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Racial and Ethnic Disparities in Preconception Health Among Women in Ohio, 2004-2008
Melissa VonderBrink, MPHOhio Department of Health
Center for Public Health Statistics and Informatics
Racial Disparities in the U.S. Racial/ethnic disparities in maternal and
child health have existed for some time in the U.S.
Unintended pregnancy and abortion rates highest among black women, followed by Hispanic1
Even controlling for socioeconomic status, infant mortality twice as high among black infants as white infants2
1 Cohen S. Abortion and Women of Color: The Bigger Picture (2008). Guttenmacher Policy Review. Vol. 11, No. 3.2Alio A., et. al. An Ecological Approach to Understanding Black-White Disparities in Perinatal Mortality. (2009). Matern Child Health J. DOI 10.1007/s10995-009-0495-9.
Objective
Describe the differences in preconception health among Ohio women by race and ethnicity to identify those most in need of intervention
Ohio’s PopulationPopulation: 11,536,504By race:
83% white12% black5% other or multiple
racesBy ethnicity:
3% Hispanic
Development of IndicatorsIn 2007, CDC’s Public Health Work Group
developed 45 preconception health indicators that could be measured at the state level
Ohio created a data book using the 37 indicators for which data were available
4 chosen from this data book to examine racial/ethnic disparities in Ohio
Indicators to Describe Racial and Ethnic Disparities in Preconception Health in
Ohio
Indicator Years Examined
Unintended pregnancy 2006-2008
High pre-pregnancy BMI 2006-2008
Diabetes 2004-2008
STD diagnoses 2006-2008
Background Unintended PregnancyAssociated with high risk maternal behaviors
and late entry into prenatal care
More than half of women in the U.S. have had an unintended pregnancy by age 453
Socioeconomic factors may explain some of racial/ethnic disparities seen among women with unintended pregnancies4
3 Frost JJ, Darroch JE, Remez L. Improving Contraceptive Use in the United States. In Brief, New York: Guttmacher Institute, 2008, No. 1. 4 Cubbin C, et al. Socioeconomic and Racial/Ethnic Disparities in Unintended Pregnancy Among Postpartum Women in California. Matern Child Health J. 2002 Dec; 6(4): 237-46.
BackgroundPre-Pregnancy Obesity
Obese women more likely to:Enter pregnancy with chronic medical
conditions and have additional problems in following years
Have baby with neural tube or heart defects at birth
Racial/ethnic disparities seen among obese women, with non-Hispanic black women having the highest prevalence5
5 Wang Y, Beydoun MA. The Obesity Epidemic in the United States – Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis. Johns Hopkins Bloomberg School of Public Health. Epidemiologic Reviews. Volume 29; 2007.
Background Diabetes and Gestational Diabetes Women with diabetes have higher risk for
other health complications. Baby also at risk for neural tube defects.
Gestational diabetes associated with macrosomia and cesarean delivery Mother has increased risk of developing Type 2
diabetes later in life
Nationally, diabetes is the 4th leading cause of death for non-white women6
6 CDC. Diabetes and Pregnancy. 2009 Nov. Available at http://www.cdc.gov/Features/DiabetesPregnancy.
Background Sexually Transmitted DiseasesChlamydia
2.8 million cases in U.S. each yearCan cause infertility, pelvic inflammatory disease
and ectopic pregnancy if untreatedGonorrhea
Concern about antibiotic-resistant strainsSimilar risks to chlamydia if untreated
Syphilis40% of pregnancies with untreated syphilis result in
fetal death Transmission rate between mother and infant is highRisks to infant include brain damage, blindness, and
bone deformities
Methods4 indicators from Ohio’s
preconception health data book were usedChose indicators with known
racial/ethnic disparities nationally to see how Ohio compares
Examined Ohio women ages 18 through 44 by race/ethnicity
Data Sources1) Ohio Pregnancy Risk Assessment Monitoring System
(PRAMS) Population-based survey that monitors maternal behaviors and
experiences before, during and shortly after pregnancy
2) Ohio Behavioral Risk Factor Surveillance System (BRFSS) Random-digit dial telephone survey that tracks health and risk behaviors
of adults 18 years and older
Descriptive statistics calculated as proportions and/or frequencies using weighted survey methods
95% confidence intervals calculated
Data are self-reported
Data Sources (continued)3) Ohio STD Surveillance
Tracks syphilis, gonorrhea, and chlamydia in Ohio. Provides data used to help prevent the spread of STDs
Data collected from health care providers and testing sites
Rates of diagnoses calculated per 100,000 women ages 18-44 using Census estimates
Results
Ohio Women Having a Live Birth Whose Pregnancy Was Unintended
n=4252
Characteristic Percent
95% CI
Mothers Age 18-44 45.0 43.0-47.0
Race/Ethnicity
Non-Hispanic White 39.8 37.5-42.2
Non-Hispanic Black 69.0 66.1-71.8
Hispanic 54.9 42.9-66.3
Non-Hispanic Other 46.3 36.9-56.1Source: 2006-2008 Ohio Pregnancy Risk Assessment Monitoring System, Center for Public Health Statistics and Informatics, Ohio Department of Health, 2010.
*Based on self-reported height and weight. Overweight defined as having BMI ≥ 25 kg/m2 but less than 30 kg/m2. Obese defined as having BMI ≥ 30 kg/m2.Error bars equal 95% confidence interval for each yearSource: Ohio Pregnancy Risk Assessment Monitoring System, Center for Public Health Statistics and Informatics, Ohio Department of Health, 2010.
2000 2001 2002 2003 2004 2005 2006 2007 20080
5
10
15
20
25
30
35
40
45
50
Women Having a Live Birth Who Were Overweight or Obese Prior to
Pregnancy*, Ohio, 2000-2008
Year
Perc
en
t
Ohio Women Who Were Overweight or Obese Prior to Pregnancy*
n = 4308
*Based on self-reported height and weight. Overweight defined as having BMI ≥ 25 kg/m2 but less than 30 kg/m2. Obese defined as having BMI ≥ 30 kg/m2.Source: 2006-2008 Ohio Pregnancy Risk Assessment Monitoring System, Center for Public Health Statistics and Informatics, Ohio Department of Health, 2010.
Characteristic Percent 95% CI
Mothers Age 18-44 45.1 43.1-47.1
Race/Ethnicity
Non-Hispanic White 43.6 41.3-46.0
Non-Hispanic Black 57.5 54.4-60.6
Hispanic 45.8 34.2-57.8
Non-Hispanic Other 30.2 22.1-39.6
Ohio Women Diagnosed with Diabetes (Including Gestational Diabetes)*
*Women who have ever been told by a health care provider that they had diabetes , including gestational diabetes (self-reported)Source: 2004-2008 Ohio Behavioral Risk Factor Surveillance System, Center for Public Health Statistics and Informatics, Ohio Department of Health, 2010.
Characteristic Percent 95% CI
Women Age 18-44 5.6 4.8-6.4
Race/Ethnicity
Non-Hispanic White 5.1 4.3-5.9
Non-Hispanic Black 8.5 6.0-11.0
Hispanic 4.0 1.8-6.1
Non-Hispanic Other 8.3 3.3-13.3
n = 8,548
*Rate per 100,000 women ages 18-44 calculated using U.S. Census estimates for that year.
Source: 2006-2008 STD Surveillance, Ohio Department of Health. Data reported as of October 8, 2010.
Non-Hispanic White
Non-Hispanic Black
Hispanic0
200400600800
100012001400160018002000
258.5
1786.5
908.4
Chlamydia Diagnoses Among Women Ages 18-44, Ohio, 2006-
2008
Race/Ethnicity
Rate
per
10
0,0
00
*
*Rate per 100,000 women ages 18-44 calculated using U.S. Census estimates for that year.Source: 2006-2008 STD Surveillance, Ohio Department of Health. Data reported as of October 8, 2010.
Non-Hispanic White
Non-Hispanic Black
Hispanic0
100200300400500600700800900
62.9
776.0
203.6
Gonorrhea Diagnoses Among Women Ages 18-44, Ohio, 2006-
2008
Race/Ethnicity
Rate
per
10
0,0
00
*
*Rate per 100,000 women ages 18-44 calculated using U.S. Census estimates for that year.Source: 2006-2008 STD Surveillance, Ohio Department of Health. Data reported as of October 8, 2010.
Non-Hispanic White
Non-Hispanic Black
Hispanic0
5
10
15
20
25
30
35
1.9
19.7
10.6
2.3
25.5
8.5
2.9
30.1
14.9
Syphilis Diagnoses Among Women Ages 18 - 44 By Race,
Ohio, 2006 - 2008
2006
2007
2008
Race/Ethnicity
Rate
per
10
0,0
00
*
Syphilis Diagnoses Among Young Women Age 18-24 By Race, Ohio, 2006-2008
*Rate per 100,000 women ages 18-24 calculated using U.S. Census estimates for that year.
Source: 2006-2008 STD Surveillance, Ohio Department of Health. Data reported as of May 12, 2011.
2006 2007 20080
10
20
30
40
50
Non-Hispanic WhiteNon-Hispanic BlackHispanic
Year
Rate
per
10
0,0
00
*
DiscussionUnderstanding how racial/ethnic disparities
affect preconception health can help public health administrators effectively plan and implement programs and policies to target those most in need
For the indicators studied, black and Hispanic women had generally poorer preconception health than white womenBut further studies needed to determine
reasons for racial/ethnic disparities
Next StepsCreated Ohio Gestational Diabetes Mellitus
Team and the Ohio Collaborative to Prevent Infant Mortality to focus on improving health care
Block Grant state performance measure designed to monitor and evaluate preconception health care efforts
Share results with state programs (STD, diabetes prevention) to more effectively target high risk populations
AcknowledgementsODH Center for Public Health Statistics and
InformaticsConnie Geidenberger, PhDCarrie A. Hornbeck, MPHBrandi BennettHolly Sobotka, MS
ODH STD Surveillance ProgramRhiannon Richman, MPH
Thank you!Melissa VonderBrink, MPHOhio Department of Health
Center for Public Health Statistics and Informatics246 N. High St.
Columbus, OH 43215(614) 644-0190
