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Premature Birth and Low Birth Weight: A Small Area Analysis

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(N=10,849; n=1,689 minority zip codes) ... (Mapped Red) - Zip codes with PBR above Minority mean of 12.5 ... since some of the zip codes with less than 50% minority ... – PowerPoint PPT presentation

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Title: Premature Birth and Low Birth Weight: A Small Area Analysis


1
Premature Birth and Low Birth Weight A Small
Area Analysis
  • Ayman El-Mohandes, MBBCh, MD, MPHInterim Chair
    ProfessorDepartment of Prevention and Community
    HealthAttending Neonatalogist and Associate
    ProfessorDepartments of Pediatrics and
    ObstetricsSchool of Public Health and Health
    Services
  • George Washington University

2
Background
Premature birth and low birth weight (LBW) are
public health problems that are readily linked
to lack of equity in populations. While medical
advances have increased the survival of babies
at high risk because of low birth weight or very
premature delivery, those newborns are at
increased risk for long term neurocognitive
deficits as well as medical complications.
3
Background
Socioeconomic measures such as parental education
and income influence rates of low birth weight
and prematurity. Demographic factors such as
maternal age and race also appear important, and
may be correlated with socioeconomic factors as
well as behavioral and health care access
factors.
4
Objectives
Using small area analysis techniques to describe
the distribution of premature births, low and
very low birth weights in the United States.
Identify geographic areas where higher than
average levels of premature birth and low birth
weights are observed. Predicting geographic
distribution of high risk births will enable
researchers and public health professionals to
develop focused interventions tailored to the
needs of the specific populations.
5
Premature Birth
Premature (or Preterm) is defined as birth at 37 completed weeks of pregnancy. This includes
very preterm births (birth rate is the number of live births in a
specific gestational age category divided by all
live births (x 100), expressed as a percentage.
6
Birth Weight
Very Low Birth (VLBW) Weight or 3.3 lbs
Low Birth Weight (LBW) lbs (includes very low birth weight)
VLBW rate and LBW rate is the number of live
births in the specific weight category divided by
all live births (x 100), expressed as a
percentage.
7
Methods
Live births, premature births, low- and very
low-births data from state Vital Statistics
offices geocoded to zip code, 1998-2000. Minority
zip code 50 or more of the population was
African American, Native American, Hispanic,
Asian or Pacific Islander Rates per 100 live
births of premature births, low and very low
births were calculated for each zip code.
Note To minimize unstable estimates due to a
low number of live births within a zip code,
rates were only computed for zip codes in which
the number of live births was greater than 200.
8
Results
Premature birth rates, low birth rates and very
low birth rates were calculated for each zip code
for which data was available (N10,849 n1,689
minority zip codes). In all, 30 states plus the
District of Columbia are included in this
analysis representing 84 of premature births
during the study period. Rates and minority
zip codes were mapped using ArcView 8.2 (ESRI,
2001) software.
9
Results
Premature Birth Rates (PBR) (Mapped Green) - Zip
codes with PBR less than National mean of
10.5 (Mapped Yellow) Zip codes with PBR
between National and Minority means 10.6-12.5
(Mapped Red) - Zip codes with PBR above
Minority mean of 12.5 Hollow - zip codes with
insufficient data Minority zip code - hatched
markings National Average 12.1 (March of
Dimes, 2002)
10
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11
Add more premature birth rate maps
12
Results
Low Birth Rates (LBW) (Mapped Green) - Zip codes
with LBW less than National mean of 5.9 (Mapped
Yellow) Zip codes with LBW between National and
Minority means 6.0-7.0 (Mapped Red) - Zip
codes with LBW above Minority mean of
7.0 National Average 7.8 (March of Dimes,
2002)
13
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15
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16
Results
Very Low Birth Rates (VLBW) (Mapped Green) - Zip
codes with VLBW less than National mean of
1.4 (Mapped Yellow) Zip codes with VLBW
between National and Minority means 1.5-1.7
(Mapped Red) - Zip codes with VLBW above
Minority mean of 1.7 National Average 1.5
(March of Dimes, 2002)
17
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19
Discussion
Geographic mapping for reproductive outcomes is
an important public health tool to define
risk associations as well as geographic locations
that require special emphasis in targeting
intervention programs. The results of this
preliminary analysis emphasizes the significant
disparity in low birth weight and preterm
distribution in minority populations.
20
Discussion
The results of the analysis, on the other hand,
also emphasize the concerning rates for low
birth weight and prematurity within rural,
socio-economically disadvantaged populations
within non-minority areas.
21
Limitations

The current analysis is based on census
classification by minority status in the overall
population and not by distribution within the
birth cohort for the same year. This may have
masked a stronger association between minority
populations and poor reproductive outcomes since
some of the zip codes with less than 50
minority residents may have had more than 50 of
their births linked to minority families.
22
Conclusions

Poor reproductive outcomes show strong geographic
clustering. Although minority status continues
to be a strong predictor it is by no means the
only one. Similar analyses need to be conducted
using distribution of ethnic groups within birth
cohorts identified by zip code distribution to
further refine these relationships. This will
require examining data collected over longer
time intervals.
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