, Minnesota Maternal and Child Health Annual Report 29-213 THE CURRENT CONDITION OF MATERNAL AND CHILD HEALTH IN OLMSTED COUNTY Population Report
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, Minnesota Maternal and Child Health Annual Report 29-213 Updated April 27, 215 Public Health Services 21 Campus Drive SE Rochester, MN 5594 Questions regarding this report or requests for full data tables can be directed to: Vicky Kramer Kramer.vicky@co.olmsted.mn.us (57) 328-746 3
Table of Contents Introduction... 5 Executive Summary... 6 Birth Rates... 7 Socio-Economic & Demographic Characteristics... 1 Prenatal and Birth Outcomes... 15 Data Sources... 21 4
Introduction Improving the health of mothers, infants, and children is an important public health goal. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. The purpose of this report is to show the current condition of maternal and child health (MCH) indicators in Olmsted County. Each indicator presented has a definition, public health implication and, as well as comparisons to Minnesota, the United States and Healthy People 22 objectives (where applicable). Data by race and ethnicity is presented when available, and is presented in a five-year aggregate (29-213). Healthy People 22 provides science-based, 1-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors, empower individuals toward making informed health decisions, and measure the impact of prevention activities 1. The Healthy People MCH goal is to improve the health and well-being of women, infants, children, and families. The makeup of in terms of racial and ethnic diversity is comparable to overall Minnesota demographics, with approximately 85% of residents being white. The diversity within has increased rapidly from 2 to 211, with a 6% increase in residents of a minority racial/ethnic background. is one of the top ten counties in Minnesota in terms of having the highest minority population. Overall, within over 2, residents have a diverse racial/ethnic background. Between 2 and 21, the actual growth rate in minority groups in was 71.7%, significantly higher than the national growth rate of 21.8%. Females make up 51% of residents, of which 38.5% are of reproductive age (15-44). Most of the data related to and Minnesota was obtained from the Minnesota Department of Health Center for Health Statistics. United States information was obtained from the Centers for Disease Control & Prevention (CDC) Center for Health Statistics and the United States Census Bureau. There is a complete list of data sources at the end of this document. In 213, had a population of 149,226. includes the cities of Rochester, Byron, Stewartville, Eyota, Dover, Oronoco, and parts of Pine Island and Chatfield. From 29 to 213, there was an average of 2,158 births per year. Rochester, the county seat, is the largest city in Minnesota outside of the Minneapolis-St. Paul-Bloomington metropolitan area. is the eighth largest county in Minnesota. Over 7 of the County s population lives in the city of Rochester. 5
Executive Summary 6
Crude Birth Rates Birth Rates Crude births are the number of live births. It is called crude because it doesn t take into account age or sex differences among the population. Crude birth rate is the number of live births divided by the estimated population multiplied by 1,. The rate is presented as live births per 1, estimated population. # of Births 2,5 2, 1,5 1, Live Births 29-213 2,191 2,138 2,217 2,8 2,163 Crude birth rates can be used to measure the growth or decline of a population due to natural causes. 5 had 2,163 births in 213, 1% less than in 29 (2,191). Between 29 and 213, there was an average of 2,158 births per year. Birth rates among blacks and Asians are significantly higher than whites (73% and 44%, respectively). Hispanic birth rates are 41% higher than non-hispanics. Rate per 1, population 3 25 2 15 1 5 13.5 Birth Rates by Race & Ethnicity 29-213 23.4 19.5 14.6 2.6 Rate per 1, total population 18 16 14 12 1 8 6 4 2 Crude Birth Rates 29-213 OC MN US 14.8 7
Birth Rates Fertility Rates Fertility rate is the number of live births divided by the estimated number of females aged 15 to 44 multiplied by 1,. Because it is more specific, it is considered an improvement over the crude birth rate. This rate is also a measure of natural population growth due to natural causes. Fertility rate gives an indication of where the population may be growing naturally. The fertility rate (73.7) has declined 2% since 29 (75.5). Fertility rates for blacks are 5 higher than whites, with Asians being 12% higher than whites. Births per 1, Females Aged 15-44 9 8 7 6 5 4 3 2 1 Fertility Rates OC MN US 73.7 Fertility Rates by Race, 29-213 Births per 1, Females Aged 15-44 12 1 8 6 4 2 17.4 8.4 71.8 White Black Asian 8
Birth Rates Teen Birth Rates The teen birth rate is defined as the number of live births per 1, females 15 to 19 years old. Teenage childbearing can have long-term negative effects for both the mother and newborn. Babies born to teen mothers are at higher risk of being low-birth weight and preterm. They are also far more likely to be born into families with limited educational and economic resources, which function as barriers to future success. 2 Healthy People 22 has two family planning goals: reduce pregnancies among adolescent females aged 15 to 17 years by to 36.2 pregnancies per 1,; and reduce pregnancies among adolescent females aged 18 to 19 years by to 15.9 pregnancies per 1,. Births per 1, Females 15-19 6 5 4 3 2 1 Teen Birth Rates OC MN US 16.1 Between 29 and 213, all teen birth rates in the US decreased. had a 41% decrease compared to Minnesota (31%) and the US (32%). In 213, teen births accounted for 3% (69) of all births in, compared to 4% in Minnesota and 7% in the US. Although overall teen birth rates have declined, racial, ethnic and socioeconomic disparities remain. In the US, the non-hispanic black youth, Hispanic/Latino youth, and socioeconomically disadvantaged youth of any race or ethnicity experience the highest rates of teen pregnancy and childbirth. In, teen birth rates among blacks (34.9) are over two times higher than whites (16.), with Asian rates (23.2) being 45% higher than whites. Hispanic teen birth rates (76.7) are more than three and a half times higher than non-hispanic teens (21.2). Births per 1, Females 15-19 1 8 6 4 2 16. Teen Births by Race & Ethnicity 29-213 34.9 23.2 21.2 76.7 White Black Asian Non-Hispanic Hispanic 9
Socio-Economic & Demographic Characteristics Child Poverty Rates Child poverty is defined as the percentage of children under the age of 18 living below the federal poverty level. Poverty contributes to a variety of health problems. Poverty is the single greatest threat to the well-being of children, often resulting in a lack of basic health care, poor nutrition, inadequate housing, lack of transportation, and compromised child development. According to national data, overweight and obesity is more prevalent among low-income children. As our proportion in poverty rises, so will obesity related challenges. Children who grow up in poverty are very likely to remain in poverty as adults. Poverty rates for children in are two times lower than the national level, yet about 3, children in are living in poverty and 5 out of every 1 black children are living in poverty. Outside the Minneapolis-St. Paul-Bloomington metropolitan area, has the third highest free and reduced lunch enrollment in schools, which is an indicator of low socioeconomic status. The percentage of children receiving free or reduce meals (34%) has increased by 23% since 29 (27.4%). % of Total Children Aged -17 % Total Population 25% 2 15% 5% 6 5 4 3 2 Children (-17) Living in Poverty OC MN US 1.3% Children (-17) Living in Poverty by Race, 29-213 6% 54% 4% White Black Asian 1
Socio-Economic & Demographic Characteristics Out-of-Wedlock Births Out-of-Wedlock refers to women who are not married at the time of conception, the time of delivery, or any time between conception and delivery. The rate is the number of live births to unmarried mothers expressed as a percent of total live births. Increases in births to unmarried women are among the many changes in American society that have affected family structure and economic security to children. Children of unmarried mothers are at higher risk of having adverse birth outcomes, such as low birth weight and infant mortality and are more likely to live in poverty than children of married mothers. Data has revealed a significant link between income and out-of-wedlock births. From 29 (28%) to 213 (25%), there was an 11% decreased in births to unmarried women in. This is 19% lower than Minnesota (33%) and 35% lower than the US (41%). From 29 to 213, births to black unmarried women (43%) were 78% higher than to white unmarried women (24%). Hispanic women were two times more likely to be unmarried than non-hispanic. % of Total Children Aged -17 % of Total Births 5 4 3 2 6 5 4 3 2 Out-of-Wedlock Births OC MN US 25.1% 24. Out-of-Wedlock Births by Race & Ethnicity 29-213 42.8% 28.6% 25.2% 51.7% White Black Asian Non-Hispanic Hispanic 11
Socio-Economic & Demographic Characteristics Maternal Education For this report, maternal education is defined as the level of education achieved before delivery, with the following categories: less than high school, four years of high school, 4 years of college, or college +. Women who are better educated are more likely to engage in healthful behaviors such as supplementing prenatally with folic acid, seeking early prenatal care, attending prenatal education and exclusively breastfeeding for six months. The rates of preterm birth, small for gestational age, stillbirth, infant mortality, smoking, exposure to secondhand smoke and alcohol consumption during pregnancy all decrease as the level of the mother s education increases. 3 The majority of women (75%) giving birth in have a four-year college degree or higher. Maternal Education 29-213 < 4 yrs HS 4 yrs HS College College+ 2 9% 16% Maternal Age Between 29 and 213, 67% of births in were to women aged 25 to 34. % of Total Births 4 35% 3 25% 2 15% 5%. Average Maternal Age 29-213 3.8% 15.6% 34.5% 32.7% 11.2% 2.3% <15 15-19 2-24 25-29 3-34 35-39 4+ Age 55% 12
Socio-Economic & Demographic Characteristics Maternal Race and Ethnicity s maternal race and ethnicity makeup has remained consistent for the last five years with 81% white, 9% black, and 8% Asian. Hispanic ethnicity makes up 6% of the maternal population. 1 9 8 7 6 5 4 3 2 81% Maternal Race & Ethnicity, 29-213 9% 8% 94% White Black Asian Non-Hispanic Hispanic 6% WIC WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. WIC provides nutritious foods, nutrition counseling, and referrals to health counseling, health care and social services. WIC participants include pregnant, postpartum and breastfeeding women, infants and children up to age 5 who are at nutritional risk and meet income guidelines. Prenatal WIC participants have been shown to have longer pregnancies, fewer premature births, lower incidence of low birth weight babies, fewer infant deaths, a greater likelihood of receiving prenatal care, and savings in health care costs than those not receiving WIC. The WIC Program has seen a 17% decrease in participation since 29. # of Participants 7, 6, 5, 4, 3, 2, 1, Women, Infants & Children Participating in WIC 6,731 6,494 6,421 5,85 5,583 13
Socio-Economic & Demographic Characteristics Non-Smokers Women who did not smoke during pregnancy, presented as a percentage of all live births. Women who smoke during pregnancy are at risk for premature birth, pregnancy complications, low-birth weight infants, still birth and a 4 higher rate of infant mortality than infants born to nonsmokers. Smoking is the most preventable cause of low birth weight in babies, and low birth weight is closely linked to infant mortality. Smoking also puts the babies at risk for sudden infant death syndrome (SIDS), poor lung development, asthma and respiratory infections. Healthy People 22 Objective Increase the percentage of females delivering a live birth that report abstaining from smoking cigarettes during pregnancy by to 98.6%. From 29 to 213, an average of 92% of women in reported that they did not smoke during pregnancy, which is below the Healthy People 22 goal of 98.6%. Minnesota and the United States had fewer women (89%) who did not smoke during pregnancy. % of Total Live Births 1 Women Who Did Not Smoke During Pregnancy, 29-213 8 6 4 2 OC MN US HP22 91.5% 14
Prenatal and Birth Outcomes Initiation of Prenatal Care Prenatal care begins when a physician or other health professional first examines and/or counsels pregnant women. Verification of pregnancy alone is not prenatal care. The rate presented for this analysis is the percent of live births where the mother received prenatal care in the first trimester. Prenatal health care received in the first three months of pregnancy for assessments, risk screening, health education, and referrals to community resources help prevent problems in the unborn baby and mother. Starting prenatal care early is associated with improved rates of low birth weight and infant mortality. Healthy People 22 Objective Increase the number of females delivering a live birth that receive prenatal care beginning in the first trimester by to 77.9%. In 213, 86% of women in received prenatal care in the first trimester; a 5% decrease from 29 (91%). Although there was a decrease, has a higher rate than Minnesota (83%) and the US (64%) and has exceeded the Healthy People 22 goal (77.9%). White women (92%) were more likely to obtain prenatal care in the first trimester than blacks (78%) and Asians (82%). % of Total Live Births 1 9 8 7 6 5 4 3 2 Women Who Received Prenatal Care in the First Trimester OC MN US HP22 86.4% Women Who Received Prenatal Care in the First Trimester by Race & Ethnicity 29-213 % of Total LIve Births 1 9 8 7 6 5 4 3 2 91.6% 9. 78.2% 81.6% 78. 15 White Black Asian Non-Hispanic Hispanic
Prenatal and Birth Outcomes Low Birth Weight Low-birth weight infants are those born weighing less than 2,5 grams, or about 5.5 pounds. Some are born prematurely, some are full-term but small for their gestational age and some are both premature and small. The rate is presented as a percent of all live births for both multiple and singleton infants. Low-birth weight infants are at a higher risk of death or long-term illness and disability than are infants of normal weight. Birth weight is one of the most important predictors of an infant s subsequent health and survival. Healthy People 22 Objective Reduce the percentage of all low-birth weight infants, including multiples, by 5% to 7.8%. From 29 to 213, (6.1%) and Minnesota (6.5%) had fewer low-birth weight infants compared to the United States (8.8%), and exceeded the Healthy People 22 goal of 7.8%. Blacks had 43% more low-birth infants than whites, with Asians being 86% higher than whites. Hispanics had 18% more low-birth infants than non-hispanics. When excluding multiples, the low birth weight rate dropped to 5%. % of Total of Singleton Births 12% 8% 6% 4% 2% 5.6% Low Birth Weight Infants by Race & Ethnicity 29-213 (Includes Multiples) 8. 1.4% 6.1% HP 22 7.2% % of Total Live Births % of Total Single Live Births 9% 8% 7% 6% 5% 9% 8% 7% 6% 5% 4% 3% Low Birth Weight Infants (Includes Multiples) OC MN US HP22 5.7% Low Birth Weight Infants Singletons Only OC MN US HP22 28 16 4.7% White Black Asian Non-Hisp Hispan
Prenatal and Birth Outcomes Prematurity Premature infants are those born before 37 weeks gestation. The rate is presented as a percent of live births for both multiple and single births. Premature babies may need to stay in the hospital longer. Some are born before vital parts of the body have fully formed. Prematurity may cause different problems in their body systems, including problems with feeding, breathing or staying warm. Possible longterm effects may include: problems with learning; vision and hearing loss; feeding and digestive problems; respiratory problems; cerebral palsy; and/or autism. Healthy People 22 Objective Reduce percent of all preterm births, including multiples by to 11.4%. In, the rate of premature births has decreased by 17% since 29. From 29 to 213, an average of 9% of all infants in were born prematurely, 29% lower than the United States (12.4%) and 24% lower than the Healthy People 22 goal (11.4%). Premature births to black mothers are 35% higher than in white mothers. Prematurity by Race & Ethnicity 2-213 (Includes Multiples) % of Singleton Live Births % of Total Live Births 12% 8% 6% 4% 2% 14% 12% 8% 6% 4% 2% Prematurity (Singletons Only) OC MN US HP22 Prematurity (Singletons Only) OC MN US HP22 8. 7.7% 14% 12% 11.5% HP22 % of Total Births 8% 6% 8.4% 9.4% 8.7% 9.2% 4% 2% 17 White Black Asian Non-Hispanic Hispanic
Prenatal and Birth Outcomes Singleton Births Singleton births are defined as an infant born singly, rather than one of multiple birth (i.e., twins, triplets). Singleton births are likely to have fewer birth complications. Multiple births are at greater risk of prematurity and low-birth weight babies. Medical conditions such as preeclampsia, gestational diabetes, placental problems and fetal growth problems are more likely. Being part of a multiple birth can also be associated with long-term health problems in infants. Developmental delays and cerebral palsy occur more commonly in twins than in single births. From 29 to 213, the percentage of singleton births remained steady at 96.6% in as well as Minnesota and the US. There are not significant differences in singleton births race and ethnicity. % of Total Births 1 9 8 7 6 5 4 3 2 Singleton Births by Race & Ethnicity 29-213 96.5% 96.9% 96.5% 96.4% 94.8% White Black Asian Non-Hisp Hispanic Method of Delivery For this report the definition of method of delivery is percent of cesarean births. Cesarean delivery involves major abdominal surgery and is associated with higher rates of surgical complications and maternal rehospitalization Healthy People 22 Objectives Reduce cesarean births among low-risk (full-term, singleton, and vertex presentation) women by to 23.9%. From 29 to 213, there were 13% less cesarean births in Olmsted County (24%) compared to Minnesota (27%) and 37% less cesarean births than the US (33%). Black women have a 15% higher rate of cesarean deliveries than white women; Asian women have a 5% lower rate than white women. % of All Live Births 4 35% 3 25% 2 15% 5% Cesarean Births OC MN US HP22 25. 18
Prenatal and Birth Outcomes Infant Mortality Rates Infant mortality rate is presented as live births dying before their first birthday per 1, live births. For this assessment, infant deaths were combined across five years to create a more stable rate due to local infant deaths fluctuating from year to year. Infant mortality rates are an important measure of the well-being of infants, children and pregnant women because it is associated with many factors including the health of the mother, quality and access to care for mother and infant, socioeconomic conditions and public health practices. Infant mortality is often considered preventable and thus can be influenced by various education and care programs. Healthy People 22 Objective Reduce infant mortality rate in the U.S. by to 6 deaths per 1, live births. From 29 to 213, there were 62 infant deaths in an average of 12 per year. s infant mortality rate (5.7) is 19% higher than Minnesota rates (4.8), 5% higher than the Healthy People 22 goal (6.), and 6.5% higher than the US (6.1). Black infant mortality rates are almost two times higher than white rates. Infant Deaths 2 18 16 14 12 1 8 6 4 2 Infant Deaths 29-213 5 Infant Deaths per 1, live births Infant Deaths per 1, live births 7 6 5 4 3 2 1 12 1 8 6 4 2 5.7 Infant Mortality Rates 29-213 OC MN US 5.7 4.8 6.1 OC MN US Infant Mortality Rates by Race & Ethnicity, 29-213 1.8 7. White Black Asian Non-Hispanic Hispanic 6. 3.3 19 HP 22
Prenatal and Birth Outcomes 6 5 4 3 2 1 Child Maltreatment For this report, child maltreatment is defined as the number of child protection (CP) reports and assessments made by Community Services. Child abuse and neglect have an impact far beyond the isolated event. Children who have been abused or neglected are at greater risk for injury, poor health, and emotional-behavioral problems. Society suffers an economic burden, whether from increased health care costs, mental health services, additional educational services, or correctional services. The Adverse Childhood Experience (ACE) Study is an investigation to assess associations between childhood maltreatment and later-life health and well-being. The study is collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente s Health Appraisal Clinic in San Diego. More than 17, Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction 2. The ACE Study findings suggest that certain experiences, including abuse and neglect, are major risk factors for the leading causes of illness and death, as well as poor quality of life, in the United States. 427 Number of Child Protection Reports Assessed or Investigated 484 476 485 518 In, reports involving substantial child endangerment or family assessment responses which identify a serious threat to child safety receive a Family Investigation (FI). Investigations occur for cases involving egregious harm of a child or sexual abuse. All other child protection reports require a Family Assessment (FA). FA is the preferred approach for child protection (CP) response in accordance with MN statue. It allows for a focus on safety and determining a need for services without making a determination of maltreatment. In, if the child was within sight or sound of domestic violence, the assessment will be conducted by the Domestic Violence Response Team. In 213, Minnesota assessed 19,62 reports of maltreatment. Of these reports, 72% received a Family Assessment response. In 213, Olmsted County assessed 1,945 reports of child maltreatment. Of these reports, 34% were referred to the Review, Evaluate and Direct (R.E.D.) team due to concerns of child maltreatment and 84% received a child protection assessment or investigation. In both and Minnesota, the most common allegation of maltreatment was for non-medical neglect (57%; 59%), followed by physical abuse (32%; 31%). A report may include allegations of different maltreatment types. 1 9 8 7 6 5 4 3 2 Assessments/Investigations by Maltreatment Type 213 Neglect Physical Abuse Sexual Abuse 11.5% 1.2% 31.7% 31. 56.9% 58.8% OC MN 2
Data Sources Data Sources 2 Centers for Disease Control & Prevention (CDC) Center for Health Statistics The Annie E. Casey Foundation Kids Count Data Center 4 Minnesota Department of Human Services 1 Healthy People 22 Minnesota Department of Health Center for Statistics Child Protection Services 211 Annual Report 3 Simcoe Muskoka District Health Unit Health Stats United States Center for Health Statistics United States Census Bureau United States Department of Agriculture 21
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