National and Regional Trends in African American Birth Outcomes .


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National and Regional Trends in African American Birth Outcomes. Karla Damus, RN MSPH PhD Associate Professor Dept OB/GYN and Women’s Health Albert Einstein College of Medicine National March of Dimes. Maternal Mortality by Race United States, 1970 -2003.
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National and Regional Trends in African American Birth Outcomes Karla Damus, RN MSPH PhD Associate Professor Dept OB/GYN and Women\'s Health Albert Einstein College of Medicine National March of Dimes

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Maternal Mortality by Race United States, 1970 - 2003 Maternal demise for every 100,000 live births Note: Rates for 1970-1988 depend on race of tyke. Rates for 1989-2003 depend on race of mother. Source: National Center for Health Statistics, last mortality information Prepared by March of Dimes Perinatal Data Center, 2006

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www.healthypeople.gov

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The Current Agenda Goal #1: Increase quality and sound years of labor of love #2: Eliminate wellbeing inconsistencies sex race/ethnicity wage and training handicap geographic area sexual introduction

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Questions What information are expected to portray variations in birth results in groups? What information should be gathered to educate conceivable purposes behind incongruities in birth results? What methodologies have been appeared to diminish incongruities? What connections/organizations should be set up to address variations in groups? What programs should be produced to address incongruities at the group and populace level? What exercises has the group attempted? What\'s worked/What hasn\'t? Why? What are practical objectives for our association/groups? What are we prepared to progress in the direction of? Openings? Scenes? Approaches? Other important associations?

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Births by Race/Ethnicity US 2001-2003 normal In 2004 there were 4,112,052 live births enlisted in the US

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Infant Mortality United States, 1915-2002 Rate for each 1,000 live births Source: National Center for Health Statistics, last mortality information Prepared by March of Dimes Perinatal Data Center, 2002

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Unexpected discoveries a large portion of increment because of: non Hispanic white >30 years wedded >high school onset PNC first trimester nonsmoker private protection www.cdc.gov/mmwr

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Infant Mortality by Maternal Race United States, 1990 - 2004* Rate for each 1,000 live births 2010 0bj Source: National Center for Health Statistics, last mortality information *preliminary information Prepared by March of Dimes Perinatal Data Center, 2007

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Black/White Infant Mortality Rate Ratio United States, 1980-2004* Source: NCHS, last mortality information *preliminary mortality information

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Racial and Ethnic Disparities Infant Mortality Rates, US 2001 Per 1,000 Live Births HP 2010 Objective 4.5 NCHS 2003

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Infant Mortality by Race/Ethnicity New York City, 1990-2001 Rate for every 1,000 live births Office of Vital Statistics and Maternal, Infant & Reproductive Health Program , NYCDOH Prepared by March of Dimes Perinatal Data Center, 20002

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Infant Mortality Rates by Race/Ethnicity US Region, 2000-2002 normal Source: National Center for Health Statistics, last mortality information Prepared by March of Dimes Perinatal Data Center, 2007

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Infant Mortality Rates by State, 2003 Source: National Center for Health Statistics, 2003 period connected birth/baby passing information.

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Three Leading Causes of Infant Mortality United States, 1990 and 2004* Rate for every 100,000 live births Source: National Center for Health Statistics *preliminary mortality information for 2004 Prepared by March of Dimes Perinatal Data Center, 2007

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Three Leading Causes of Infant Deaths by Race/Ethnicity, US , 2000 Per 1,000 Live Births NCHS 2001

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Preterm Birth Rates United States, 1983, 1993, 2003, 2005* Percent > 1 out of 8 births or 508,000 children conceived preterm in 2005 Percent HP 2010 Objective >30% Increase Preterm is under 37 finished weeks development. Source: National Center for Health Statistics, last natality information Prepared by March of Dimes Perinatal Data Center, 2005 *preliminary

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Preterm (<37 wks) Births by Maternal Race/Ethnicity, US, 1990-2004 Source: National Center for Health Statistics, last natality information. Take note of: All race classes reject Hispanic births. Information from 1990 avoids NH and OK. Information from 1991 and 1992 avoids NH. The reporting of Hispanic ethnicity was not required in these states amid these years.

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Preterm Birth Rates by Race/Ethnicity and US Region, 2001-2003 normal Source: National Center for Health Statistics, last natality information Prepared by March of Dimes Perinatal Data Center, 2007

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Preterm Birth Rates by Race/Ethnicity & Education, IOM 2006

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Singleton Preterm Births by Maternal Race/Ethnicity and Education, 2001-2002 http://diversitydata.sph.harvard.edu

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Definitions Preterm birth: < 37 finished weeks incubation Late preterm (or Near-Term): 34-36 finished weeks Very preterm: <32 finished weeks

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Total (<37 weeks), Very (<32 weeks) and Late Preterm Births (34-36 weeks) U.S., 1990-2003 Percent Late Preterm

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Distribution of Preterm Births by Gestational Age, US, 2002 (<32 Weeks) "Close term newborn children had essentially more therapeutic issues and expanded clinic costs contrasted and contemporaneous full term babies Near term babies may speak to an unrecognized at-hazard neonatal populace." Wang, et al. Clinical Outcomes of Near-Term Infants, Pediatrics (114) 372-6, 2004 . (36 Weeks) (32 Weeks) (33 Weeks) ~71% of PTB 34 - 36 weeks late preterm (34 Weeks) (35 Weeks) Source: National Center for Health Statistics, 2002 natality document Prepared by the March of Dimes Perinatal Data Center, 2004

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Total and Primary Cesarean and VBAC United States, 1993 - 2005 Preliminary (1) Per 100 births (2) Per 100 births to ladies with no past cesarean (3) Per 100 births to ladies with a past cesarean Source: NCHS, last natality information, 1993-2003 and 2004 preparatory information Prepared by March of Dimes Perinatal Data Center, 2005

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Human Brain Growth in Gestation Kinney, 2006

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PEDIATRICS Vol. 118 No. 3 Sept 2006, pp. 1207-1214

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Differences in Singleton Preterm Birth Rates by Race/Ethnicity, 1992 and 2002

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Late Preterm Cesarean Section and Labor Induction Rates among Singleton Live Births by Week of Gestation US, 1992 and 2002

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Birth Weight and Coronary Heart Disease Barker Hypothesis Age Adjusted Relative Risk Birthweight (lbs) Rich-Edwards 1997

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Birth Weight and Insulin Resistance Syndrome Barker Hypothesis Odds proportion balanced for BMI Barker 1993 Birthweight (lbs)

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Factors that Contribute to Increasing Rates of Preterm Birth Increasing rates of births to ladies 35+ years old Independent danger of cutting edge PATERNAL age Increasing rates of different births Indicated conveyances Induction Enhanced administration of maternal and fetal conditions Patient inclination/consumerism (CDMR) Substance manhandle Tobacco Alcohol Illicit medications Bacterial and viral contaminations Increased stretch (calamitous occasions, DV, bigotry)

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Risk Factors for Preterm Labor/Delivery The best indicators of having a preterm birth are: flow multifetal pregnancy a past filled with preterm work/conveyance or earlier low birthweight mid trimester dying (rehash) some uterine, cervical and placental abnormalities Other hazard variables: low pre-pregnant weight corpulence contaminations sickliness real push absence of social backings tobacco utilize unlawful medication utilize liquor mishandle folic corrosive inadequacy unintended pregnancy maternal age (<17 and >35 yrs) dark race low SES unmarried past fetal or neonatal passing 3+ unconstrained terminations uterine anomalies bumbling cervix cervical techniques hereditary inclination

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1985

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Folic Acid-Specific Knowledge March of Dimes Folic Acid Survey Percentage of ladies ages 18-45

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Folate Levels Drop Significantly A CDC contemplate discharged Thursday found a 8 to 16 % decrease in folate levels in light of consequences of the NHANES (meetings, PE, and blood trial of around 4,500 US ladies, ages 15 to 44, done somewhere around 1999 and 2004). It was the first run through such a decrease has been seen since the begin of government wellbeing effort asking ladies to ensure they get enough folic corrosive. The decay was most purported in white ladies, albeit dark ladies keep on being the racial gathering with minimal folate in their blood.

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Smoking Among Women of Childbearing Age US, 2003 Smoking is characterized as having ever smoked 100 cigarettes in a lifetime and as of now smoking regular or some days. Percent reported is among ladies ages 18-44. Source: Smoking: Behavioral Risk Factor Surveillance System. Behavioral Surveillance Branch, Centers for Disease Control and Prevention..

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Multiple Birth Ratios by Maternal Race/Ethnicity United States, 1992-2002 Per 1,000 live births Percent Change \'96-\'02 = 21.5% Source: National Center for Health Statistics, last natality information Prepared by March of Dimes Perinatal Data Center, 2005

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Higher-Order Multiple Birth Ratios By Maternal Race, United States, 1980-2002 Ratio for each 100,000 live births Source: NCHS, last natality information Prepared by March of Dimes Perinatal Data Center, 2004

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Institute of Medicine Report, July 2006 The IOM gauges the aggregate national cost of untimely births to be at the very least $26.2 billion . This gauge incorporates numerous costs, for example, in-patient healing facility costs, lost wages and efficiency and early mediation programs.

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Institute of Medicine Report on Preterm Birth, 2006 - One of the three noteworthy subjects is inconsistencies in PTB rates among various gatherings (racial, ethnic, or financial). - Literature on reasons for racial/ethnic variations in PTB and impacts of nativity should be created. - Studies demonstrate that distinctions in PTB between African-American and white ladies stay subsequent to altering for financial contrasts. - L

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