Women’s Healthcare in Georgia

1. Women’s Healthcare in Georgia Senate Women's Adequate Healthcare Study Committee September 14, 2015 Brenda Fitzgerald, M.D. Commissioner and State Health Officer Georgia Department of Public Health

2. In 2013 Maternal Mortality Georgia Ranks # 50 nationally AWHONN 2013

3. Maternal Mortality • Thedeath of a woman during pregnancy or up to one year after delivery • Pregnancy-related death is a death during or within one year of pregnancy that was caused by a complication of pregnancy • Pregnancy-associated death is the death of a woman from any cause while she is pregnant or within one year of pregnancy

4. Maternal Mortality Case Reviews 2012 Case Reviews • 122 cases • 60 pregnancy-associated deaths • 25 pregnancy-related deaths • 37 not pregnant

5. Leading Causes ofPregnancy-Associated Death Number of deaths

6. Leading Causes ofPregnancy-Related Death Number of deaths

7. Georgia Infant Mortality 2002-2006 • 5,743 babies in Georgia died before their first birthday • Georgia’s Infant Mortality Rate was 15-20 percent higher than national average • All live births grouped by one-mile squares, based on location of mothers’ residency at delivery • Six significantly increased clusters of higher mortality rates identified • The leading causes of death identified by cluster

8. Georgia Infant Mortality Clusters2002-2006

9. Georgia Infant Mortality Clusters 2002-2006

10. Leading Causes of Infant Death by Cluster

11. Infant Mortality Reduction Strategic Plan (2012–2016) Objective 1: Strengthen the Regional Perinatal System Objective 3: Develop external collaborations to support initiatives Objective 2: Develop targeted educational campaigns RPC standards of care Tobacco Cessation Early Elective Deliveries 17-Hydroxy P Registry Safe Sleep 1115 Waiver Utilization to Improve Birth Spacing & Conception Planning Fetal/Infant mortality review committee Breastfeeding and Baby-Friendly Hospitals & Businesses Maternal mortality review committee Community-based home visitation programs LARC Placement Perinatal Quality Collaborative

12. Obstetric Care Provider Shortage • 38 Georgia counties with NOOB services • 20 Georgia counties with a deficit of OB services

14. Telehealth Goals • Increase access to care • Address Georgia’s health challenges • Infant mortality • Oral health • Obesity and associated diseases • Connect Georgians with specialized care that may not exist in every community, i.e. monitoring of a high-risk pregnancy • Increase capacity at DPH sites statewide

15. GA Early Elective Deliveries Reduced 39-week elective deliveries • Public and private collaboration • Georgia Hospital Association • March of Dimes • GA OB/GYN Society • GA Chapter of American Academy of Pediatrics • 2009: 65%

16. Georgia Early Elective Deliveries * As of October 1, 2013 Medicaid in Georgia no longer pays for early elective deliveries Source: Georgia Hospital Association

17. Georgia Early Elective Deliveries Georgia has been under the national 2% standard for the past 21 months Source: Georgia Hospital Association

18. Georgia Infant Mortality RateAmerica’s Health Rankings 48% DECREASE SINCE 1990 Source: America’s Health Rankings 2014

19. Cardiovascular Disease in Georgia • Cardiovascular Disease (CVD) includes: heart disease, stroke, hypertension, atherosclerosis, and other diseases of the arteries or heart muscle • Cardiovascular Disease in Georgia • CVDis the leading cause of death • 29 women die each day from CVD • 4,012 women die annually from heart disease • 2,185 women die annually from stroke Source: BRFSS 2013

20. Cost of Cardiovascular Disease in Georgia • $6.1 billion annually • $4.2 billion for heart disease • Average charge per heart-related hospitalization $45,700 • $940 million for strokes • Average charge per stroke-related hospitalization $39,453

21. Obesity in Georgia • 3 million Georgians are obese • Georgia's adult obesity rate is 30%,up from 10% in 1990 • 66% of adults are either overweight or obese • 73% males • 59% females • Obesity in women has increased 2.2% since 2011

22. Cost of Obesity in Georgia • $2.5 billion annually • Direct healthcare costs • Lost productivity • Disability • Death • Estimated $10.8 billion by 2018 if • obesity rate continues to increase • Average hospital stay for obese • individuals is 60% longer than for • healthy weight individuals

23. Obesity in Georgia • Interventions • Promote and adopt healthy eating habits • Increase physical activity • Increase access to healthy food and physical activity in work place • GA Shape • Power Up for 30

24. Diabetes in Georgia • Diagnosed diabetes is 9.7% compared to prevalence of undiagnosed diabetes at 6.5% • Between 2000-2010 prevalence of diabetes increased from 6.8% to 9.7% • 11.7% of Georgia women are diagnosed with diabetes • Gestational diabetes during pregnancy causes increased blood sugar levels and risk of complication for mother and baby

25. Diabetes in Georgia

26. Cost of Diabetes in Georgia • $5.1 billion annually • $3.3 billion direct medical cost • $1.8 billion loss of productivity and sick days • Does not account for undiagnosed diabetes or those with prediabetes

27. Diabetes in Georgia Interventions • Increase the number of accredited Diabetes Self-Management Education (DSME) sites in the state • Increase the number of telehealth sites offering DSME programs • Educate providers on the importance of referring patients DSME and diabetes prevention programs

28. Tobacco Use in Georgia Women 2011-2013 Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

29. Health Effects of Tobacco Use • Early death • Cancer • Women who smoke are 26 times more likely than non-smokers to develop lung cancer • Risk factor for cancer of the cervix, ovary, colon, kidney • Increased risk of heart disease and stroke • Lung Damage • Chronic coughing, wheezing, trouble breathing, and long-term lung disease • Reproductive health problems • Trouble getting pregnant • Bleeding, premature birth, and emergency C-section • Miscarriages, stillbirths, and low birth-weight babies

30. Cost of Tobacco Use in Georgia • $5.0 billion annually • $1.8 billion direct medical cost • $3.2 billion loss of productivity and sick days • Tobacco use is the number one preventable cause of death in Georgia

31. Tobacco Use in Georgia Interventions • Establish smoke free policies and social norms • Promote cessation and assist tobacco users to quit • Prevent initiation of tobacco use • Enacting comprehensive smoke free policies • Fund hard hitting mass-media campaigns • Making cessation services fully accessible to tobacco users

32. Georgia Tobacco Quitline 24 hours a day, 7 days a week English: 1.877.270.STOP (1.877.270.7867) Spanish: 1.877.2NO.FUME (1.877.266.3863) Hearing Impaired, TTY Services: 1.877.777.6534

33. Cancer in Georgia • 44,000 new cases annually (all sites) • 23,000 men • 21,000 women • Breast cancer is the leading cause of cancer in Georgia women • 6,410 new cases annually • 400 new cases of cervical cancer annually

34. Cancer in Georgia

36. Cancer Cost in Georgia • $3.7 billion annually • Direct medical costs • $243 million annually • Lost productivity and sick days • More than one million days • 15,150 cancer deaths in Georgia annually • 8,013 males • 7,135 females 2012 BRFSS State Summary

37. Alzheimer’s Disease in Georgia • 120,000 Georgians currently with Alzheimer’s disease • 160,000 Georgians by 2025 with Alzheimer’s disease • 63% of Georgians age 65+ with Alzheimer’s disease are women • Women are twice as likely to develop Alzheimer's as breast cancer • 12.6% of Georgia women age 45+ reported increased confusion or memory loss in the past year

38. 2014 Alzheimer’s DiseaseFacts and Figures

40. Alzheimer’s Disease and Related Dementias Registry Goals for Registry • Usable data in the preparation and planning for aging population • Identify epidemiological trends • Bring awareness at state level to issues that affect healthy aging • Inform stakeholders for planning and future implementation needs • Improve urban and rural parity