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Deborah Campbell, MD, FAAP Division of Neonatology June 15, 2007

Bronx Center to Reduce and Eliminate Ethnic and Racial Health Disparities Impact of Perinatal Health Issues on Infant Mortality and Morbidity in the Bronx. Deborah Campbell, MD, FAAP Division of Neonatology June 15, 2007. Faculty Disclosure Form.

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Deborah Campbell, MD, FAAP Division of Neonatology June 15, 2007

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  1. Bronx Center to Reduce and Eliminate Ethnic and Racial Health DisparitiesImpact of Perinatal Health Issues on Infant Mortality and Morbidity in the Bronx Deborah Campbell, MD, FAAP Division of Neonatology June 15, 2007

  2. Faculty Disclosure Form In the past 12 months, I have not had any significant financial interest or relationship with the manufacturers of the products or providers of the services that will be discussed in my presentation. This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA.

  3. Bronx Health Center and Community Districts

  4. Overview Perinatal Health in the Bronx • Rates for infant and maternal mortality, low birth weight, teen pregnancy, late or no prenatal care exceed city, state and US averages • Large racial disparities for black and Hispanic women and infants

  5. Overview of Bronx Perinatal Health • Highest IMR are in Morrisania, Williamsbridge and East Tremont sections of the Bronx • > 10% infants are born LBW • 12% of Bronx births are to teen mothers • Mott Haven, Hunts Point, East Tremont, Morrisania • ~ 66% Bronx births are to women on MA – NYS rate is 20% • Mott haven, Hunts Point, Unionport/Soundview, Concourse/Highbridge, Fordham, Williamsbridge • 25% pregnant women have late/no PNC • Additional 41% inadequate PNC • Fordham, Bronx Park, Central Bronx, Highbridge, Morrisania, Mott Haven and Hunts Point

  6. Overview of Bronx Perinatal Health • > 50% delivering women in the Bronx are immigrants • Primarily from Latin America • > 50% Spanish speaking • Highest rates of asthma in NYC • Breastfeeding rates

  7. Live Births, Induced Terminations and Spontaneous Terminations

  8. Live Births, Induced Terminations and Spontaneous Terminations, NYC 1986-2005

  9. 2005 Live Births, Spontaneous and Induced Terminations of Pregnancy

  10. Live Births, Induced TerminationsNYC, 2005

  11. Live Births by Maternal Ethnicity

  12. Live Births by Race/Ethnicity & Borough 2005

  13. Bronx Live Births 2005: 20,766

  14. NYC Live Birth Characteristics

  15. Distribution of Births By Gestational Age

  16. NYC - 122,725 LB Puerto Rican 9922 Dominican 9907 Mexican 7986 African-Am. 16448 Chinese 7426 Jewish/Hebrew 7632 Other Hispanic 6769 Bronx – 20,766 LB Puerto Rican 1337 Dominican 4052 Mexican 1754 African-Am. 4005 Jamaican 745 Other Hispanic 1132 Ancestry of Mother in 2005

  17. Teen Childbearing • Preliminary data for 2005 • Decline in birth rate by 2% to 40.4/1000 women 15-19 yrs. • Greatest decline among 15-17 yr olds. to 21.4/1000 • Rate for 18-19 yr olds. stable at 69.9/1000 • Rate for 10-14 yr olds. unchanged: 0.7/1000 • 3% decline for non-Hispanic white and non-Hispanic black teens 15-19 yrs old, between 2004-2005 • 6% for non-Hispanic black teens 15-17 yrs old

  18. Teen Birth Rate for 15-19 year olds: 1991 v. 2005

  19. Teen Live Births: 2003-2005 US rate for 2004: 10.3% 2005 rate for 15-19 y/o: 40.4

  20. Infant, Neonatal and Post-Neonatal Mortality Rates, NYC 1988-2005

  21. Citywide Infant Mortality • 2005 • 6.0/1000 LB v. 6.8/1000 LB for the entire US • Decline in births by 1.1 % from 2004 • Decline in infant mortality by 3.8% • Since 1990 there has been a 48% decrease in NYC’s IMR • Infant mortality is influenced by multiple factors • Maternal health, SES over the perinatal care continuum, substance use, access to and utilization of quality service, levels of stress and social support • Knowledge about safe sleep position and other risk factors for SIDS

  22. 2005 IMR by Borough

  23. Infant Mortality Rate by Borough: NYC, 1994-2004

  24. Infant Mortality Rate/1000 LB: Bronx Health Districts 2001-2005

  25. 2005 Infant Mortality Rate by Ethnicity

  26. Trends in Infant Mortality Rate by Race/Ethnicity: NYC, 1994-2004

  27. Distribution of Deaths: Fetal-Neonatal-Infant Mortality Non-Hispanic Black 13.6 Non-Hispanic white 5.7 Hispanic 5.65 US: 6.79 4.52 2.27

  28. Components of Perinatal Period of Risk

  29. The Role of Maternal Morbidity and Mortality

  30. Maternal Mortality Ratios for White Women:1987-1996 Note: The colors on these maps show the states divided into three terciles based on their MMR.

  31. A Regional Look at Maternal Mortality Ratios* for the Year 2000 12.9 in NYS 15.9 in NYS 23.1 in NYC 23.1 in NYC *Per 100,000 live births

  32. Findings of the SMICauses of Death (n=33) August 2003 – June 2005 • Embolism 24.2% • PIH 24.2 % • Hemorrhage 15.2 % • Infection 15.2 % • Cardiomyopathy 6.1 % • Anesthesia None • Other/Unknown 15.2 %

  33. SMI: A Look at Chronic Disease • 54% of the pregnancy-related deaths had a history of chronic disease • Hypertension • Cardiac Disease • DVT • Diabetes • Scleroderma • Sickle Cell Disease • Obesity was the most commonly identified (66%)

  34. Trends in Maternal Mortality Ratio by Race/Ethnicity: NYC OVS, 1993-2004 Source: NYC DOHMH Office of Vital Statistics Standard surveillance

  35. New York City Initiative • Leadership – Gina Brown, MD • Multi-disciplinary Committee on Maternal Mortality • Enhanced Surveillance and Case Reviews • Bureau of Maternal Infant Reproductive Health

  36. BMIRH MMR Enhanced Surveillance Methods • Case ascertainment Vital Statistics, Medical Examiner, SPARCS • Case Review Medical records, ME reports, maternal death certificates, infant birth certificates • Data entry and analysis

  37. Location of Death: BMIRH 1998-2000

  38. Percent of Live Births and Maternal Deaths By Race/Ethnicity: BMIRH 1998-2000 Live Births Maternal Deaths

  39. MMR and Race/ EthnicityBMIRH1998-2003 93.2 33.3 19.9 19.2

  40. US Historical Perspective:Racial Disparities Sources: MMWR 2003; JAMWA 57(3), 2002

  41. MMWR 2003:52(No.SS-2)

  42. MMR by Birth PlaceBMIRH1998-2003 58.1 50.2 37.8

  43. Comparing Leading Causes of Death (%) *International WHO 1993, JAMWA 2002 **National MMWR 2003 ***NYC BMIRH 1998-2000

  44. Hemorrhage Related DeathsBMIRH 1998-2000 Black 64 % Hispanic 21 % White 8 % Asian/Pacific Isl. 8 % In hospital 97%

  45. Obesity: Maternal Mortality Risk From HemorrhageBMIRH 1998-2000

  46. Hemorrhage Initiative • Hemorrhage alert – Commissioner of Health, NYC • Hemorrhage protocols • Hemorrhage Poster • Unusual collaboration between the NYC DOH, NYS DOH and ACOG

  47. What About the Bronx?

  48. MMR by BoroughBMIRH1998-2003

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