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Jamie S. Kim, MPH Co-Authors: Carol Gilbert, MS and Laurin Kasehagen, MA, PhD June 5, 2012

Perinatal Periods of Risk (PPOR) approach to better understand fetal-infant mortality: A State-level analysis in Kansas 2005-2009. Jamie S. Kim, MPH Co-Authors: Carol Gilbert, MS and Laurin Kasehagen, MA, PhD June 5, 2012. Acknowledgement.

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Jamie S. Kim, MPH Co-Authors: Carol Gilbert, MS and Laurin Kasehagen, MA, PhD June 5, 2012

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  1. Perinatal Periods of Risk (PPOR) approach to better understand fetal-infant mortality: A State-level analysis in Kansas 2005-2009 Jamie S. Kim, MPH Co-Authors: Carol Gilbert, MS and Laurin Kasehagen, MA, PhD June 5, 2012

  2. Acknowledgement • CityMatCH: Carol Gilbert and Dr. Laurin Kasehagen http://www.citymatch.org/ • Kansas Department of Health and Environment: http://www.kdheks.gov/ • Bureau of Epidemiology and Public Health Informatics - Greg Crawford, Carol Moyer, Dr. Farah Ahmed and Joy Crevoiserat • Bureau of Family Health staff (especially Linda Williams, Dr. Debbie Richardson, Joseph Kotsch, Jamey Kendall, Marc Shiff and Dave Thomason) • Center for Performance Management - Brenda Nickel • Center for Health Equity - Aiko Allen • Kansas Blue Ribbon Panel on Infant Mortality and Connie Satzler (and her staff): http://kansasinfantmortality.org/

  3. Infant Mortality in Kansas

  4. The Problem Source: Bureau of Epidemiology and Public Health Informatics, KDHE; National Center for Health Statistics

  5. The Problem HP2020 = 6.0 Desired Direction = Below Line HP2010 = 4.5 U.S. 2010 preliminary data Source: Bureau of Epidemiology and Public Health Informatics, KDHE; National Center for Health Statistics

  6. The Problem *BNH= non-Hispanic black; **WNH=non-Hispanic white Source: Bureau of Epidemiology and Public Health Informatics, KDHE

  7. The Problem *BNH= non-Hispanic black; **WNH=non-Hispanic white Source: Bureau of Epidemiology and Public Health Informatics, KDHE

  8. What We’re Doing • The Kansas Blue Ribbon Panel on Infant Mortality http://kansasinfantmortality.org/index.asp • Releases updated recommendations (Apr 2011) and actionable logic model (Oct 2011)

  9. What We’re Doing • KDHE Center for Health Equity (i.e., office of minority health) and SIDS Network of Kansas coordinate multi-year statewide health promotion campaign on infant mortality. • Healthy Baby Begins With You Tour KS/Tonya Lewis Lee (April 2011): Wichita, Topeka, Kansas City • 506 media events and estimated 6,112,313 audience reach (Sept, Oct, Nov - national campaign months for Infant Mortality, SIDS, Prematurity)

  10. What We’re Doing SIDS Network of Kansas expands Safe Sleep Education outreach. Sedgwick County FIMR releases first FIMA data report. (July 2011) Preconception Peer Educator Training (PPE) Wichita, Topeka, Kansas City (Sept 2012)

  11. What We’re Doing • Healthy Communities Wyandotte (HCW) releases recommendations (Oct 2011) • March of Dimes provides grants to Saline, Sedgwick, Shawnee and Geary counties to establish community collaboratives that will address birth disparities through prenatal care and community health partnerships.

  12. What We’re Doing • State/County collaboration to facilitate use of PPOR • Kansas Leadership Center • National FIMR Conference – Geary, Reno, Saline, Sedgwick, Shawnee and Wyandotte • FIMR in Kansas: Long-Term

  13. Purpose • A recommendation from the Kansas Blue Ribbon Panel on Infant Mortality • Describes the Perinatal Periods of Risk (PPOR) approach to analyze resident fetal and infant death data in Kansas for the period 2005-2009.

  14. Purpose • Gain greater insight into the underlying factors contributing to Kansas’ fetal and infant deaths. • Data to Action: Results offer important information that can be used to develop community-based prevention strategies related to racial/ethnic disparities in infant mortality rate (IMR).

  15. Methods • Perinatal Periods of Risk (PPOR) approach • Phase 1: identifies populations and periods of risk with excess mortality • Phase 2: explains excess mortality and identifies important risk factors

  16. The Perinatal Periods of Risk Birth weight

  17. PPOR Intervention Model Preconceptional Health Health Behaviors Perinatal Care, etc. Maternal Health/ Prematurity Prenatal Care High Risk Referral Obstetric Care, etc. Maternal Care Perinatal Management Neonatal Care Pediatric Surgery, etc. Newborn Care Infant Health Safe Sleep Position Breast Feeding Injury Prevention, etc. Preconceptional Health Health Behaviors Perinatal Care, etc. Prenatal Care High Risk Referral Obstetric Care, etc. Maternal Care Perinatal Management Neonatal Care Pediatric Surgery, etc. Newborn Care Safe Sleep Position Breast Feeding Injury Prevention, etc. Infant Health

  18. Data Sources • Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment • Fetal death certificate data • Live birth certificate data • Linked birth-death cohort data

  19. Study Population • Fetal deaths 2005-2009 • 24 weeks or greater gestational age • 500 grams or larger • Live births 2005-2009 • 500 grams or larger • Linked birth and death data 2005-2009 • 500 grams or larger • Residents of Kansas at time of birth

  20. Reference Group • External: USA 2000-2002 Reference Group • Defined by maternal characteristics • 20 or more years of age • 13 or more years of education • Non-Hispanic white women • Residents of the US at the time of baby’s birth

  21. Phase 1

  22. Overall PPOR Map of Fetal-Infant DeathsKansas, 2005-2009

  23. Fetal-Infant Mortality RateKansas, 2005-2009

  24. Calculating Excess RatesKansas, 2005-2009

  25. Excess MortalityKansas, 2005-2009

  26. Kansas Excess MortalityKansas, 2005-2009

  27. Non-Hispanic White Kansas, 2005-2009

  28. Fetal-Infant Mortality Rate Non-Hispanic White Kansas, 2005-2009

  29. Calculating Excess Rates Non-Hispanic White (WNH) Kansas, 2005-2009

  30. Excess MortalityNon-Hispanic White Kansas, 2005-2009

  31. Non-Hispanic White Excess MortalityKansas, 2005-2009

  32. Non-Hispanic BlackKansas, 2005-2009

  33. Fetal-Infant Mortality RateNon-Hispanic BlackKansas, 2005-2009

  34. Calculating Excess Rates Non-Hispanic Black (BNH)Kansas, 2005-2009

  35. Excess MortalityNon-Hispanic Black Kansas, 2005-2009

  36. Non-Hispanic Black Excess MortalityKansas, 2005-2009

  37. HispanicKansas, 2005-2009

  38. Fetal-Infant Mortality RateHispanicKansas, 2005-2009

  39. Calculating Excess RatesHispanicKansas, 2005-2009

  40. Excess MortalityHispanicKansas, 2005-2009

  41. Hispanic Excess MortalityKansas, 2005-2009

  42. Phase I: Summary

  43. Period-Specific and Fetal Infant Mortality Rates by Race and Hispanic Origin of Mother in Kansas, 2005-2009

  44. Excess Fetal-Infant Mortality RatesKansas, 2005-2009

  45. Calculating excess number of deaths from fetal-infant mortality ratesKansas, 2005-2009

  46. Estimated Excess Number of DeathsKansas, 2005-2009

  47. Phase 2

  48. Part A: Infant Health Risk Period

  49. ExcessFetal-Infant Mortality RatesKansas, 2005-2009

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