Perinatal Periods of Risk Results 2003-2005

Jacksonville, FL

Thomas Bryant IIIAdministrator/Senior Researcher

Institute for Health, Policy and Evaluation Research

Duval County Health Department

Duval County Overview

Infant Mortality Rates, Florida and Duval County, 2000-2006

7.27.277.57.57.37

9.5

11.610.910.59.6

11.29.7

0

2

4

6

8

10

12

14

2000 2001 2002 2003 2004 2005 2006

Ra

te P

er

1,0

00

Liv

e B

irth

s

Florida Duval

Duval County Overview

• Higher rate than Florida & U.S. – All infant deaths, neonatal deaths,

postneonatal deaths, and SIDS deaths– LBW & VLBW

• Lower rate than Florida & U.S.– Getting prenatal care 1st trimester– Early & adequate prenatal care

Duval County OverviewRisk Factors for Poor Pregnancy Outcomes

by Race, Duval County, 2006

4.6

19.322.1

12.5

16.3

12.1

0

5

10

15

20

25

Births to Mothers whoSmoked During

Pregnancy

Births to Mothers withLess than High School

Education

Preterm Births(<37Weeks Gestation)

Pe

rce

nt

of

To

tal B

irth

s

Black White

Duval County Overview

• Higher rate than Florida & U.S. – Births to adolescent females 15-17 per

1000 females– Repeat births to females 15-19 per 1000

previous teen birth (compared to FL only)– Percent of live births born pre-term

500-

1499g

1500+g

Fetal(24+ Wks

Gestation)Neonatal Postneonatal

Maternal Health/Prematurity

N=150 Rate= 3.84

Maternal Care

N=95 Rate=2.43

Newborn Care

N=46 Rate=1.18

Infant Care

N=107 Rate=2.74

Total Feto-Infant Death Rate = 10.55

Rate = #Deaths/(Live Births + Fetal Deaths) * 1000

Total Live Births + Fetal Deaths = 39,047

Total Infants Deaths = 412

PPOR Results 03-05All Races

PPOR Results 03-05by Race

500-

1499g

1500+g

Fetal(24+ Wks Gestation) Neonatal Postneonatal

Maternal Health/PrematurityBlack N=81, Rate = 6.00 White N=64, Rate = 2.77

RR=2.18 95% CI (1.57, 3.02)

Maternal CareBlack N=49, Rate=3.63

White N=44, Rate=1.90

RR=1.91 95% CI (1.27, 2.88)

Newborn CareBlack N=19, Rate=1.41

White N=23, Rate=1.00

RR=1.42 95% CI (0.77, 2.61)

Infant CareBlack N=40, Rate=2.96

White N=61, Rate=2.64

RR=1.13 95% CI (0.76, 1.68)

Total Feto-Infant Death Rate = 13.99 (Black) 8.31 (White)

Rate = #Deaths/(Live Births + Fetal Deaths) * 1000

Denominators: 13,507 (Black) 23,111 (White)

Internal Reference Group

• 20 years of age or older

• Non-Hispanic white women

• 13 or more years of education

• Used as the standard because they have the best outcomes

500-

1499g

1500+g

Fetal(24+ Wks

Gestation) Neonatal Postneonatal

Maternal Health/PrematurityAll Races: 3.84-2.64=1.20

Black: 6.00-2.64=3.36

White: 2.77-2.64=0.13

Maternal CareAll Races:

2.43-1.57=0.87

Black: 3.63-1.57=2.06

White: 1.90-1.57=0.34

Newborn CareAll Races:

1.18-0.82=0.35

Black: 1.41-0.82=0.58

White: 1.00-0.82=0.17

Infant CareAll Races:

2.74-1.32=1.42

Black: 2.96-1.32=1.64 White: 2.64-1.32=1.32

Total Difference between Ref Group & All Races: 3.84

Total Difference between Ref Group & Blacks: 7.64

Total Difference between Ref Group & Whites: 1.96

Excess Death Rates as Determined by Using Internal Reference Group

Contribution to Mortality Difference

Birth WeightBwt Dist.

MortalityRate

Bwt

Dist.

Mortality

Rate

500-749 0.8% 625.0 0.4% 800.0

750-999 0.6% 255.8 0.2% 83.3

1000-1249 0.7% 163.3 0.2% 133.3

1250-1499 0.9% 114.0 0.3% 166.7

1500-1999 2.6% 68.2 1.4% 63.2

2000-2499 8.0% 27.9 4.3% 23.2

2500+ 86.3% 5.5 93.1% 2.8

Total 100% 17.9 100% 8.5

Black WomenInternal

Reference Group

Contribution to Mortality Difference (continued)

Birth Weight Birth Weight Distribution

Mortality Rate

Combined

500-749 3.3 -1.1 2.3

750-999 0.8 0.7 1.5

1000-1249 0.7 0.1 0.9

1250-1499 0.7 -0.3 0.4

1500-1999 0.8 0.1 0.9

2000-2499 1.0 0.3 1.3

2500+ -0.3 2.5 2.2

Total 6.9 2.4 9.3