back to the future perinatal outcomes in latinos n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Back to the Future: Perinatal Outcomes in Latinos PowerPoint Presentation
Download Presentation
Back to the Future: Perinatal Outcomes in Latinos

Loading in 2 Seconds...

play fullscreen
1 / 51

Back to the Future: Perinatal Outcomes in Latinos - PowerPoint PPT Presentation


  • 70 Views
  • Uploaded on

Back to the Future: Perinatal Outcomes in Latinos. Elena Fuentes-Afflick, MD, MPH San Francisco General Hospital University of California, San Francisco. Disclosures. None. Objectives.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Back to the Future: Perinatal Outcomes in Latinos' - idola-yang


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
back to the future perinatal outcomes in latinos

Back to the Future: Perinatal Outcomes in Latinos

Elena Fuentes-Afflick, MD, MPH

San Francisco General Hospital

University of California, San Francisco

objectives
Objectives
  • To review perinatal statistics for infant mortality, low birth weight, and prematurity in Latinos.
  • To identify areas for future research in perinatal outcomes in Latinos.
us population
US population

Census Bureau

births in the us 1990 2005
Births in the US, 1990-2005

National vital statistics reports, 2009

latino births in the us 1990 2005
Latino births in the US (%), 1990-2005

National vital statistics reports, 2009

us births by ethnicity 2006
US births (%), by ethnicity: 2006

National Center for Health Statistics, 2009

infant mortality 1940 1995
Infant mortality: 1940-1995

National Center for Health Statistics

infant mortality rate 1995 2005
Infant mortality rate: 1995-2005

National Center for Health Statistics

slide10

Neonatal mortality rate: Texas, 1970-9

Powell-Griner and Streck, Am J Public Health 1982

slide11
“We tentatively conclude from our study that the low neonatal mortality rates observed in Texas among the Spanish surname population are due in part to underreporting of neonatal deaths.”

Powell-Griner and Streck, Am J Public Health 1982

infant mortality harris county texas 1974 75
Infant mortality: Harris County Texas, 1974-75

Selby et al, Am J Public Health 1984

slide13
“These consistently paradoxical findings lead us to conclude that the Spanish surname infant mortality rate is not a valid indicator of health status for the Mexican American population of Harris County, Texas.”

Selby et al, Am J Public Health 1984

infant mortality rate by ethnicity ca 1990 93
Infant mortality rate, by ethnicity: CA 1990-93

Hessol NA, Fuentes-Afflick E, Ann Epidemiol 2000

odds of infant death by ethnicity
Odds of infant death, by ethnicity

Hessol NA, Fuentes-Afflick E, Ann Epidemiol 2000

causes of infant mortality
Causes of infant mortality

Hessol NA, Fuentes-Afflick E, Ann Epidemiol 2000

slide18
Population-based indicators of health
  • Low birth weight and prematurity are significant risk factors for infant mortality
  • Low birth weight and prematurity are associated with neurologic impairment, cerebral palsy, learning differences
low birth weight and prematurity us 2005
Low birth weight and prematurity: US, 2005

National Center for Health Statistics, 2008

low birth weight in the us
Low birth weight in the US

Healthy People 2010 goal

www.nchs.gov

low birth weight ca 1981
Low birth weight: CA, 1981

Williams et al, Am J Public Health 1986

low birth weight 32 studies
Low birth weight: 32 studies

Fuentes-Afflick E and Lurie P, Arch Pediatr Adolesc Med 1997

low birth weight among latina and white women in ca 1992
Low birth weight among Latina and White women in CA, 1992

Fuentes-Afflick E, Hessol NA, Perez-Stable EJ, Arch Pediatr Adolesc Med 1999

low birth weight latinas in ca 1992
Low birth weight: Latinas in CA, 1992

*

*

Fuentes-Afflick E, Hessol NA, Perez-Stable EJ, Arch Pediatr Adolesc Med 1999

slide26

Nutrition/

Diet

Behavioral

Social Support

Cultural

Perinatal

Outcomes

Community

Obstetric

Reproductive

Medical

Healthy Immigrant

Artifact

behavioral factors
Behavioral factors

Latina women have lower rates of behavioral risk factors (tobacco and alcohol use) than African American or White women

Foreign-born women generally have lower rates of tobacco and alcohol use than US-born women

nutrition obesity
Nutrition - Obesity

http://wellroundedmama.blogspot.com

medical factors
Medical factors
  • Are Latina women healthier than women of other ethnic groups?
  • Are immigrant Latinas healthier than women in their population of origin?
  • Are immigrant Latinas healthier than women in the receiving population?
obstetric reproductive
Obstetric / Reproductive
  • Interpregnancy interval?
  • Do Latina women have a reproductive advantage?
summary
Summary
  • Latina women have low rates of infant mortality, low birth weight, and prematurity
  • We do not understand why Latina women have such favorable perinatal outcomes
objectives1
Objectives
  • 1. To review perinatal statistics for infant mortality, low birth weight, and prematurity in Latinos.
  • 2. To identify areas for future research in perinatal outcomes in Latinos.
acculturation
Acculturation

“… the process by which immigrants adopt the attitudes, values, customs, beliefs and behaviors of a new culture.”

Abraido-Lanza A et al, AJPH 2005

last names in the us 2009
Last names in the US, 2009

#1 Smith

#2 Johnson

#3 Williams

#4 Brown

#5 Jones

#8 Garcia

#9 Rodriguez

Census Bureau

foreign born childbearing women us 2005
Foreign-born childbearing women: US, 2005

National Center for Health Statistics

low birth weight by birthplace latina women in ca 1992
Low birth weight, by birthplace: Latina women in CA, 1992

VLBW

OR 0.92 (0.80-1.07)

MLBW*

OR 0.91 (0.86-0.96)

Fuentes-Afflick E, Hessol NA, Perez-Stable EJ, Arch Pediatr Adolesc Med 1998

infant mortality by birthplace latina women ca 1990 93
Infant mortality, by birthplace: Latina women CA, 1990-93

Unadjusted

OR 1.08 (1.03-1.13)*

Adjusted

OR 0.88 (0.80-0.97)*

Hessol NA, Fuentes-Afflick E, Ann Epidemiol 2000

two dimensions of the epidemiologic paradox
Two dimensions of the epidemiologicparadox

Latina women have surprisingly favorable perinatal outcomes relative to African American and White women

Foreign-born Latinas have surprisingly favorable perinatal outcomes relative to US-born women

slide44

Implications of the epidemiologic paradox

Risk factor models – one size fits all?

Interventions – tailored? Universal?

Protective factors versus risk factors

community factors
Community factors

“The paradox of Hispanic health represents a group-level correlation between ethnicity and mortality that cannot be explained in terms of an individual-level model.”

Scribner R, Am J Public Health 1996

lifecourse approach
Lifecourse approach
  • Demographic risk factors
  • Medical/health status
  • Obstetric/reproductive factors
promising areas
Promising areas
  • Acculturation
  • Prematurity
  • Interpregnancy interval
challenging areas
Challenging areas
  • Methodologic and challenges
  • Body mass, maternal
  • Paternal factors
  • Community-level factors
  • Acculturation ‘web’