bronx community health dashboard - montefiore...bronx has the highest burden of infant mortality, of...
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1
Bronx Community Health Dashboard: Maternal and Child Health
Last Updated: 1/31/2018
See last slide for more information about this project.
2
Source: https://aneconomicsense.org/2013/11/22/us-health-
care-high-cost-and-mediocre-results/ Global Burden of Disease, 2016. Map constructed using GBD Compare Viz Hub.
https://vizhub.healthdata.org/gbd-compare/ Infant mortality rate in the U.S. is higher than
the average for other higher-income countries
Disability due to low birth weight and
short gestation (DALYs per 100,000)
238
Japan, 28
Germany, 88
3 Data source: CDC Wonder Linked Birth/Infant Death Records, 2003-2015.
70
66
0
10
20
30
40
50
60
70
80
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Fert
ilit
y r
ate
per
1,0
00
Bronx Brooklyn Manhattan
Queens Staten Island United States
In the Bronx, 25-29 year olds have the highest birth rate
26
78
100 96
59
16
0
20
40
60
80
100
15-19 yr 20-24 yr 25-29 yr 30-34 yr 35-39 yr 40-44 yr
Fert
ilit
y r
ate
per
1,0
00
, 2
01
5
Similar to national rates, the fertility rate* in the Bronx
has declined modestly by 6%
*The fertility rate is the number of births over
the number of women 15-44 years of age.
4
Teen (age 15-19y) birth rate
5
Bronx has the highest teen birth rate in New York City
25.6
18.2
10.3
14.2
11.2
0
5
10
15
20
25
Bronx Brooklyn Manhattan Queens Staten Island
Te
en
bir
th r
ate
pe
r 1
,00
0
Data source: CDC Wonder Births Data and Bridged-Race Population Estimates, 2015.
6 Data source: CDC Wonder Births Data and Bridged-Race Population Estimates, 2003-2015.
51.8
25.6
30.1
14.7
0
10
20
30
40
50
60
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Te
en
bir
th r
ate
per
1,0
00
Bronx Rest of NYC
Teen birth rate in Bronx has declined by 50% since 2003, but is still 75% higher than the rest of NYC
7
56.8
29.7
39.6
22.5 18.1
10.8
0
10
20
30
40
50
60
2007 2008 2009 2010 2011 2012 2013 2014 2015
Hispanic NHB NHW
Teen birth rates have declined in all racial/ethnic groups but the disparities remain constant
Data source: CDC Wonder Births Data and Bridged-Race Population Estimates, 2007-2015.
29.7
22.5
10.8
0
5
10
15
20
25
30
35
Hispanic NHB NHW
Te
en
bir
th r
ate
per
1,0
00
8
In the Bronx, Morrisania has the highest teen birth rate
0
5
10
15
20
25
30
35
40
Te
en
bir
th r
ate
per
1,0
00
Community District
(CD number in parentheses)
7
5 6
4 3
2 1
8 12
11
10
9
Data source: NYC Vital Statistics, National Vital Statistics Reports (Births: Final Data, 2015).
9
Timely initiation of prenatal care Defined as starting prenatal care in 1st, 2nd or 3rd month of pregnancy
10
In the Bronx, 9.3% of women do not get prenatal care until the 3rd trimester if not at all, compared to 5.5% in the rest of NYC and 5.9% nationally
0.6%
64.6%
26.0%
8.7%
No pernatal care 1st trimester 2nd trimester 3rd trimester
0.4%
80.8%
13.7%
5.1%
Rest of New York City
Bronx
1.5%
77.0%
17.0%
4.4%
United States
Data source: NYC Vital Statistics, National Vital Statistics Reports (Births: Final Data, 2015).
11
Bronx has a much lower percent of mothers getting their first prenatal care visit in the first trimester of pregnancy than other NYC boroughs
64.6
79.9
83.8
78.9
88.3
0
10
20
30
40
50
60
70
80
90
Bronx Brooklyn Manhattan Queens Staten Island
Pe
rce
nt
sta
rtin
g p
ren
ata
l c
are
in
th
e f
irs
t tr
ime
ste
r
Data source: NYC Vital Statistics, National Vital Statistics Reports (Births: Final Data, 2015).
12
The proportion of women starting prenatal care in the first trimester has increased, though the disparity has between the Bronx and rest of NYC has marginally worsened
59.5
64.6
72.2
80.8
0
10
20
30
40
50
60
70
80
2008 2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt
sta
rtin
g p
ren
ata
l c
are
in
th
e f
irs
t tr
ime
ste
r
Bronx Rest of NYC
Data source: NYC Vital Statistics, National Vital Statistics Reports (Births: 2000-2015).
13
Teen women, non-Hispanic black women and those with less education are least likely to start prenatal care in the first trimester
50.6
59.7
65.7 68.7 67.9
66.6
58.2
71.7
58.3
65.1
72.8
0
10
20
30
40
50
60
70
<20 20-24 25-29 30-34 35+ Hispanic NHB NHW <HS HS/Somecollege
College+
Pe
rce
nt
sta
rtin
g p
ren
ata
l c
are
in
th
e f
irs
t tr
ime
ste
r
Data source: CDC Wonder Linked Birth/Infant Death Records, 2011-2015.
14
Racial/ethnic disparities in the early initiation of prenatal care in the Bronx have largely persisted
60.2 66.6
55.0
58.2
70.1 71.7
0
10
20
30
40
50
60
70
80
2008 2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt
sta
rtin
g p
ren
ata
l c
are
in
th
e f
irs
t tr
ime
ste
r
Hispanic NHB NHW
Data source: NYC Vital Statistics, National Vital Statistics Reports (Births: 2000-2015).
15
In the rest of NYC, the percent of teen mother’s starting prenatal care in the first trimester has increased by 13% as compared to 6% in the Bronx
47.8
50.6
51.9
58.7
0
10
20
30
40
50
60
70
2008 2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt
sta
rtin
g p
ren
ata
l c
are
in
th
e f
irs
t tr
ime
ste
r Bronx NYC, excluding the Bronx
Data source: CDC Wonder Births Data, 2007-2015.
16
Low birth weight Defined as <2,500 grams
Data are limited to single births because there is evidence that multiple births are more
likely to result in low birth weight.
Source: Ventura SJ, Martin JA, Curtin SC, Mathews TJ. Report of final natality statistics, 1996. Hyattsville, Maryland: US Department
for Health and Human Services, CDC, National Center for Health Statistics. Monthly vital statistics reports (vol 46, no. 11).
17
Percent of total births with low birth weight has decreased by 10% in the Bronx
8.3 7.5
0
1
2
3
4
5
6
7
8
9
10
2007 2008 2009 2010 2011 2012 2013 2014 2015
Perc
en
t o
f b
irth
s t
ha
t a
re l
ow
bir
th w
eig
ht
(%)
Bronx Brooklyn Manhattan Queens Staten Island
Data source: CDC Wonder Births Data, 2007-2015.
Data limited to single births.
1.4%
6.1%
85.9%
6.6%
Very low birth weight (<1500g)
Low birth weight (1500-2499)
Normal birth weight (2500-3999)
Macrosomic (≥4000)
Birth weight
distribution in
the Bronx, 2015
18
In the Bronx, non-Hispanic blacks have the highest percent of total births with low birth weight
6.7
9.1
4.8
0
2
4
6
8
10
Hispanic NHB NHW
Pe
rce
nt
of
bir
ths
th
at
are
lo
w b
irth
we
igh
t (%
)
Data source: CDC Wonder Births Data, 2007-2015.
Data limited to single births.
7.5
6.8
10.5
9.1
4.7 4.8
0
2
4
6
8
10
2007 2008 2009 2010 2011 2012 2013 2014 2015
Hispanic NHB NHW
2015
19
Teens (and older women) are more likely to have a low birth weight infant as are women with less education
9.3
7.5
6.8 7.2
9.0
8.1
7.6
7.0
0
1
2
3
4
5
6
7
8
9
10
<20 20-24 25-29 30-34 35+ <HS HS/Somecollege
College+
Pe
rce
nt
of
bir
ths
th
at
are
lo
w b
irth
we
igh
t (%
)
Data source: CDC Wonder Births Data, 2011-2015.
Data limited to single births.
20
Preterm delivery Defined as <37 weeks
Data are limited to single births because there is evidence that multiple pregnancies
greatly increase the risk for preterm delivery.
Source: Kurdi AM, Mesleh, RA, Al-Hakeem MM, et al. Multiple pregnancy and preterm labor. Saudi Med J 2004;25:632-7.
21
Percent of total births delivered preterm has declined by 9% in the Bronx
8.7
7.9
0
1
2
3
4
5
6
7
8
9
10
2007 2008 2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt
of
tota
l b
irth
s d
eli
ve
red
pre
term
Bronx Brooklyn Manhattan Queens Staten Island
Data source: CDC Wonder Births Data, 2007-2015.
Data limited to single births.
Preterm defined as giving birth <37
weeks based on obstetrician/clinical
estimate of gestational age
1.5%
6.4%
92.1%
<32 weeks
32-36 weeks
≥37 weeks
Gestational age
distribution in
the Bronx, 2015
22
In the Bronx, non-Hispanic blacks have the highest percent of preterm births
7.7
8.8
5.5
0
2
4
6
8
10
Hispanic NHB NHW
Pe
rce
nt
of
tota
l b
irth
s d
eli
ve
red
pre
term
Data source: CDC Wonder Births Data, 2015.
Data limited to single births.
8.2
7.7
10.1
8.8
6.2
5.5
0
2
4
6
8
10
2007 2008 2009 2010 2011 2012 2013 2014 2015
Hispanic NHB NHW
Preterm defined as giving birth <37
weeks based on obstetrician/clinical
estimate of gestational age
23
Teens (and older women), as well as those with less education tend to have a higher preterm birth percentage
8.4
7.4 7.1
7.5
10.2
8.4 8.2
6.3
0
2
4
6
8
10
<20 20-24 25-29 30-34 35+ <HS HS/some college ≥College
Pe
rce
nt
of
tota
l b
irth
s d
eli
ve
red
pre
term
Data source: CDC Wonder Births Data, 2015.
Data limited to single births.
Preterm defined as giving birth <37
weeks based on obstetrician/clinical
estimate of gestational age
24
Infant mortality rate
25
Bronx has the highest burden of infant mortality, of which the leading cause is disorders related to preterm and low birth weight, followed by congenital problems
5.0
3.9
3.5
4.0 3.9
0.0
1.0
2.0
3.0
4.0
5.0
Bronx Brooklyn Manhattan Queens Staten Island
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
liv
e b
irth
s
262
210
38 37
35 29 26
21
502
Disorders related topreterm/LBW
Congenital problems
Respiratory distress
Complications ofplacenta/cord
Unintentional injury
Necrotizing enterocolitis
Bacterial sepsis
Influenza & pneumonia
Other
2007-2015
Numbers of deaths of children < 1 year
old due to each cause are shown
Data source: CDC Wonder Linked Birth/Infant Death Records, 2015.
26
Infant mortality rate in the Bronx has declined by 33%, but remains higher than the infant mortality rate in the rest of NYC
9.6
5.0
7.8
3.9
0
2
4
6
8
10
1995-6 1997-8 1999-2000 2001-02 2003-04 2005-06 2007-08 2009-10 2011-12 2013-14 2015
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
liv
e b
irth
s
Bronx NYC, excluding the Bronx
Data source: CDC Wonder Linked Birth/Infant Death Records, 1995-2014.
27
In the Bronx, mothers younger than 20 years old, non-Hispanic black, and without a high school diploma have the highest infant mortality rates
7.7
4.9
5.2
4.9
6.2
4.8
7.0
3.6
6.2
5.3
3.9
0
2
4
6
8
<20 20-24 25-29 30-34 35+ Hispanic NHB NHW <HS HS/Somecollege
College+
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
liv
e b
irth
s
Data source: CDC Wonder Linked Birth/Infant Death Records, 2011-2015.
28
In the Bronx, infant mortality rate has declined by 40% among non-Hispanic blacks and disparities have modestly declined but do remain
7.0
6.1
11.6
9.1
4.9
3.6
0
2
4
6
8
10
12
1995-98 1999-02 2003-06 2007-10 2011-14 2015
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
liv
e b
irth
s
Hispanic NHB NHW
Data source: CDC Wonder Linked Birth/Infant Death Records, 1995-2015.
29
In the Bronx, twins have an increased risk of infant mortality, as do very low birth weight and very preterm infants
6.2
15.5
170.6
11.7
1.7
143.0
9.7 5.4
1.9
0
20
40
60
80
100
120
140
160
Single birth Twin birth <1500 1500-2499 2500-4499 <32 35-35 36 ≥37
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
liv
e b
irth
s
Data source: CDC Wonder Linked Birth/Infant Death Records, 2011-2014.
Limited to single births
Birth weight (g) Gestational Age
(weeks)
30
In the Bronx, Pelham Parkway has the highest infant mortality rate
8.1 7.7
6.4 6.0
5.8 5.4
5.1
4.4 4.3 4.2 3.8
3.6
0
2
4
6
8
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
liv
e b
irth
s
Community District
(CD number in parentheses)
Data source: NYC Vital Statistics, 2013-2015.
12
11
10
9
1 2
3 4
5 6
7
8
31
Bronx has the second highest infant mortality rate among teen mothers
7.6
6.2 6.4
6.9
10.1*
0
2
4
6
8
10
Bronx Brooklyn Manhattan Queens Staten Island
Infa
nt
mo
rtali
ty r
ate
per
1,0
00
tee
n b
irth
s
Data source: CDC Wonder Linked Birth/Infant Death Records, 2010-2015.
* Interpret with caution due to small numbers.
32
Maternal mortality rate from pregnancy or delivery complications
33
Maternal mortality rate from pregnancy or delivery complications has increased by 12% in the Bronx, but decreased by 31% in the rest of NYC
34.6
38.8
23.7
19.9
28.6
0
5
10
15
20
25
30
35
40
2007-09 2010-12 2013-15
Ma
tern
al m
ort
ali
ty r
ate
per
10
0,0
00
liv
e b
irth
s f
rom
p
reg
nan
cy o
r d
eli
ve
ry c
om
pli
ca
tio
ns
Bronx NYC, excluding the Bronx U.S.
Data sources: CDC Wonder Underlying Cause of Death Data and Births Data, 2007-2015.
34
In the Bronx, 35+ year olds and non-Hispanic blacks have the highest mortality rates from pregnancy or delivery complications
18.0
35.7
70.1
33.7
60.7
0
10
20
30
40
50
60
70
<25 25-34 35+ Hispanic NHB
Ma
tern
al m
ort
ali
ty r
ate
per
10
0,0
00
liv
e b
irth
s f
rom
p
reg
nan
cy o
r d
eli
ve
ry c
om
pli
ca
tio
ns
Data sources: CDC Wonder Underlying Cause of Death Data and Births Data, 2007-2015.
# of deaths for non-Hispanic whites are not statistically reliable.
35
Pre-pregnancy BMI
36
The Bronx has the highest percent of women who are obese prior to pregnancy and this percentage has increased since 2008
23.0
26.2
15.5 15.4
0
5
10
15
20
25
2008 2009 2010 2011 2012 2013 2014 2015
Bronx NYC, excluding the Bronx
Data source: New York City Vital Statistics Birth Data, 2008-2015.
26.2
15.8
11.8
16.2
19.9
0
5
10
15
20
25
Bronx Brooklyn Manhattan Queens Staten Island
Pe
rce
nt
ob
es
e p
rio
r to
pre
gn
an
cy (
%)
2015
37
Diabetes during pregnancy
38
In both the Bronx and the rest of NYC the prevalence of diabetes during pregnancy has increased substantially
4.4
9.2
4.9
7.8
6.5
0
2
4
6
8
10
2007 2008 2009 2010 2011 2012 2013 2014 2015
Dia
bete
s d
uri
ng
pre
gn
an
cy (
%)
Bronx NYC, excluding the Bronx United States
Data source: CDC Wonder Births Data, 2007-2015.
Defined as gestational diabetes
+ established diabetes
39
Diabetes during pregnancy is most common among older moms and those with less education
Data source: CDC Wonder Births Data, 2013-2015.
2.2
4.1
6.8
10.2
14.4
7.4 7.7
6.8
9.0
8.4
7.1
0
2
4
6
8
10
12
14
≤19 20-24 25-29 30-34 35+ Hispanic NHB NHW <HS HS/somecollege
≥college
Pe
rce
nt
wit
h d
iab
ete
s (
%)
Age-adjusted
Defined as gestational diabetes
+ established diabetes
40
Chronic hypertension
41
Chronic hypertension during pregnancy is 2.5-times higher among women in the Bronx as compared to the rest of NYC
1.6
3.1
1.0
1.2 1.1
1.6
0
1
2
3
4
2007 2008 2009 2010 2011 2012 2013 2014 2015
Ch
ron
ic h
yp
ert
en
sio
n d
uri
ng
pre
gn
an
cy (
%)
Bronx NYC, excluding the Bronx United States
Data source: CDC Wonder Births Data, 2007-2015.
42
Among Bronx women, chronic hypertension during pregnancy is much more common among non-Hispanic black women and older women
Data source: CDC Wonder Births Data, 2013-2015.
0.8
4.1
2.4
2.9
6.2
2.1
4.5
1.5
0
1
2
3
4
5
6
≤19 20-24 25-29 30-34 35+ Hispanic NHB NHW
Ch
ron
ic h
yp
ert
en
sio
n d
uri
ng
pre
gn
an
cy (
%)
43
Intent to exclusively breastfeed
44
The Bronx has the lowest percentage of women saying they plan to breastfeed exclusively & the disparity with the rest of NYC has widened
26.3 24.6
31.3
38.3
0
5
10
15
20
25
30
35
40
45
2008 2009 2010 2011 2012 2013 2014 2015
Bronx NYC, excluding the Bronx
Data source: New York City Vital Statistics Birth Data, 2008-2015.
24.6
35.7
47.5
37.6
30.4
0
5
10
15
20
25
30
35
40
45
Bronx Brooklyn Manhattan Queens StatenIsland
Perc
en
t o
f w
om
en
in
ten
din
g t
o b
reastf
eed
exclu
siv
ely
(%
) [2
015]
45
About the Community Health Dashboard Project
The goal of the project is to provide Bronx-specific data on risk factors and health outcomes with an
emphasis on presenting data on trends, socio-demographic differences (e.g., by age, sex,
race/ethnicity, etc.) and sub-county/neighborhood level data
Data will be periodically updated as new data becomes available.
Produced by Montefiore’s Office of Community & Population Health using publicly-available data
sources
For more information please contact Colin Rehm, PhD, Manager of Research & Evaluation