nicu

Views:
 
Category: Entertainment
     
 

Presentation Description

gfjsr

Comments

Presentation Transcript

The Neighborhood and Neonatal Intensive Care : 

The Neighborhood and Neonatal Intensive Care A population-based analysis of the demand for neonatal intensive care in Detroit, Michigan (1984-1988) Michael Russell Rip & Steven A. Dosh DEPARTMENT OF EPIDEMIOLOGY MICHIGAN STATE UNIVERSITY

Key Points - I : 

Key Points - I Population-based (ecological) risks contribute substantially to LBW, NMR, and the demand for neonatal intensive care Geocoding of linked birth and death certificates can be a powerful tool for assessing ecological level risks, demand, and cost

Key Points - II : 

Key Points - II Geocoded linked birth and death certificates can also contribute to an understanding of the concentration of individual risk factors in a population Geocoded linked birth and death certificates can also contribute to understanding of the interaction of individual risk factors in a population

Key Points - III : 

Key Points - III Neighborhood-level analysis of LBW risk factors and demand for neonatal intensive care is critical for planning interventions in large urban populations

Background - I : 

Background - I Neonatal mortality accounts for most (60%) infant mortality in the U.S. and other industrialized countries Neonatal mortality is closely associated with LBW (especially VLBW) Preterm delivery accounts for most LBW infants in the U.S.

Background - II : 

Background - II The cause of most preterm deliveries is unknown Social disadvantage is associated with preterm delivery Preterm birth disproportionately affects Blacks and urban populations

Background - III : 

Background - III IMR improved 64% between 1970 (20 per 1,000 live births) and 1998 (7.2 per 1,000 live births) in the U.S. Neonatal mortality accounts for over 60% of infant mortality High LBW rates account for high neonatal mortality rates in the United States

Background - IV : 

Background - IV Even though LBW and VLBW rates remain high, the IMR and NMR in the U.S. have improved dramatically over the past 30 years Regionalized neonatal intensive care is responsible for most of the improvement in infant and neonatal mortality over the past 30 years

Background - V : 

Background - V Neonatal intensive care has been responsible for most of the reduction in the NMR over the past 30 years In the face of persistently high risk (high LBW rates) neonatal intensive care plays a critical roll in reducing the U.S. IMR - especially in poor urban populations

Key Points - I : 

Key Points - I Population-based (ecological) risks contribute to LBW, NMR, and the demand for neonatal intensive care

Wayne County, Michigan : 

Wayne County, Michigan Detroit City

Neighborhoods from Census Tracts (1990) : 

Neighborhoods from Census Tracts (1990)

47 Neighborhoods of Detroit : 

47 Neighborhoods of Detroit

Poverty in Detroit Michigan(1990 census) : 

Poverty in Detroit Michigan(1990 census) Median household income = $17,348 Percent of households with income >150% of the federal poverty level = 57% Percent of population with < high school education = 71% Percent female head of household = 30%

Variation in Median Household Income by Neighborhood : 

Variation in Median Household Income by Neighborhood

Low Birthweight and Infant Mortality in Detroit (1984 - 1988) : 

Low Birthweight and Infant Mortality in Detroit (1984 - 1988) LBW rate = 13% (U.S. = 7%) VLBW rate = 2.5% (U.S. = 1.2%) IMR = 15/1,000 live births (U.S. = 10/1,000 live births) NMR = 9/1,000 live births (U.S. = 7/1,000 live births)

Demand and Cost for NICU Beds in Detroit 1984 - 1988 : 

Demand and Cost for NICU Beds in Detroit 1984 - 1988 Demand = 5.4 NICU beds/1,000 live births (U.S. = 4) Incremental cost/live birth = $822 ($US, 1989)

Variation in Demand by Neighborhood : 

Variation in Demand by Neighborhood

Variation in Costby Neighborhood : 

Variation in Costby Neighborhood

Key Points - I : 

Key Points - I Population-based (ecological) risks contribute substantially to LBW, NMR, and the demand for neonatal intensive care Geocoding of linked birth and death certificates can be a powerful tool for assessing ecological level risks, demand, and cost

Key Points - II : 

Key Points - II Geocoded linked birth and death certificates can also contribute to an understanding of the concentration of individual risk factors in a population Geocoded linked birth and death certificates can also contribute to understanding of the interaction of individual risk factors in a population

Key Points - II : 

Key Points - II Geocoded linked birth and death certificates can also contribute to an understanding of the concentration of individual risk factors in a population Geocoded linked birth and death certificates can also contribute to understanding of the interaction of individual risk factors in a population

Birth certificates and Individual Risks : 

Birth certificates and Individual Risks Maternal age Race Maternal education Smoking history Drinking history

Neonatal Mortality Ratesaccording toMaternal & Community Education Level : 

Neonatal Mortality Ratesaccording toMaternal & Community Education Level

Key Points - I : 

Key Points - I Population-based (ecological) risks contribute substantially to LBW, NMR, and the demand for neonatal intensive care Geocoding of linked birth and death certificates can be a powerful tool for assessing ecological level risks, demand, and cost

Key Points - II : 

Key Points - II Geocoded linked birth and death certificates can also contribute to an understanding of the concentration of individual risk factors in a population Geocoded linked birth and death certificates can also contribute to understanding of the interaction of individual risk factors in a population

The Future : 

The Future Geocoded birth certificates Linked to death certificates Linked to hospital data (e.g. MIDB) Length of stay Diagnoses Procedures

Conclusion : 

Conclusion Neighborhood level analysis of risk, demand, and cost can be a valuable tool for planning public health interventions directed at improving neonatal mortality