Severe Maternal Morbidity in Georgia, 2009-2020.

BACKGROUND: The increasing focus of population surveillance and research on maternal-and not only fetal and infant-health outcomes is long overdue. The United States maternal mortality rate is higher than any other high-income country, and Georgia is among the highest rates in the country. Severe maternal morbidity (SMM) is conceived of as a "near miss" for maternal mortality, is 50 times more common than maternal death, and efforts to systematically monitor SMM rates in populations have increased in recent years. Much of the current population-based research on SMM has occurred in coastal states or large cities, despite substantial geographical variation with higher maternal and infant health burdens in the Southeast and rural regions. METHODS: This population-based study uses hospital discharge records linked to vital statistics to describe the epidemiology of SMM in Georgia between 2009 and 2020. RESULTS: Georgia had a higher SMM rate than the United States overall (189.2 vs. 144 per 10,000 deliveries in Georgia in 2014, the most recent year with US estimates). SMM was higher among racially minoritized pregnant persons and those at the extremes of age, of lower socioeconomic status, and with comorbid chronic conditions. SMM rates were 5 to 6 times greater for pregnant people delivering infants <1500 grams or <32 weeks' gestation as compared with those delivering normal weight or term infants. Since 2015, SMM has increased in Georgia. CONCLUSION: SMM represents a collection of life-threatening emergencies that are unevenly distributed in the population and require increased attention. This descriptive analysis provides initial guidance for programmatic interventions intending to reduce the burden of SMM and, subsequently, maternal mortality in the US South.

Heat illness: predictors of hospital admissions among emergency department visits-Georgia, 2002-2008.

Heat-related illnesses (HRI) are the most frequent cause of environmental exposure-related injury treated in US emergency departments (ED). While most individuals with HRI evaluated in EDs are discharged to home, understanding predictors of individuals hospitalized with HRI may help public health practitioners and medical providers identify high risk groups who would benefit from educational outreach. We analyzed data collected by the Georgia Department of Public Health, Office of Health Indicators for Planning, regarding ED and hospital discharges for HRI, as identified by ICD-9 codes, between 2002 and 2008 to determine characteristics of individuals receiving care in EDs. Temperature data from CDC's Environmental Public Health Tracking Network were linked to the dataset to determine if ED visits occurred during an extreme heat event (EHE). A multivariable logistic regression model was developed to determine characteristics predicting hospitalization versus ED discharge using demographic characteristics, comorbid conditions, socioeconomic status, the public health district of residence, and the presence of an EHE. Men represented the majority of ED visits (75 %) and hospitalizations (78 %). In the multivariable model, the odds of admission versus ED discharge with an associated HRI increased with age among both men and women, and odds were higher among residents of specific public health districts, particularly in the southern part of the state. Educational efforts targeting the specific risk groups identified by this study may help reduce the burden of hospitalization due to HRI in the state of Georgia.

Very low birth weight births in Georgia, 1994-2005: trends and racial disparities.

OBJECTIVE: To investigate the nature of very low birth weight (VLBW) births in Georgia-a major contributor to the overall and the black-white disparity in infant mortality-as a step toward elucidating strategies for reducing VLBW births. METHODS: This population-based retrospective cohort study utilized maternally linked vital records data from Georgia to examine the status of and contributors to the VLBW rate for non-Hispanic blacks and whites by comparing trends in the proportion represented by singleton versus multiple gestations, first versus recurrent events, and specific subtypes over three, consecutive 4-year periods (1994-1996 through 2003-2005); and logistic regression to model the risk of various subtypes of VLBW as a function of maternal and obstetrical characteristics. RESULTS: Georgia's VLBW rate remained unchanged from 1994-1996 to 2003-2005, although there was a significant decrease in the rates of twin and first VLBW and a significant increase in recurrent VLBW. For both first and recurrent VLBW, there was a statistically significant increase for blacks and a decrease for whites. The strongest risk factor for a VLBW birth of any subtype for blacks and whites was a prior VLBW, with recurrent VLBW accounting for 4.8-16% of all VLBW depending upon the subtype. CONCLUSION: From 1994-1996 to 2003-2005, the rate of recurrent VLBW increased while the rate of first VLBW decreased in Georgia. For both first and recurrent VLBW, the black-white disparity widened. Because the strongest risk factor for a VLBW birth is a previous one, there is a need to identify strategies to prevent a woman's first VLBW birth and to reduce recurrences.

Racial residential segregation and stroke mortality in Atlanta.

OBJECTIVE: To assess the association between neighborhood-level racial residential segregation and stroke mortality using a spatially derived segregation index. DESIGN: Cross-sectional study SETTING: Atlanta Metropolitan Statistical Area METHODS: The study population consisted of non-Hispanic Black and White residents of the Atlanta Metropolitan Statistical Area during the time period Jan 1, 2000 to December 31, 2006. Census tract-level stroke death rates for Blacks and Whites were modeled as a function of the segregation index while controlling for two neighborhood-level chronic stressors (poverty, low education). RESULTS: Racial segregation was positively associated with stroke mortality for both Blacks and Whites aged 35-64 years. Among Blacks and Whites aged 65 or older, segregation was negatively associated with stroke mortality after controlling for the two stressors, suggesting that they were pathways between segregation and stroke death rates. CONCLUSION: Future studies are needed to identify additional pathways between residential segregation and other health outcomes, and to collect data that support a life course approach to understanding the impact of residential segregation on health.

Identifying perinatal risk factors for infant maltreatment: an ecological approach.

BACKGROUND: Child maltreatment and its consequences are a persistent problem throughout the world. Public health workers, human services officials, and others are interested in new and efficient ways to determine which geographic areas to target for intervention programs and resources. To improve assessment efforts, selected perinatal factors were examined, both individually and in various combinations, to determine if they are associated with increased risk of infant maltreatment. State of Georgia birth records and abuse and neglect data were analyzed using an area-based, ecological approach with the census tract as a surrogate for the community. Cartographic visualization suggested some correlation exists between risk factors and child maltreatment, so bivariate and multivariate regression were performed. The presence of spatial autocorrelation precluded the use of traditional ordinary least squares regression, therefore a spatial regression model coupled with maximum likelihood estimation was employed. RESULTS: Results indicate that all individual factors or their combinations are significantly associated with increased risk of infant maltreatment. The set of perinatal risk factors that best predicts infant maltreatment rates are: mother smoked during pregnancy, families with three or more siblings, maternal age less than 20 years, births to unmarried mothers, Medicaid beneficiaries, and inadequate prenatal care. CONCLUSION: This model enables public health to take a proactive stance, to reasonably predict areas where poor outcomes are likely to occur, and to therefore more efficiently allocate resources. U.S. states that routinely collect the variables the National Center for Health Statistics (NCHS) defines for birth certificates can easily identify areas that are at high risk for infant maltreatment. The authors recommend that agencies charged with reducing child maltreatment target communities that demonstrate the perinatal risks identified in this study.