramatic in teen moms (15-19 years) and an in mature moms (35-44 years).

AC has large % of non US-born moms (Asian, Latino).

88

Key Takeaways

2. How healthy are moms, newborns, and infants in Alameda County?

Overall, AC moms, newborns and infants are very healthy!

AC has high % of moms receiving prenatal care and breastfeeding. (Pacific Islanders inequities persist.)

AC has seen a in preterm births over time.

Other AC indicators have remained steady. Likely due to persistent African American inequities.

Differences exist between US and non-US born Black and Pacific Islander mothers.

◼ Non-US born Black mothers have lower % low birth weight and preterm births. Yet, Non-US born Black mothers have lower % of early and adequate prenatal care.

◼ Non-US born Pacific Islander mothers have higher % low birth weight and preterm births and similar rates of PNC.

89

Key Takeaways

SIDS, Safe Sleep Practices and Breastfeeding

African Americans disproportionately affected by SIDS deaths.

Majority of AC moms engage in safe sleep behaviors and many breastfeed infants. African American inequities persist.

Reproductive Planning

About 1/3 of pregnancies were unintended or unsure with % among African Americans and Latinos.

Majority of AC moms use birth control postpartum. However, substantial unmet need for family planning services in Alameda County (50%).

Fetal and Infant Mortality

AC has seen a in infant mortality over time. The fetal death trend is unclear due to underreporting in 2015.

African American Fetal and Infant Mortality is much higher than all other race/ethnic groups in AC.

Infant Mortality with neighborhood poverty, especially for African Americans.

Racism is an underlying cause of maternal and infant health inequities in Alameda County.

90

Key Takeaways

3. How healthy are young children and women 18-44 years in Alameda County?

Most young children are women of childbearing age are very healthy.

Racial/ethnic inequities exist in key SES indicators: poverty rates, health insurance, injury and high school completion.

African American, Latino, and American Indian young children and women are most affected.

4. How has Alameda County been doing over time and within different communities?

High neighborhood poverty is associated with poor mom and infant health outcomes.

Life course approaches are needed.

MPCAH has targeted programs to improve African American mother, infant and child outcomes.

5. How is Alameda County doing compared to Healthy People 2020, within California?

AC does very well compared to other counties on key birth and family planning indicators.

91

EVERYONE in Alameda County –no matter who you are,

where you live, how much money you make,or the color of your skin –

can lead a healthy, fulfilling and productive life.

Our Vision of Health Equity92

93

For Additional Alameda County Maternal, Child, and Adolescent Health Indicators:www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx

Lisa Goldberg, MPCAH Epidemiologist, Alameda County Public Health Department.Contact by phone at 510-267-8024 or by email: [email protected]

Kiko Malin, Director, Family Health Services Division, Alameda County Public Health Department.Contact by phone at 510-267-5979 or by email: [email protected]

http://www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx

http://www.acphd.org/data-reports/reports-by-topic/maternal,-child,-and-adolescent-health.aspx

mailto:[email protected]

mailto:[email protected]

Documents

ALAMEDA COUNTY MATERNAL AND INFANT …ALAMEDA COUNTY MATERNAL AND INFANT HEALTH INDICATORS Alameda County Public Health Department Health Care Services Agency October 2018 Kiko Malin,