II: / & ( ) , APPENDIX III: MCH

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2 TABLE OF CONTENTS EXECUTIVE SUMMARY...6 QUANTITATIVE DATA...13 Population Data...13 Poverty...17 Uninsured/Underinsured...18 Pregnant Women / Pregnancy Outcomes...23 Births...23 Teen Births...24 No Prenatal Care...28 Low/Very Low Birthweight...29 Maternal Tobacco Use...30 Drug/Alcohol Use...37 Magee-Women s Hospital Drug & Alcohol Study ( )...37 Infants and Children...40 Infant Mortality...40 Healthy Start...43 SIDS...46 Intentional and Unintentional Injury: Infants and Children...47 Immunizations...48 Adolescents...49 Intentional and Unintentional Injury: Adolescents...49 Dropouts...50 Children with Special Health Care Needs...51 Early Intervention...51 Childhood Obesity...56 ACHD Program Data...58 Women, Infants and Children (WIC)...58 Breastfeeding...59 Childhood Lead Poisoning Prevention...61 Dental...62 Resource Mothers Program...63 Sexually Transmitted Disease...66 QUALITATIVE PRESENTATION OF DATA Allegheny County Health Department Strategic Planning Session...71 Maternal and Child Health Planning Session...76 Needs Assessment Survey of Pediatricians...83 RESOURCE/SERVICE ASSESSMENT...93 NEEDS ANALYSIS APPENDIX I: Participants involved in the 2001 Strategic Planning Process APPENDIX II: Participants Involved in the Maternal and Child Health Planning Session February 10, APPENDIX III: MCH Pediatrician Survey Data Entry Form ACKNOWLEDGMENTS

3 Table 1: Allegheny County Population...13 Table 2: City of Pittsburgh Population...13 Table 3: Allegheny County/Pittsburgh Gender...14 Table 4: Allegheny County Age Distribution (in years)...14 Table 5: City of Pittsburgh Age Distribution (in years)...14 Table 6: Population by Age - Female...15 Table 7: Population by Age - Male...15 Table 8: Change in Residents Aged 17 and Younger...16 Table 9: Race/Ethnicity for County and City Table 10: Hispanic Breakdown...16 Table 11: Allegheny County Poverty Levels by Age Table 12: Children Enrolled in Medicaid or CHIP...17 Table 13: Children Receiving TANF/AFDC...17 Table 14: Health Professional Shortage Areas...21 Table 15: Numbers of Births by Race: Table 16: Selected Birth Statistics by Race Table 17: Pregnancy Outcome by Age Table 18: Number of Births and % ( )...24 Table 19: Select Birth Statistics by Age, Table 20: Allegheny County Teen Births by Race and Age ( )...25 Table 21: Pittsburgh Teen Births by Race and Age ( )...25 Table 22: No Prenatal Care in First Trimester Table 23: No Prenatal Care in First Trimester by Race County...28 Table 24: No Prenatal Care in First Trimester by Race City...28 Table 25: Low Birthweight Infants: Table 26: Very Low Birthweight Infants: Table 27: Maternal Tobacco Use for Resident Live Births County...30 Table 28: Maternal Tobacco Use for Resident Live Births-2002-County...30 Table 29: Maternal Tobacco Use for Resident Live Births City...31 Table 30: Maternal Tobacco Use for Resident Live Births-2002-City...31 Table 31: Birthweights Among Smokers & Nonsmokers City...32 Table 32: Birthweights Among Smokers & Nonsmokers-2002-City...33 Table 33: Birthweights Among Smokers & Nonsmokers County...34 Table 34: Birthweights Among Smokers & Nonsmokers-2002-County...35 Table 35: Most Prevalent Substances Abused in Allegheny County...37 Table 36: Alcohol Consumption - Race...38 Table 37: Alcohol Consumption Race & Age...38 Table 38: Cocaine Use - Race...38 Table 39: Cocaine Use Race & Age...38 Table 40: Marijuana Use - Race...39 Table 41: Marijuana Use Race & Age...39 Table 42: Narcotic Addiction - Race...39 Table 43: Narcotic Addiction Race & Age...39 Table 44: 2002 Infant Mortality Allegheny County/Pittsburgh...40 Table 45: Infant Mortality by Area Allegheny County/Pittsburgh...40 Table 46: Infant Mortality by Race Allegheny County...41 Table 47: Infant Mortality by Race Pittsburgh...41 Table 48: Mortality due to Specific Injuries: Allegheny County - Age under 1 Year...47 Table 49: Mortality due to Specific Injuries: Allegheny County - Ages 1-4 Years

4 Table 50: Mortality due to Specific Injuries: Allegheny County - Ages 5-9 Years...47 Table 51: Mortality due to Specific Injuries: Allegheny County - Ages Years...49 Table 52: Mortality due to Specific Injuries: Allegheny County - Ages Years...49 Table 53: Mortality due to Specific Injuries: Allegheny County - Ages Years...49 Table 54: Public Secondary School Dropouts...50 Table 55: Alliance Diagnoses...52 Table 56: Alliance Referrals...52 Table 57: Pittsburgh Public Schools EI Program School Year...52 Table 58: Allegheny County 2003 Inpatient Discharges 0-4yr...54 Table 59: Allegheny County 2003 Inpatient Discharges Ages 5-9yr...54 Table 60: Allegheny County 2003 Inpatient Discharges Ages 10-14yr...54 Table 61: Allegheny County 2003 Inpatient Discharges Ages 15-19yr...55 Table 62: Allegheny County 2003 Inpatient Discharges Ages 0-19 White...55 Table 63: Allegheny County 2003 Inpatient Discharges Ages 0-19yr Black...55 Table 64: Allegheny County 2003 Inpatient Discharges Ages 0-19yr Other Race...56 Table 65: Allegheny County Health Department WIC Program Table 66: WIC Breastfeeding Data Initiation Table 67: USA Breastfeeding Data Duration Table 68: PA/ACHD WIC Breastfeeding Data - Average Duration...60 Table 69: PA/ACHD WIC Breastfeeding Data - Long Term Duration...60 Table 70: Allegheny County Managed Care Organizations Table 71: Top 6 Identified Needs

5 Figure 1: Geographic Access to Health Care...20 Figure 2: Medicaid HMO Obstetric Providers & Patients...21 Figure 3: Teen Birth Rate Allegheny County Figure 4: Teen Birth Rate Pittsburgh Figure 5: Infant Mortality Rates Figure 6: Infant Mortality Rates - Healthy Start...43 Figure 7: Low Birthweight - Healthy Start...44 Figure 8: SIDS Deaths Figure 9: RMP/Allegheny County Infant Mortality...63 Figure 10: RMP/Allegheny County Infant Mortality Change...63 Figure 11: RMP/Allegheny County Low Birthweight...64 Figure 12: RMP/Allegheny County Low Birthweight Change...64 Figure 13: RMP/Allegheny County 1st Trimester Care...65 Figure 14: RMP/Allegheny County 1st Trimester Care Change...65 Figure 15: Allegheny County STD Reported Morbidity...66 Figure 16: Allegheny County HIV Test Results...68 Figure 17: Allegheny County HIV Cases by Age Group & Sex...69 Figure 18: Allegheny County Reported HIV Cases by Race, by Sex...69 Figure 19: Allegheny County Reported HIV Cases by Risk Factor

6 EXECUTIVE SUMMARY This assessment of the health status and needs of the maternal and child population of Allegheny County was completed, in part, to fulfill the contractual requirements with the Pennsylvania Department of Health. Such an assessment is a component of the Maternal and Child Health Services Block Grant (Title V). It was completed utilizing Needs Assessment and Planning Guidelines for County and Municipal Health Departments (February 2004) distributed by the Pennsylvania Department of Health, Bureau of Family Health. It represents an update and enhancement of an assessment report submitted in Additionally, this needs assessment was completed to provide a foundation upon which Allegheny County Health Department and other institutions and agencies can plan and implement interventions to reduce risks and improve the health status of child-bearing families in our area. It is hoped that many will find the assessment information useful as we work together toward the Healthy People 2010 goals. Achieving these goals for healthy children and families will require the participation and commitment of every segment of society. Health care providers, education, voluntary agencies, business, the faith community, civic groups, foundations and government all have critical roles in promoting and maintaining the health status of our community. The quantitative data in this report are comprised of population and health indicators frequently used in conducting MCH needs assessments. Qualitative data are derived from two strategic planning sessions attended by participants from various Allegheny County agencies focusing on the needs of the maternal, infant, child and adolescent populations. A survey of pediatricians was conducted to gather information regarding children with special health care needs. Through analysis of the quantitative and qualitative data, specific needs were prioritized utilizing the APEX strategy. The ranked needs were then reviewed in relation to the 2010 Healthy People Objectives. The top six prioritized health needs of the maternal and child population identified are: reduce infant mortality, reduce very low birth weight infants, reduce low birth weight infants, reduce prenatal exposure to smoking, increase breastfeeding rates and address children with special health care needs medical care coordination with emphasis on a medical home. The Title V work plan is designed to address the prioritized health needs. The work plan is structured under three components: Primary and Preventive Maternal and Infant Services, Primary and Preventive Child Health Services and Services for Children with Special Health Care Needs. Demographic Data The analysis of data included in this report is based on the 2000 census. The population of both Allegheny County and the City of Pittsburgh has been declining since The population has declined by 20% from The decline is slowing in recent years with the migration out of the county being the lowest (4.1%) of the three decades (9.6%, 7.8%, 4.1%). The median age for the City of Pittsburgh and Allegheny County has increased (City 35.5 Years and County 39.6 years). Men make up a smaller proportion of both Allegheny County (47.4%) and the City of Pittsburgh (47.6%) than women (52.6% and 52.4%). In Allegheny County, 84.3% of the population is white and 12.4% is African American. In the City of Pittsburgh, 67.6% of the population is white and 27.1% is African American. There is more 6

7 ethnic diversity within the City of Pittsburgh than the County of Allegheny as a whole. The population of Allegheny County has a median family income of $49,815 and the median income in the City of Pittsburgh is $38,795. In Allegheny County, 11.2% of individuals are below the poverty level and in the City of Pittsburgh, 20.4% of individuals live in poverty. In Allegheny County, greatest proportion of people living in poverty is the year olds and children under 5 years of age. In Allegheny County in 2003, one in four children received Medicaid. The number of children enrolled in Children s Health Insurance Program (CHIP) has increased by 10% in the past 4 years. In Allegheny County, it is estimated that a little over 6% of children do not have health insurance compared to 8.3% of Pennsylvania s three million children. Welfare reform has reduced the Temporary Assistance to Needy Families (TANF). This is the cash assistance program that replaced Aid to Families with Dependent Children (AFDC). The lowest rate of children receiving TANF occurred in One in 15 children received TANF in Allegheny County vs. one in 18 children in the State of Pennsylvania. Geographic Access to Health Care Allegheny County had nine areas federally designated as Health Professional Shortage Areas (HPSA) in 2000 and in 2002 twelve areas were identified. The HPSA are defined by four criteria: the proportion of the population below the poverty level, the ratio of full time primary care physicians to population, the infant mortality rate and the fertility rate of the population. Seven of the twelve HPSA are in the City of Pittsburgh. Four out of nine delivery hospitals are in the City of Pittsburgh. The three Medicaid managed care organizations in Allegheny County have adequate obstetric providers. Many of the providers offices are within the City of Pittsburgh. Pregnant Women and Infants The number of births to Allegheny County women has been declining. Births to teenagers have also been declining, so the proportion of birth to teens has shown little change. In 2002, the group that had the most births were women 30 and over. Teenagers were less likely than women 20 years and older to initiate prenatal care during the first trimester of pregnancy and they were more likely to deliver low birth weight infants. Women who live in Pittsburgh were also less likely than Allegheny County women to receive early prenatal care and were more likely to have a low birth weight infant. African American teenagers delivered more infants than teenagers of other racial groups. Other comparison by race revealed that low birth weight rates, very low birth weight rates, late entry into prenatal care and infant mortality rates were higher for African Americans. In 2002, the white infant mortality rate for Allegheny County was 4.6 infants per thousand and the black infant mortality rate was 21.1 infants per thousand. The Pittsburgh white infant mortality rate was 6.8 and black infant mortality rate was The Allegheny County white rate met the Healthy People 2010 objective but efforts need to continue for the African American population in both the City and Allegheny County. Intensive, sustained efforts will be required on many fronts to reduce poverty and eliminate racial disparities indicators such as infant mortality and low birth weight rates. 7

8 The incidence and duration of breastfeeding among Allegheny County WIC participants have increased since 1992 when only 13% of women breastfed their infants. In January 2005, 31.8% of WIC postpartum women initiated breastfeeding. Duration expressed in weeks has increased from 9.8 weeks in 1992 to 15 weeks in The Healthy People 2010 breastfeeding goal is to have 75% of women breastfeeding at hospital discharge, 50% breastfeeding at six months postpartum and 25% of women continuing to breastfeed until their infants are one year of age. Cigarette smoking during pregnancy contributes to low birth weight infants. In Allegheny County in 2002, with the exception of the under 19 year old group, a higher percentage of African American mothers reported smoking than white mothers. However, in 2002, smoking rates had begun to decrease from the rate of 25.5% of total births in Pittsburgh. The 2002 rate of maternal smoking in Pittsburgh is 21.4%. Maternal smoking is more prevalent in the City of Pittsburgh than Allegheny County. In Allegheny County, alcohol abuse is the most prevalent substance requiring services by the Department of Human Services Drug and Alcohol programs. Abuse tends to increase with age. Heroin ranks second in need for treatment. Data was not available by race or pregnancy status. From a study of 45,649 women conducted at the largest birthing hospital in Allegheny County, Magee-Womens Hospital, between , less than.5% of mothers reported alcohol use, 1.6% reported marijuana use and.4% reported using a narcotic. Pregnant women used marijuana more than other drugs. Infants, Children and Adolescents Immunizations Immunization levels among school age children are high but efforts must be maintained especially among those two years of age and younger. SIDS Sudden Infant Death Syndrome (SIDS) is the major cause of infant death after the first month of age and has no known cause. Despite decreases in the incidence of SIDS from the early 1990 s since the Back to Sleep campaign was initiated, SIDS remains the leading cause of infant death beyond the neonatal period. Education on the risks factors such as smoking and bed sharing should continue. In Allegheny County, there were ten deaths attributed to SIDS in 2002 and six deaths attributed to SIDS in Deaths Due to Intentional and Unintentional Injury Infants, children and adolescents are at risk from deaths due to intentional and unintentional injury. From 1998 to 2002, there were 25 deaths to children between birth and 4 years of age due to motor vehicle crashes, drowning, fires and homicides. There were more deaths among white children (15) than black children (10) in this age group. However, the rate for blacks (10.9) is over two times that of whites (5.3). During the same time period, there were 15 deaths to 5 to 9 years olds for these same causes. There were more white deaths (11) than black deaths (3). The rates for whites and blacks are similar. The number one injury cause of death for children under age nine is homicide. Fire and drowning are the second leading causes. Between , there were 21 injury deaths to children years. The major causes were 8

9 drowning, fire and smoke and homicides. The overall death rate among blacks year olds (18.5) is 7.7 times greater than for whites (2.4). In the same time period, more white adolescents between years died due to motor vehicle crashes and suicide than black adolescents. More black adolescents and die of homicide. Secondary School Dropout Rates The public secondary school dropout rate for grades 9-12 remains fairly stable in Allegheny County and is below the State rate. In ,the Allegheny County rate was 1.8 per 100 students enrolled: the State rate was 2.1. Pennsylvania dropout rates have consistently declined from to Children with Special Health Care Needs According to the 2000 census, Allegheny County has 314,875 children birth through 19 years. Utilizing the new Federal definition of Children with Special Health Care Needs, researchers estimate between 13% and 18% of children birth through 19 years have a special health care need. Estimates of special needs children in Allegheny County may range from 40,000-56,000 children birth through nineteen. Children from birth to age five receive services from the Early Intervention Programs, primary care physicians and specialty physicians. School age children and teens with special needs have their academic needs in combination with special needs addressed by the local intermediate units. Health needs continue to be met by the primary care physician and specialty physicians. The care coordination system for the school age child is not as well defined as that for pre school children. In 2003, hospital discharge data for children demonstrated the major reasons younger children 0-14 years were hospitalized. They were hospitalized for disease/conditions of the respiratory system and mental health diseases/disorders. Children years of age were hospitalized/discharged with diagnostic categories of pregnancy/child birth, mental health diseases and diseases/disorders of the digestive system. Childhood obesity has become a serious public health problem. In Allegheny County Health Department WIC Program, 18 percent of children in 2004 qualified for WIC because they were either obese or at risk for becoming obese. School age children are being identified for obesity by the administration of the BMI (Body Mass Index) measurements. Parents, schools and health practitioners need to address the children s nutritional requirements as well as the need for physical exercise. Allegheny County Health Department Programs for Women and Children In 2004, at 10 WIC offices, 16,118 pregnant, postpartum and breastfeeding women and children up to 5 years of age received service. Eight per cent (8%)were pregnant women. Three (3%) breastfeeding women and twelve (12%) postpartum women were active participants. Infants and children were the largest group of participants, 30% and 40% respectively. The Allegheny County Childhood Lead Poisoning Prevention Program provided door to door screening, medical case management and environmental investigation for lead poisoning identification in designated high risk neighborhoods. In 2004, there were 49 confirmed cases of lead poisoning among the at risk children at > 20ug/dL. One hundred per cent of the children were referred for medical confirmation and follow-up medical treatment. 9

10 The Allegheny County Health Department s Dental Program provided preventative/corrective clinical dental services for children and adolescents 2 ½ to 21 years of age from low income families. The Dental Program strived to reduce the prevalence of dental caries in children by placing sealant on the molars of second grade children, by providing dental examination for these children and by making a dental education programs available for all elementary school children in targeted schools. In the Allegheny County Sexually Transmitted Disease Clinic, chlamydia and gonorrhea were the two most commonly identified sexually transmitted diseases. In 2003, female adolescents aged years of age represented 41.8% of the total female chlamydia infections in Allegheny County. Also, during 2003, there were no congenital syphilis cases identified in Allegheny County. The highest number of AIDS cases in both sexes is the year age range. For 2003, 8519 people were HIV tested with 35 positives tests; 27 males and 8 women. The largest group requesting testing for males and females were those years of age. Prioritized Needs Addressed in the MCH Title V Workplan The top ranked health needs of the maternal and child health populations of Allegheny County as determined by the needs analysis are: reduce the infant mortality rate, reduce very low and low birth weight rates, reduce prenatal substance exposure to smoking, increase breastfeeding rates and address children with special health care needs medical care coordination with the emphasis on a medical home. The MCH Title V work plan is divided into three sections: Primary and Preventive Maternal and Infant Services, Primary and Preventive Child Health Services and Services for Children with Special Health Care Needs. The manner in which the prioritized needs are integrated into the work plan is as follows: Primary and Preventive Maternal and Infant Services All organizations, institutions, foundations, agencies and consumers of health care desire healthy outcomes for pregnant women and infants born in Allegheny County. The Allegheny County Health Department s Maternal and Child Health Program services are designed to embrace and work with these groups in our efforts to improve birth outcomes. It takes a community to raise a child. With our SIDS program, education shall be given to individual families, providers of childcare, medical personnel and other groups on methods to prevent further SIDS deaths. Through utilization of the Perinatal Periods of Risk (PPOR) methodology, we plan to identify Allegheny County s specific issues dealing with fetal and infant mortality and develop strategies to reduce fetal and infant deaths. The PPOR team also looks at maternal factors that lead to prevention of very low and low birth weight infants. The Healthy Start Program, a federally funded initiative, focuses on pregnant and postpartum women and their children who live in the six areas of Allegheny County with the highest infant mortality rates and very low/low birth weight rates. The Title V Program in Allegheny County through a sub grant with Healthy Start Inc. provides an outreach and home visiting program called the Resource Mothers Program. The Resource Mothers Program services pregnant women in low income families in Homestead, McKeesport and North Braddock, the next three communities in Allegheny County with high infant mortality rates 10

11 outside the Healthy Start target areas. Public health nurses provide prenatal and postpartum home visiting services to families. All services to pregnant, postpartum women and their infants provide assessment, education and referral to community agencies. Education is given on importance of regular and early prenatal care, nutritional needs during pregnancy, smoking cessation, danger signs of pre term labor, anticipatory guidance for infant care, safe sleeping, infant nutrition, child development, immunizations and the need for consistent well child care. Prenatal smoking is a MCH prioritized need. Unfortunately, the City of Pittsburgh has a very high rate of maternal smoking. The Smoke Free Mothers/Smoke Free Families Coalition has been formed under the leadership of the Allegheny County Health Department. Members include the University of Pittsburgh, community and voluntary agencies, insurance providers, hospitals and clinics. Consensus has been reached on an action plan that includes enforcing policies and regulation, engaging people at the neighborhood level, collecting data to measure progress and reporting outcomes publicly, getting health care providers involved and giving everyone an opportunity to contribute in reducing maternal smoking. All MCH Title V staff has been trained in smoking cessation techniques and are knowledgeable of referral sources for smoking cessation counseling available to Allegheny County MCH families. WIC breastfeeding rates have been improving but efforts need to continue to improve the proportion of mothers who initiate and maintain breastfeeding for the first year of their infants lives. The MCH Title V Breastfeeding Promotion Program maintains a Breastfeeding Telephone Helpline with hours from 8:00 am to 10:00 pm daily (including holidays). International Board Certified Lactation Consultants service the line and provide home visits to breastfeeding women to help mothers establish and continue breastfeeding. Prenatal home visits are made as well to promote breastfeeding as the norm in Allegheny County. Reducing infant deaths and illness through post partum care teaching/interventions is the goal of Project LAMB (Love And Mother your Baby) Program. This program provides home visits that targets women who had little or no prenatal care during their pregnancy. Primary and Preventive Child Health Services The goal of this section of the work plan is to promote optimal health of children age one through 18 years. Through the Pediatric Nurse Home Visiting Program, children seen are administered a developmental screening and parents receive education in home safety, child health, discipline, nutrition and child development. Specific medical concerns are addressed based on the child s needs and medical conditions. The nurses discuss the importance of regular well child care, immunizations and the need for a medical home. Similar home visiting efforts occur in the Resource Mothers Program. Program development in the child health area is a goal in this grant period. The Title V MCH Program plans to develop and implement a follow-up program to ensure all school age children are completely immunized and assist the schools in following up on children that are not. A second priority is to implement a pre-conceptional counseling/teaching program for preteens, teen and young adults. 11

12 Services for Children with Special Health Care Needs (CSHCN) The goal in this section of the Title V work plan is to improve the developmental outcomes for CSHCN. Home visiting nurses provide health screening and education to parents of children in the Alliance For Infants and Toddlers Program. These children (birth to 3) are entered into Allegheny County s early intervention program due to specific developmental at risk categories. The MCH/ACHD role is to provide ongoing medical/health assessment and developmental tracking. A Care Coordination Pilot Program will be developed to increase the proportion of children with special health care needs who have a medical home. Centralized coordination of care for all children with special needs is paramount to each child s progress. The public health nurses will work with families, their doctors, insurance companies, schools and community agencies to access and arrange for services. An assessment of the child s needs will hopefully lead to a design of a care coordinated system for children with special health care needs and the designation of a medical home. 12

13 QUANTITATIVE DATA Population Data Allegheny County is located in southwestern Pennsylvania and covers an area of square miles. More than 95% of the population is classified as urban. Less than 5% of the population is classified as rural. The 2000 U.S. Decennial Census reports 1,281,666 people living in Allegheny County. The largest minor civil division in Allegheny County is the City of Pittsburgh. The City is square miles with a 2000 population of 334,563 residents. Although the City of Pittsburgh accounts for only 7.6% of Allegheny County s area, it contains 26.1% of the county s population. The socio-economic and racial composition of the City of Pittsburgh differs from Allegheny County. Since various health outcomes, such as infant mortality, low birth weight, and certain injuries have been associated with race and socioeconomic status, it is important to designate and report population and health indicators for the City of Pittsburgh as well as Allegheny County. As a whole, the City residents are not as affluent as the County. The population of Allegheny county has a median family income of $49,815, and the median income for City residents is $38,795. In the County, 11.2% of individuals are below poverty level, and in the City, 20.4% of individuals live in poverty. There are significantly more City people living in poverty. Pittsburgh residents are 90% more likely to be in poverty than County residents as a whole. The populations of both Allegheny County and Pittsburgh have changed during the past four decades. The following tables present city and county population changes based on the U.S. Census Bureau s last four decennial censuses. Since 1970 there has been substantial loss of population for both the city and the county. However, the rate of loss appears to be slowing, as reflected in the percent change between 1990 and Table 1: Allegheny County Population Change from Change from % Change from % Change from Total 1,605,016 1,450,085 1,336,449 1,281, ,731-54, Male 762, , , ,002-58,588-19, Female 842, , , ,664-55,048-35, Table 2: City of Pittsburgh Population Change from Change from % Change from Total 520, , , ,563-54,059-35, Male 242, , , ,119-24,729-12, Female 277, , , ,444-29,330-22, The population of both Allegheny County and the City of Pittsburgh has been declining since The population has declined by about 20% from 1970 to The decline is slowing in recent years, with the migration out of the county being the lowest (4.1%) of the three decades (9.6%, 7.8%, 4.1%). % Change from 90-00

14 Table 3: Allegheny County/Pittsburgh Gender Allegheny County Pittsburgh % Reside in Pittsburgh Females 709, , , , % 26.0% Males 626, , , , % 26.2% Total 1,336,449 1,281, , , % 26.1% Men make up a smaller proportion of both Allegheny County (47.4%) and the City of Pittsburgh (47.6%) than women (52.6%, 52.4%). The population of Allegheny County is aging. There was a 36.5% increase in the number of people over the age of 85 between 1990 and The median age of the population has been slowly but steadily increasing since It is currently 4.3 years higher than the median age of the population of the United States (35.3), but only slightly higher (1.6 years) than the median age of PA residents (38.0). Table 4: Allegheny County Age Distribution (in years) Change from Change from % of Change from % of Change from Under 5 116,350 79,245 84,113 71,081 4,868-13, , , , ,095-68,839 12, ,464 77,570 56,138 50,319-21,432-5, , ,597 73,732 59,172-31,865-14, , , , ,251 44,656-53, , , , ,542-31,944 47, ,132 97,421 64,860 63,512-32,561-1, ,393 85,802 76,963 54,278-8,839-22, , , , ,549 11,794-24, ,382 58,690 74,238 87,724 15,548 13, plus 12,436 15,641 20,619 28,143 4,978 7, Median Age Table 5: City of Pittsburgh Age Distribution (in years) Change from Change from % of Change from % of Change from Under 5 34,726 22,383 22,788 17, , ,200 68,445 50,591 48,901-17,854-1, ,672 28,966 23,941 23,294-5, ,032 38,067 27,751 26,167-10,316-1, , , ,340 95,730 8,539-15, ,203 42,281 31,439 41,082-10,842 9, ,876 27,301 15,906 14,142-11,395-1, ,151 25,851 19,787 12,606-6,064-7, ,765 41,702 37,426 26,483-4,276-10, ,571 20,485 22,286 21,362 1, plus 4,698 5,656 6,624 7, Median Age

15 The City of Pittsburgh is younger than the surrounding region (Allegheny County). The median age of the city population is increasing, but has not reached that of the county. The median age of Pittsburgh residents (35.5 years) is very similar to that of the United States as a whole, and is younger than the state of PA (38.0). Table 6: Population by Age - Female Age Categories for Females Allegheny County City of Pittsburgh ,156 34,721 11,176 8, ,193 38,610 10,154 9, ,073 40,548 9,328 9, ,160 39,916 13,470 12, ,352 37,861 18,380 17, ,801 38,593 15,869 12, ,283 43,097 15,641 11, ,269 49,714 13,833 11, ,016 54,439 11,080 12, ,846 50,560 8,942 11, ,840 43,412 8,319 9, ,043 34,191 8,777 7, ,969 29,781 11,181 7, ,550 29,787 11,723 7, ,838 34,199 10,587 8, ,321 31,427 8,954 7, ,841 23,373 5,910 5, ,166 20,435 4,833 5,284 Total Females 709, , , ,444 Table 7: Population by Age - Male Age Categories for Males Allegheny County City of Pittsburgh ,957 36,360 11,612 8, ,897 40,775 10,591 9, ,611 42,140 9,364 9, ,260 41,805 13,184 12, ,394 37,931 17,812 17, ,757 38,125 15,723 13, ,284 41,462 15,369 11, ,841 46,567 13,318 11, ,473 51,254 10,507 11, ,320 47,724 7,488 10, ,932 39,846 6,690 8, ,817 29,321 7,129 6, ,994 24,497 8,606 5, ,692 23,464 8,513 5, ,974 25,099 6,603 5, ,157 20,426 4,782 4, ,919 12,498 2,640 2, ,453 7,708 1,791 1,905 Total Males 626, , , ,119 15

16 The number of people in most age groups in both the Allegheny County and Pittsburgh populations are declining. During the 1990 census, there were 80,090 children aged 5-9. In 2000, this cohort, now aged 15-19, totaled 81,721. This small proportion of the population has shown a small increase. The population in their late 20 s to early 30 s seems to be declining, though. This may indicate that as the population enters the workforce, they are moving elsewhere to find employment. Table 8: Change in Residents Aged 17 and Younger Change from The number of children aged 17 years and younger have steadily declined over the past two decades in both the county and the city. The effect of this decrease in population among those 17 years and younger coupled with an increase in our elderly population can be seen when comparing the median age of the population between 1970 and In 1970 the median age of Allegheny County was 32.1 years. For 2000 the median age of county residents is nearly 40 years (39.6). The overall population of children in Allegheny County and the City of Pittsburgh has declined since The bigger change occurred between , but has declined slightly since 1990, as well. The City experienced a greater loss of children than the County as a whole. Table 9: Race/Ethnicity for County and City Percent change from Change from Percent change from Allegheny County -63, , City of Pittsburgh -17, , White African- American American Indian and Alaskan Native Asian Native Hawaiian and Other Pacific Islander Some other race There is more ethnic diversity within the City of Pittsburgh than the County of Allegheny as a whole. Two or more races Allegheny County 1,080, ,058 1,593 21, ,399 13,765 Percent 84.3% 12.4% 0.1% 1.7% 0.03% 0.3% 1.1% Pittsburgh 226,258 90, , ,218 5,403 Percent 67.6% 27.1% 0.2% 2.7% 0.03% 0.7% 1.6 % Living in Pittsburgh 20.9% 57.1% 39.4% 42.3% 33.1% 50.4% 39.3% Table 10: Hispanic Breakdown Hispanic Mexican Puerto Rican Cuban Central American All other Hispanic or Latino Allegheny County 11,166 3,568 2, ,326 Percent 0.9% 0.3% 0.2% 0.1% 0.03% 0.3% Pittsburgh 4,425 1, ,918 Percent 1.3% 0.4% 0.2% 0.1% 0.1% 0.5% % Living in Pittsburgh 39.6% 34.6% 36.5% 47.3% 39.2% 44.3% 16

17 Poverty Table 11: Allegheny County Poverty Levels by Age under plus total under 100% 17.4% 16.4% 12.2% 23.9% 9.2% 7.4% 9.0% 11.2% % 5.4% 5.2% 4.5% 6.2% 3.4% 2.7% 6.2% 4.3% % 10.7% 10.8% 9.8% 9.9% 8.0% 5.7% 13.3% 9.0% % 2.4% 2.9% 2.6% 2.4% 2.2% 1.6% 3.7% 2.4% 200% plus 64.1% 64.7% 70.8% 57.6% 77.4% 82.6% 67.9% 73.1% In Allegheny County, the age group with the greatest proportion of people living in poverty is the year olds; 23.9% of all within this age group live in poverty. The next most impoverished group is those under 5 years of age; 17.4% of them live in poverty. The group whose fewest members live in poverty is those aged In all age groups, most people have an income that exceeds 200% of the poverty limit. Table 12: Children Enrolled in Medicaid or CHIP Medicaid CHIP County State County State Dec , ,501 9, ,326 Dec , ,441 10, ,047 Dec , ,578 11, ,424 Dec , ,300 12, ,429 4yr change +6, ,799 +3, , one in 1 in 4 1 in 4 1 in 23 1 in 22 The number of children enrolled in the Childrens Health Insurance Program (CHIP) has increased by about 10% in the past 4 years. Similar enrollment increases were seen in the state and its urban areas. Table 13: Children Receiving TANF/AFDC per 100 children under 18 County State 1993 rate total 17, , rate rate change one in 1 in 15 1 in 18 TANF Numbers Reduced Welfare reform has indeed reduced child participation in Temporary Assistance to Needy Families (TANF), the cash assistance program that replaced Assistance to Families with Dependent Children(AFDC). Examination of the rates in Allegheny County show the highest rate of participation occurred in The lowest rate occurred in There was a sharp decline beginning in fiscal year , when welfare reform was implemented, and it is characterized by an average annual reduction of 1.6 marks this reduction. Thus, welfare reform appears to be reducing the TANF rolls. Poverty data are from The State of the Child in Pennsylvania 2004, Pennsylvania Partnerships for Children. 17

18 Uninsured/Underinsured In Pennsylvania there are three major insurance programs for those who do not have health insurance. Children s Health Insurance Program provides basic health insurance coverage for eligible children based on income. Adult Basic Program provides basic health insurance coverage for $30 per month to adults with income below 200% of the poverty level is a vital source of health insurance for the working poor, low middle income, and the unemployed. Medical Assistance provides health coverage for the very poor. According to Pennsylvania Partnerships for Children, it is estimated in Pennsylvania that about half of uninsured children, or almost 126,000 are eligible for medical assistance benefits but are not enrolled. More than one-fourth, or 73,000 children, are estimated to be eligible for the Children s Health Insurance Program but are not enrolled. The remaining 59,000 children are estimated to be ineligible for coverage under any government program. More children than ever before are eligible for CHIP. Increases in income guidelines, plus additional considerations for families work and child care expenses, bring more children into the program. In Allegheny County, it is estimated that a little over 6% of children do not have health insurance compared to 8.3% of Pennsylvania s three million children. Regarding adults without health insurance coverage, it is estimated that 1.38 million Pennsylvanians are health uninsured. According to Consumer Health Coalition, for many, Adult Basic is the only health insurance option. As a result, Adult Basic is an extremely popular program even though it provides bare bones coverage (physician and hospital coverage.) 54% of enrollees have earned income (47% under $10,000 income; 39%, $10,000 20,000, 14% over 20,000); 62% are female. Almost half enrolled because they lost employment, or the job stopped coverage or raised the cost of health insurance. According to Pennsylvania Health Law Project 39,121 are enrolled in the Adult Basic Insurance program, 100,000 are on the waiting list. The Allegheny County Health Department has reported data on health care coverage and utilization from a survey, which assessed behavioral health risks in adults of nearly 5,000 households countywide. The Behavioral Risk voluntary survey, the first of its kind in any local health department, was conducted in 2002 and gathered information in telephone calls to randomly selected households. Participants were questioned about health issues and personal behaviors known to have a strong effect on health. Sponsored by the Health Department and other local, state and national agencies, the survey was carried out by the University of Pittsburgh Graduate School of Public Health. According to this survey, ten percent of adults reported they had no health insurance coverage; lower than the statewide (13%) and nationwide (14%) percentages, based on 2002 state and national surveys. The countywide uninsured percentage was significantly higher for African-Americans (16%) than whites (10%) and for males (13%) than females (8%). The percentage of uninsured decreased with age: 18-29, 20%; 30-44, 9%; 45-64, 5%; (65+, Medicare-eligible); decreased with education: less than high school, 17%; high school, 14%; some college, 11%; college degree, 5%; and was significantly higher at the lowest income levels: under $15,000, 18%; $15,000-24,999, 25%; $25,000-49,999, 10%; $50,000-74,999, 7%; 75,000+, 2%. The main reasons given for not having health insurance were lost job or changed employers (35%) and could not afford to pay premiums (30%). 18

19 Twenty-one percent of the uninsured had no coverage in the last six months; 34% in the past year; 13% in the past two years; and 32% in the past two to five years or longer. Seven percent of adults said they needed to see a doctor in the past year but could not because of the cost. The percentage was significantly higher for African-Americans (11%) than whites (7%), but varied little between males (8%) and females (7%). It was drastically higher for the uninsured (37%) versus the insured (5%). The percentage who could not afford a doctor decreased with age; 18-29, 13%; 30-44, 8%; 45-64, 7%; 65+, 2%; differed significantly with education: less than high school, 6%; high school, 9%; some college, 8%; college degree, 4%; and decreased with income: less than $25,000, 14%; $15,000-24,999, 14%; $25,000-49,999, 5%; $50,000-74,999, 5%; $75,000+, 3%. The insured were significantly more likely than the uninsured to have an annual checkup, 83% versus 43%; have their blood cholesterol checked, 77% versus 45%; have a mammogram in the past year, 75% versus 49%; have a breast exam in the past year, 83% versus 71%; have a digital rectal exam for prostate cancer in the past year, 65% versus 34%; and have a sigmoidoscopy or colonoscopy for colorectal cancer in the past two years, 66% versus 48%. The uninsured were significantly more likely than the insured to suffer from severe mental illness, 19% versus 8%, based on responses indicating difficulties dealing with life situations. 19

20 Figure 1: Geographic Access to Health Care Access to medical care can be an issue, even in an urbanized area such as Pittsburgh. Some areas are not as densely populated with physicians as the more affluent areas of the county. Area of residence may present a barrier to accessing health care. Certain areas within Allegheny County have been identified as medically underserved areas or health professional shortage areas (HPSA). If a community has been designated as a HPSA, then this area has a shortage of primary care health professionals. The higher the score the greater the shortage. The following table presents the areas in Allegheny County that are currently (as of 2002) designated as a HPSA. 20

21 Table 14: Health Professional Shortage Areas HPSA Score HPSA Score Arlington Heights/St. Clair 19 Low Income Clairton 13 Hill District 17 McKees Rocks - Stowe 11 Manchester 17 South Pittsburgh-Homeless 10 West End 16 McKeesport 7 Homewood Brushton 15 North Braddock 7 Hazelwood 14 South Braddock 7 Health professional shortage areas are defined by three criteria: the proportion of the population below poverty level, the ratio of full-time primary care physicians to population, the infant mortality rate, and the fertility rate of the population. Based on these criteria, Allegheny County had nine areas federally designated as Health Professional Shortage Areas in 2000, and in 2002 had twelve areas, as seen above. Figure 2: Medicaid HMO Obstetric Providers & Patients 21

22 The map above displays information about Medicaid-HMO activity in Allegheny County, OB/GYN practices which participate in the 3 major MA-HMO plans, and women who received select obstetric services from these OB/GYNs and paid for by these plans. The 3 major plans are Gateway, MedPLUS+ and UPMC for You. The OB/GYN office street addresses were retrieved from their respective plan websites. Their addresses were geocoded using ArcGIS v8.3. Data for women were gleaned from Health Care Cost Containment Council (HC4) hospital discharge records using Data Bay Navigate v4.1 (formerly HCMAS). Resident street addresses were not available for women patients. Zipcode of residence was available and used to create dot-density maps. Dot-density maps represent quantities by a random pattern of dots within a polygonal feature, e.g. zipcode. The greater the value, the more dots are displayed. They convey quantities precisely but the random distribution within zipcode may be different from exact location of residence. The services selected for inclusion in this analysis were the following Diagnosis Related Groups: CESAREAN SECTION WITH CC CESAREAN SECTION WITH NO CC VAGINAL DELIVERY W COMPLICATING DIAG WI VAGINAL DELIVERY W/O COMPLICATING DIAG VAGINAL DELIVERY W STERILIZATION &/OR D&C VAGINAL DEL W OR PROC EXC STERIL &/OR D&C POSTPART & POST ABORTION DIAG W/O OR PROC POSTPART & POST ABORTION DIAG W OR PROC ECTOPIC PREGNANCY WITH NO CC THREATENED ABORTION WITH NO CC ABORTION W/O D&C WITH NO CC ABORTION W D&C, ASPIR CURET OR HYSTEROT FALSE LABOR WITH NO CC OTHER ANTEPARTUM DIAG W MEDICAL COMPLIC OTHER ANTEPARTUM DIAG W/O MEDICAL COMPL 22

23 Pregnant Women / Pregnancy Outcomes Births Table 15: Numbers of Births by Race: Mothers Less than 15 Years Old Mothers 15 to 19 Years Old Mothers 20 Years and Older Total Births by Race White 20 (0.04%) 2,698 (5.0%) 51,533 (95.0%) 54,252 Black 103 (0.8%) 2,904 (21.6%) 10,424 (77.6%) 13,433 Other 1 (0.04%) 68 (2.9%) 2,280 (97.1%) 2,349 All Races 126 (0.18%) 5,719 (8.1%) 64,408 (91.7%) 70,264 The table above highlights that between , more black women 19 years of age and younger delivered infants than other racial groups. For example, approximately 22% of all the births to black women occur to mothers who are 19 years old or younger compared to 5% of births to mothers in the same age group who are white. Other birth statistics provide additional comparisons between races. The numbers of low birth weight infants, births to mothers under 18 years of age, and no prenatal care during the first trimester are higher for blacks than whites. The following table provides an illustration for Of all new mothers less than 15 years old, 81.7% are black. Only 12.4% of the population of Allegheny County is black. African-Americans are disproportionately represented in this group of mothers less than age 15. Statistical testing confirmed (p<.05) that Allegheny County blacks have a higher proportion of their births occurring in mothers less than 15 or than whites or other races. Table 16: Selected Birth Statistics by Race 2002 Births to Mothers Under 18 years (%) No Prenatal Care First Trimester (%) Low Birthweight (%) Total Births by Race White 150 (1.5%) 579 (5.8%) 704 (6.9%) 10,134 Black 261 (10.0%) 426 (17.3%) 390 (15.0%) 2,605 All Races 420 (3.1%) 1,075 (8.3%) 1,144 (8.5%) 13,391 The table above suggests that public health efforts should be targeted towards black families because they are more likely to deliver low weight infants and start prenatal care late. Significantly (p<.05) more black residents (17.3%, ) than white residents (5.8%, ) go without prenatal care in the first trimester. In addition, black residents are more likely (p<.05) to have a low birthweight pregnancy outcome. Fifteen percent ( ) of black mothers have a low birthweight baby, while only 6.9% ( ) of whites have a low birthweight outcome. 23