the perinatal periods of risk approach sanil thomas ms biostatistics candidate april 27, 2010
Post on 20-Dec-2015
217 views
TRANSCRIPT
![Page 1: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/1.jpg)
The Perinatal Periods of Risk Approach
Sanil ThomasMS Biostatistics candidate
April 27, 2010
![Page 2: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/2.jpg)
Introduction
• Infant mortality rate (IMR) is a critical indicator of nation’s health
• IMR remains higher in United States than in other industrialized countries
• But IMR does not provide sufficient information to understand the factors that contribute to infant mortality
![Page 3: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/3.jpg)
Introduction
• Traditional methods don’t include the fetal death counts for the analysis of mortality rates
• Fetal-infant mortality is a multi dimensional issue and a detailed analytical approach to fetal- infant mortality is needed to focus community initiatives for improving maternal and infant health.
![Page 4: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/4.jpg)
Objectives
• To look at Feto-Infant mortality in a new way
• Apply PPOR framework for New York State
• To see the distribution of common risk factors by county level
![Page 5: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/5.jpg)
Perinatal Periods of Risk (PPOR) Approach
• The Perinatal Periods of Risk Approach was developed by Dr. Brian McCarthy from the W.H.O. Perinatal Collaborative Center at CDC and other W.H.O. colleagues.
• Simple method that is based on a strong conceptual
prevention
• The PPOR Data allow you to look at feto-infant mortality in new ways
![Page 6: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/6.jpg)
PPOR : 6 Basic Steps
Step 1: Assure Analytic and Community Readiness Step 2: Conduct Analytic Phases of PPOR Step 3: Develop Strategic Actions for Targeted
Prevention Step 4: Strengthen Existing and/or Launch New
Prevention InitiativesStep 5: Monitor and Evaluate ApproachStep 6: Sustain Stakeholder Investment and Political
Will
![Page 7: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/7.jpg)
Analytic Phases of PPOR
Phase 1: Identifies populations and periods of risk with the largest excess mortality.
Phase 2: Explains why the excess deaths occurred.
![Page 8: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/8.jpg)
PPOR Examines Deaths in TWO dimensions simultaneously:
• Age at death
• Weight at birth
![Page 9: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/9.jpg)
Conce
ption
Birth 1
Year
Fetal Infancy20 wks 28 wks
4 wks
Spontaneous Abortion
Early Fetal
Late Fetal Neonatal
Postneonatal
Infant
Feto-Infant
Age at Death
The First Dimension Of PPOR Analysis:
![Page 10: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/10.jpg)
Second Dimension: Birthweight
• Very Low Birthweight (PPOR limit)= less than 1500 grams (3.3 pounds)
• Low Birthweight= less than 2500 grams (5.5 pounds)
• Normal Birthweighte.g., a 7.5-pound baby weighs 3,400 grams
Birth
weig
ht
![Page 11: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/11.jpg)
PPOR “Map” fetal & infant deaths
Age at Death
Birth
weig
ht
500-1499 g
1500+ g
Fetal
(24+
wks
)
Neonat
al
Postneo
natal
1 2 3
54 6
![Page 12: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/12.jpg)
PPOR “Map” fetal & infant deaths
500-1499 g
1500+ g
Fetal Death Neonata
l
Post- neonata
lMaternal Health/
Prematurity
Maternal Care
Newborn Care
Infant Health
Birth
wei
gh
t
Age at Death
![Page 13: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/13.jpg)
PPOR is about ACTION(each period of risk is associated with a set of possible areas for action)
Maternal Health/ Prematurity
Maternal Care
Newborn Care
Infant Health
Preconception Health Health Behaviors Perinatal Care
Prenatal Care High Risk Referral Obstetric Care
Perinatal Management Neonatal Care Pediatric Surgery
Sleep Position Breast Feeding Injury Prevention
![Page 14: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/14.jpg)
PPOR: Phase 2
• Poisson log linear modeling• Covariates/Fixed effects
a. Mother’s race
b. Mother’s education
c. Mother’s age
d. Payor • Random effect - County
![Page 15: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/15.jpg)
PPOR: Phase 2
• Fetal death was not used
• 2004-2007
• Predicted death counts were used to obtain smoothed death rates
• Modeling done for each countyRelative risk calculated from the beta estimates
![Page 16: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/16.jpg)
Data
• New York State Dept. of Health. a. Electronic records of births
b. Linked birth-death cohort
c. selected fetal deaths
Phase 1 : 2003-2007 Phase 2 : 2004-2007
![Page 17: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/17.jpg)
Software used
• SAS
• Excel
• ArcGIS
![Page 18: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/18.jpg)
Results
![Page 19: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/19.jpg)
Phase 1 ResultsObs County
Total number of deaths
Sum of Live births and Fetal
deaths
Death rates per 1000 live births and Fetal deaths
(PPOR categories)
Total DeathMaternal
health/prematurity
Maternal care Newborn care Infant health
1 ST LAWRENCE 61 6215 9.81 2.74 2.25 2.74 2.09
2 BROOME 101 10438 9.68 3.35 2.59 1.92 1.82
3 OSWEGO 62 6884 9.01 2.91 3.63 1.45 1.02
4 BRONX 1015 112785 9.00 4.34 2.66 0.79 1.21
5 JEFFERSON 76 8523 8.92 3.40 3.17 1.29 1.06
6 SCHENECTADY 76 9142 8.31 3.17 2.30 1.31 1.53
7 KINGS 1607 201738 7.97 3.66 2.35 0.86 1.10
8 ONEIDA 101 12905 7.83 2.40 1.55 1.63 2.25
9 ULSTER 72 9212 7.82 2.93 1.85 1.41 1.63
10 ALBANY 120 15904 7.55 3.58 1.76 0.75 1.45
11 RENSSELAER 66 8822 7.48 2.83 1.70 1.13 1.81
12 ERIE 373 50694 7.36 2.88 2.05 1.12 1.30
13 ONONDAGA 197 27648 7.13 2.89 1.77 1.23 1.23
14 QUEENS 990 153600 6.45 2.85 1.93 0.69 0.97
15 MONROE 273 43613 6.26 2.64 1.44 0.87 1.31
16 NEW YORK 629 102684 6.13 2.69 2.01 0.56 0.87
17 NIAGARA 70 11444 6.12 2.97 0.96 0.87 1.31
18 ORANGE 159 26316 6.04 2.24 1.25 1.18 1.37
19 RICHMOND 171 29176 5.86 3.29 1.34 0.55 0.69
20 ROCKLAND 134 23110 5.80 2.08 1.51 1.51 0.69
21 WESTCHESTER 342 61189 5.59 2.27 1.31 1.14 0.87
22 SUFFOLK 531 96216 5.52 2.53 1.29 0.91 0.79
23 NASSAU 411 77325 5.32 2.16 1.33 0.69 1.14
24 SARATOGA 60 11946 5.02 2.18 1.26 0.75 0.84
25 DUTCHESS 71 15763 4.50 2.03 0.38 1.33 0.76
![Page 20: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/20.jpg)
Phase 1 Results
New York State
Death Rates per 1000 live births and fetal deaths
2.58Maternal Health/ Prematurity
1.63 Maternal
Care
1.12 Newborn
Care
1.21Infant
Health
![Page 21: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/21.jpg)
![Page 22: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/22.jpg)
Phase 2 Results
Poisson Log Linear model estimatesSolutions for Fixed Effects
Effect mom_race mom_educn mom_age payor EstimateStandard
Error DF t Value Pr > |t|Intercept -5.7132 0.06320 56 -90.40 <.0001
mom_race asian -0.1806 0.1431 2730 -1.26 0.2071
mom_race black_alone 0.9248 0.05255 2730 17.60 <.0001
mom_race other_races 0.1056 0.07598 2730 1.39 0.1646
mom_race z_white_alone 0 . . . .
mom_educn HighSchoolorAssoc 0.4346 0.05602 2730 7.76 <.0001
mom_educn lessthan_HighSchool 0.6420 0.07174 2730 8.95 <.0001
mom_educn z_Bachelors&above 0 . . . .
mom_age 35&above 0.1367 0.05468 2730 2.50 0.0125
mom_age lessthan20 0.2512 0.06412 2730 3.92 <.0001
mom_age z_20to34 0 . . . .
payor medicaid 0.03220 0.04705 2730 0.68 0.4937
payor other 0 . . . .
![Page 23: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/23.jpg)
![Page 24: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/24.jpg)
![Page 25: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/25.jpg)
![Page 26: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/26.jpg)
![Page 27: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/27.jpg)
![Page 28: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/28.jpg)
![Page 29: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/29.jpg)
![Page 30: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/30.jpg)
Conclusions
• Infant mortality Higher risk ratio for black mothers relative to white mothers Higher risk ratio for mothers having education less than high school when
compared to mothers having education more than bachelors Higher risk ratio for mothers of age less than 20 when compared to mothers
of age between 20 and 34
• Smoothed rates are higher in St.Lawrence, Erie, Schenectady, Oneida, Broome, Cortland etc
• Risk ratio for black mothers relative to white mothers are higher in the counties Orleans, Oswego, Chenango and Cortland
![Page 31: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/31.jpg)
Limitation
• Missing data 12428 records out of 497787 records 246 deaths
• Inconsistent fetal data
![Page 32: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/32.jpg)
Future study
• Detailed Phase 2 analysis including fetal deaths• MHP and IH categories – Protocol for Phase 2
studies
• Cluster Analysis• Spatial smoothing analysis
![Page 33: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/33.jpg)
Reference
• http://www.citymatch.org/ppor_index.php
• Cai, J, Hoff GL, Dew PC et al. Perinatal periods of risk: analysis of fetalinfant mortality rates in Kansas City, Missouri. Matern Child Health J.2005;9:199-205
• Cai J, Hoff GL, Archer R et al. Perinatal periods of risk analysis of infant mortality in Jackson County, Missouri. J Public Health Manage Pract. 2007;13:270-277.
![Page 34: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/34.jpg)
Acknowledgments
• Dr. Glen D. Johnson, PhD, MS, MA• Dr. Marilyn A. Kacica, M.D.,M.P.H
![Page 35: The Perinatal Periods of Risk Approach Sanil Thomas MS Biostatistics candidate April 27, 2010](https://reader036.vdocuments.site/reader036/viewer/2022062516/56649d4d5503460f94a2baa1/html5/thumbnails/35.jpg)
Questions???