Infant Mortality July 27, 2012 Shannon Walker Community Health - - PowerPoint PPT Presentation
Strategies to address South LA Infant Mortality July 27, 2012 Shannon Walker Community Health Councils Objectives Understanding the Problem Breakdown of SPA 6 Infant Mortality PPOR analysis Risk factors and demographics
July 27, 2012 Shannon Walker Community Health Councils
▫ PPOR analysis ▫ Risk factors and demographics ▫ Focus Group Results
▫ MLK recommendations ▫ Prevention strategies
“The Perinatal Periods of Risk (PPOR) approach is a new analytic framework that enables urban communities to better understand and address fetal and infant mortality…[and] translate data into strategic action.”
Source: Peck 2010
Infant Fetal Neonatal Postneonatal
Source: Dr Chao, LA County Public Health
Fetal Neonatal Post- Neonatal <1500 grams 1500+ grams
Birthweight
Age at Death
Source: Dr Chao, LA County Public Health
When excess deaths are calculated for SPA 6, Infant Health and Maternal Health are found to hold the greatest disparities
Source: Dr Chao, LA County Public Health
PPOR Focus Area
Potential Community Interventions
Maternal Health/Prematurity
Preconceptual Health Health Behaviors Perinatal Care Maternal Care
Prenatal Care Referral System High Risk OB Care Newborn Care
Perinatal Management Perinatal System Pediatric Surgery Infant Health
Sleep Position Breast-Feeding Injury Prevention
Source: Dr Chao, LA County Public Health
2 4 6 8 10 12 14 Antelope Valley East Metro San Fernando San Gabriel South South Bay West Average Rate, %
Preterm births
Antelope Valley East Metro San Fernando San Gabriel South South Bay West Average
Source: LA County Perinatal Indicator Factsheet (2007 Data)
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 Rate, %
Very Low Birthweight
5 5.2 5.4 5.6 5.8 6 6.2 6.4 6.6 Rate, %
Low Birthweight
Source: LA County Perinatal Indicator Factsheet (2007 Data)
5 10 15 20 25 % Late Entry Into Prenatal Care % Inad. Prenatal Care Rate, % California Los Angeles LA - SPA 6
Source: LA County Perinatal Indicator Factsheet (2007 Data)
Late entry into prenatal care does not correlate with poor birth outcomes unless there is NO prenatal care
Source: LA County Title V Perinatal Indicators, “Prenatal Care,” 2009
2 4 6 8 10 12 14 16 18 Percent of live births to women under age 20 Location
Percent of babies born to Teen Moms
Southwest Southeast South Compton SPA 6 California United States 10 20 30 40 50 60 70 80 Teen Birth Rate, %
Rate of birth to teens aged 15- 19
Antelope Valley East Metro San Fernando San Gabriel South South Bay West LA County
Source: LA County Dept Public Health – Key Indicators of Health by SPA (2009) Source: California Dept of Public Health (2010), and CDC National Vital Statistics
2 4 6 8 10 12 14 16 18 20 Smoked in 6 months before pregnancy Smoked during pregnancy Exposure to 2nd hand smoke during pregnancy Percent of mothers
Smoking Prevalence in Adults
Los Angeles White Latina Black Asian SPA 6
Source: 2007 LA County Health Survey…LAMB?
0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% Compton South Southeast Southwest Los Angeles Percent of Children (age 0-5yrs) Location
Percent of children whose moms were advised about dangers of environmental tobacco smoking
Source: 2007 LA County Health Survey
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% California Los Angeles SPA 6 Other (non-Hispanic) Asian/Pacific Islander (non- Hispanic) Black (non-Hispanic) White (non-Hispanic) % Hispanic
Source: IPODR 2008
Applications:
asthma, illegal drug use, STDs, babies sleeping on stomachs (SIDS)
have insurance; Foreign-born have better health, birth
Infant and Fetal Mortality Rates* SPA 6 vs. Countywide 2001-2009
10.4 10.3 10.3 9.6 10.2 9.8 10.3 9.9 9.6
13.1 12.2 12.2 11.8 12.2 11.5 12.5 12.4 12.1
23.1 21.3 23.5 22.0 20.8 19.6 22.1 22.2 20.6
5 10 15 20 25 2001 2002 2003 2004 2005 2006 2007 2008 2009 Countywide SPA 6 SPA 6 African American
Infant & fetal Death per 1,000 live births plus fetal deaths *2001-2009 vital statistics files
Source: Dr Chao, LA County Public Health
Source: LA County Dept Public Health – Key Indicators of Health by SPA (2009)
indicators:
▫ Most Poverty ▫ Least education ▫ Most unemployment ▫ Most unsafe neighborhood
indicators:
▫ Obesity ▫ Hypertension ▫ Mental Illness ▫ Also high rates of: asthma, cancer, high cholesterol
Source: LA County Dept Public Health – Key Indicators of Health by SPA (2009)
▫ Interconception Health (T.H.E. Clinic, BBC) ▫ Progesterone Treatments during prenatal care ▫ Implementation of pre-conception guidelines ▫ Peer pre-conception counselors ▫ School-based pre-preconception efforts
▫ NICU (mixed feedback) ▫ Transportation coordination and education ▫ Wellness Center / Centering Pregnancy ▫ Midwifery program? ▫ Community Festival?
▫ Expanding Data-Driven Interconception Care Plan ▫ Implementing Preconception Care Guidelines
▫ Better coverage for preconception women ▫ Lowering costs of progesterone treatments ▫ More provider incentives for preconception care visits