Boston Births and Infant Deaths, 2000 Barbara Ferrer, PhD, MPH - - PowerPoint PPT Presentation

Boston Births and Infant Deaths, 2000

Barbara Ferrer, PhD, MPH Deputy Director

Boston Public Health Commission

February 26, 2002

Boston Births,1990-2000

8,079 8,017 7,883 7,822 7,717 8,034 8,450 8,808 9,273 9,700 10,332

6,000 7,000 8,000 9,000 10,000 11,000 12,000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Number of Births

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

White 35.2% Black 31.0% Hispanic 21.7% Asian 8.3% Other/Unknown 3.8%

Live Births by Race/Ethnicity of the Mother Boston, 2000

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Percentage of All Births Within Age Group Boston % 10.0% 19.0% 24.9% 28.1% 18.1% MA % 6.6% 14.7% 24.2% 32.9% 21.6% Ages <20 Ages 20-24 Ages 25-29 Ages 30-34 Ages 35+

DATA SOURCE: Boston resident live births and Massachusetts resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Births by Age of Mother Boston and Massachusetts, 2000

Multiple Births as a Percentage of All Births by Race/Ethnicity by Year Boston, 1991-1998

0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

1992 1993 1994 1995 1996 1997 1998 1999 2000

White

0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

1992 1993 1994 1995 1996 1997 1998 1999 2000

Asian

0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

1992 1993 1994 1995 1996 1997 1998 1999 2000

Black

0.0% 1.0% 2.0% 3.0% 4.0% 5.0%

1992 1993 1994 1995 1996 1997 1998 1999 2000

Hispanic

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

PROMISING INDICATORS

0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 Births per 1,000 Females Ages 15-19

White 16.3 18.8 14.2 14.5 11.6 9.5 13.3 10.8 10.2 Black 104.3 101.3 98.3 88.1 75.0 76.8 74.6 63.3 63.7 Hispanic 98.5 99.3 120.1 94.9 92.1 101.1 95.1 78.8 71.6 Asian 18.1 19.2 18.1 19.3 18.2 26.6 9.8 10.1 10.3 Boston 54.9 54.4 53.2 47.4 43.0 44.9 44.3 37.3 35.3 1992 1993 1994 1995 1996 1997 1998 1999 2000

Birth Rates Among Adolescents Ages 15-19 By Year and Race/Ethnicity of the Mother Boston, 1992-2000

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Percentage of All Births Within Race/Ethnicity White 24.4% 17.4% 17.0% 14.6% 14.5% 11.7% 12.0% 9.4% 7.9% Black 13.5% 11.8% 12.5% 9.8% 10.6% 8.9% 8.4% 6.8% 7.3% Hispanic 5.5% 4.5% 5.1% 4.3% 4.7% 5.0% 4.1% 3.9% 3.6% Asian 2.1% 1.1% 1.1% 0.9% 0.5% 1.9% 1.4% 2.1% 1.7% 1992 1993 1994 1995 1996 1997 1998 1999 2000

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Self-Reported Smoking During Pregnancy By Race/Ethnicity of the Mother Boston, 1992-2000

PRENATAL CARE

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% Percentage of Births Within Race/Ethnicity Private 77.9% 37.3% 25.9% 57.3% Public 20.9% 61.9% 72.6% 41.8% Other* 1.2% 0.8% 1.5% 0.9% White Black Hispanic Asian

Source of Payment for Prenatal Care by Race/Ethnicity, Boston, 2000

*Includes self pay, Worker's Compensation, and other unspecified sources of payment DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 95.0% Percentage of All Births Within Race/Ethnicity 1999 89.9% 80.1% 83.5% 85.0% 84.3% 2000 90.0% 77.4% 76.1% 82.9% 83.7% White Black Hispanic Asian BOSTON

Adequate/Adequate Plus Prenatal Care* By Race/Ethnicity, Boston,1999 and 2000

*Kotelchuck Index DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Adjusted Odds Ratio Lower 95% CI Upper 95% CI Race/Ethnicity White

†

1.00 Black 3.53 1.57 7.96 Hispanic 0.78 0.20 2.96 Asian/Pacific Islander and Other 2.85 0.97 8.39 Smoking During Pregnancy No† 1.00 Yes 6.17 3.09 12.35 Method of Payment Private Insurance

†

1.00 Non-Private Insurance 5.07 1.92 13.38

†Reference group DATA SOURCE: Boston resident births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

No Prenatal Care

Adjusted Odds Ratios for No Prenatal Care Boston, 1999

NOTE: The following variables were excluded from the final regression model because they were not significantly associated with the odds of receiving no PNC: mother's marital status, mother's level of education, mother's age,

BIRTHWEIGHT and GESTATIONAL AGE

8.8% 8.8% 8.9% 8.7% 8.8% 9.2% 8.8% 8.5% 9.0% 1.9% 1.9% 1.9% 2.1% 1.9% 2.0% 1.6% 1.9% 2.1% 0.28% 0.24% 0.21% 0.23% 0.17% 0.22% 0.18% 0.24% 0.26% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 1992 1993 1994 1995 1996 1997 1998 1999 2000 Percentage of All Live Births

LBW (<2,500 grams) VLBW (<1,500 grams) ELBW (<500 grams)

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Low, Very Low, and Extremely Low Birthweight Infants As a Percentage of all Births, By Weight and by Year Boston, 1992-2000

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% Percentage of All Births Within Race/Ethnicity 1999 6.2% 12.4% 7.0% 5.5% 2000 6.7% 13.1% 7.9% 6.7% White Black Hispanic Asian

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

LBW by Race/Ethnicity of the Mother Boston, 1999 and 2000

0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% Percentage of All Births Within Race/Ethnicity 1999 1.1% 3.5% 1.1% 1.0% 2000 1.0% 3.9% 1.6% 1.1% White Black Hispanic Asian

DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

VLBW by Race/Ethnicity of the Mother Boston, 1999 and 2000

Adjusted Odds Ratio Lower 95% CI Upper 95% CI Race/Ethnicity White, non-Hispanic † 1.00 Black, non-Hispanic 3.8 2.53 5.84 Hispanic 1.9 0.90 4.03 Asian/Pacific Islander and Other 1.4 0.77 2.68 Plurality Singleton† 1.00 Twins or Higher 12.5 8.41 18.47 Smoking During Pregnancy No† 1.00 Yes 1.89 1.12 3.20 Maternal Birthplace US-Born† 1.00 Foreign-Born ‡ 0.65 0.44 0.96

†Reference group ‡Includes US territories

Adjusted Odds Ratios for Very Low Birthweight Boston, 1999

NOTE: The following variables were included in the original model, but excluded because they did not attain statistical significance: source of payment, adequacy of prenatal care, mother's marital status, mother's level of education, mother's age. DATA SOURCE: Boston resident births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Very low birthweight (<1,500 grams)

8.0% 14.2% 8.9% 7.6% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% White Black Hispanic Asian Percentage of Births Within Race/Ethnicity

Preterm Births by Race/Ethnicity of the Mother

Boston, 2000

Preterm Birth: Less than 37 completed weeks’ gestation DATA SOURCE: Boston resident live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Adjusted Odds Ratio Lower 95% CI Upper 95% CI Race/Ethnicity White, non-Hispanic † 1.00 Black, non-Hispanic 1.77 1.47 2.14 Hispanic 1.13 0.90 1.43 Asian/Pacific Islander and Other 1.11 0.79 1.57 Plurality Singleton † 1.00 Twins or higher 18.84 14.36 24.71 Smoking During Pregnancy No† 1.00 Yes 1.47 1.10 1.95 Prenatal Care Adequate Prenatal Care † 1.00 Intermediate Prenatal Care 0.88 0.71 1.10 Inadequate Prenatal Care 0.86 0.57 1.31 No Prenatal Care 3.64 1.71 7.73 Method of Payment Private Insurance † 1.00 Non-Private Insurance 1.90 1.24 2.92

†Reference group NOTE: The following variables were excluded from the final regression model because they were not significantly accociated witth the odds of preterm birth: mother's marital status, mother's level of education, mother's age, mother's birthplace. DATA SOURCE: Boston resident births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Adjusted Odds Ratios for Preterm Birth Boston, 1999

Preterm Birth (<37 weeks)

INFANT MORTALITY

Boston Infant Mortality Rate, 1990-2000

9.1 10.2 6.7 8.4 8.4 7.4 6.3 6.7 7.3 10.6 9.8 0.0 2.0 4.0 6.0 8.0 10.0 12.0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Deaths per 1,000 Births

DATA SOURCE: Boston resident deaths and live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

8.5 14.2 9.8 4.9 12.2 5.6

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

White Black Hispanic Deaths per 1,000 Births Smoker Nonsmoker

Infant Mortality Rate by Smoking Status and Race/Ethnicity of the Mother

DATA SOURCE: Boston resident linked birth/infant death files, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Boston, 1991-1998

RACE/ETHNICITY BIRTHS DEATHS White 2,837 8 2.8 Black 2,498 34 13.6 Hispanic 1,750 9 5.1 Asian 668 2 ** Other/Unknown 304 1 ** TOTAL 8,057 54 6.7

DATA SOURCE: Boston resident deaths and live births, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

RATE*

Number of Births and Infant Deaths and Infant Mortality Rate by Race/Ethnicity, Boston, 2000

*Deaths per 1,000 live births ** N<5

0.0 5.0 10.0 15.0 20.0 Deaths per 1,000 Births White 5.9 5.9 7.2 4.7 6.7 9.5 4.0 5.6 2.8 Black 19.0 15.0 12.5 11.9 9.9 12.8 12.0 13.1 13.6 Hispanic 4.6 8.9 8.2 3.0 5.2 3.6 4.5 4.1 5.1 1992 1993 1994 1995 1996 1997 1998 1999 2000

NOTE: Because some 1998 death data were reported late, the 1998 IMR for Black infants given in previous presentations has been revised. DATA SOURCE: Boston resident deaths and live births, Massachusetts Department of Public Health. DATA ANALYSIS: Boston Public Health Commission, Research Office

Infant Mortality Rates by Race/Ethnicity Boston, 1992-2000

YEAR BLACK WHITE RATIO 1992 19.0 5.9 3.2 1993 15.0 5.9 2.5 1994 12.5 7.2 1.7 1995 11.9 4.7 2.5 1996 9.9 6.7 1.5 1997 12.8 9.5 1.3 1998 12.0 4.0 3.0 1999 13.1 5.6 2.3 2000 13.6 2.8 4.9

Infant Mortality Rates by Race Boston, 1992-2000

NOTE: Because some 1998 death data were reported late, the 1998 IMR for Black infants given in previous presentations has been revised. DATA SOURCE: Boston resident deaths and live births, Massachusetts Department of Public Health. DATA ANALYSIS: Boston Public Health Commission, Research Office

Birthweight-Specific Mortality by Race/Ethnicity, Boston, 1996-2000

200 400 600 800 1000

White Black Hispanic

White 846.2 260.9 18.2 1.4 Black 851.9 237.1 7.6 2.1 Hispanic 692.0 214.3 8.6 1.0 <500g 500-999g 1,000-2,499g 2,500g+

DATA SOURCE: Boston resident live births and infant deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Cumulative Birthweight Distribution <2,500g Boston, 1996-2000

<500g <750g <1,000g <1,500g <2,000g <2,500g White 0.1% 0.4% 0.6% 1.0% 2.4% 3.9% Black 0.4% 1.3% 2.0% 3.4% 5.8% 8.3% Hispanic 0.2% 0.4% 0.8% 1.5% 3.3% 4.8% Asian 0.1% 0.2% 0.4% 0.7% 2.1% 3.4% Other 0.2% 0.7% 0.8% 1.9% 3.8% 5.7%

DATA SOURCE: Boston resident live birth file, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission, Research Office

Setbacks To Efforts To Improve Outcomes And Eliminate Racial And Ethnic Disparities

• Reduction in federal support of Boston

Healthy Start Initiative

• Cuts in state home-visiting funding for

transitional assistance recipients

• Losses of support for case manage-

ment, AIDS, substance abuse, and tobacco control programs

Action Needed

• Advocacy for restoration of support for women’s

health-related programs

• Heightened efforts to eliminate racial and ethnic

disparities in health

• Existing initiatives

– Health of Women and Infants Working Group

• FIMR

– Boston Healthy Start Initiative – REACH 2000/Women’s Health Demonstration Project – Healthy Baby/Healthy Child