Women’s Healthcare in Georgia

Brenda Fitzgerald, M.D.Commissioner and State Health Officer Georgia Department of Public Health

Senate Women's Adequate Healthcare Study Committee

September 14, 2015

IN 2013

MATERNAL MORTALITY

G E O R G I A RA N K S

# 50

N A T I O N A L LYAWHONN 2013

Maternal Mortality• The death of a woman during

pregnancy or up to one year after delivery Pregnancy-related death is a

death during or within one year of pregnancy that was caused by a complication of pregnancy

Pregnancy-associated death is the death of a woman from any cause while she is pregnant or within one year of pregnancy

Maternal Mortality Case Reviews

2012 Case Reviews• 122 cases• 60 pregnancy-

associated deaths

• 25 pregnancy-related deaths

• 37 not pregnant

Leading Causes ofPregnancy-Associated Death

Motor Vehicle Accidents

(MVA)

Homicides Suicides Drug Overdose0

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Leading Causes ofPregnancy-Related Death

Hemorrhage Hypertension Cardiac events Embolisms0

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Georgia Infant Mortality 2002-2006

• 5,743 babies in Georgia died before their first birthday

• Georgia’s Infant Mortality Rate was 15-20 percent higher than national average

• All live births grouped by one-mile squares, based on location of mothers’ residency at delivery

• Six significantly increased clusters of higher mortality rates identified

• The leading causes of death identified by cluster

Georgia Infant Mortality Clusters2002-2006

Georgia Infant Mortality Clusters 2002-2006

Atlanta Area

Augusta Area

Columbus Area

Macon Area

Savannah Area

Valdosta Area

11.8 15.1 15.8 14.7 13.3 17.5

Georgia IMR 2002-2006 = 8.4 deaths per 1,000 live births

Leading Causes of Infant Death

by ClusterA B C D E F

Congenital malformations, chromosomal abnormalities 2 3 2 2 3 3

Newborn affected by maternal complications of pregnancy 2

Respiratory distress of newborn 1

Short for gestational age, LBW, not otherwise classified 1 2 1 1 1 1

Sudden infant death syndrome 3 3 3 2

Objective 1: Strengthen the

Regional Perinatal System

Objective 2: Develop targeted

educational campaigns

Objective 3: Develop external

collaborations to support initiativesRPC standards of

care 17-Hydroxy P RegistryFetal/Infant mortality

review committeeMaternal mortality review

committeeCommunity-based home visitation

programs

Tobacco Cessation Safe Sleep

Breastfeeding and Baby-Friendly Hospitals & Businesses

Early Elective Deliveries

1115 Waiver Utilization to Improve Birth

Spacing & Conception Planning

Perinatal Quality Collaborative

Infant Mortality Reduction Strategic Plan (2012–2016)

LARC Placement

Obstetric Care Provider Shortage• 38 Georgia counties with NO OB services

• 20 Georgia counties with a deficit of OB services

Telehealth Goals• Increase access to care

Address Georgia’s health challenges▫Infant mortality▫Oral health▫Obesity and associated diseases

Connect Georgians with specialized care that may not exist in every community, i.e. monitoring of a high-risk pregnancy

• Increase capacity at DPH sites statewide

GA Early Elective Deliveries Reduced 39-week elective

deliveries • Public and private collaboration

Georgia Hospital Association March of Dimes GA OB/GYN Society GA Chapter of American Academy of Pediatrics

• 2009: 65%

Georgia Early Elective Deliveries

* As of October 1, 2013 Medicaid in Georgia no longer pays for early

elective deliveries

Source: Georgia Hospital Association

Quarter Rate1Q12 7.83%2Q12 6.32%

3Q12 5.81%

4Q12 4.60%

1Q13 3.51%

2Q13 3.11%

3Q13 3.35%

4Q13 1.88%*

1Q14 1.05%

2Q14 1.1%

3Q14 1.15%

4Q14 1.11%

2015% of

Hospitals Reporting

January 0.76% 87%February 0.63% 80%

March 0.44% 84%April 0.62% 74%May 0.79% 59%

Georgia Early Elective Deliveries

Source: Georgia Hospital Association

Georgia has been under the national 2% standard for the past 21 months

Georgia Infant Mortality RateAmerica’s Health Rankings

Georgia IMR

U.S. Rank

2012 7.7 442013 6.93 342014 6.6 31

Source: America’s Health Rankings 2014

48% DECREASE SINCE 1990

Cardiovascular Disease in Georgia

• Cardiovascular Disease (CVD) includes: heart disease, stroke, hypertension, atherosclerosis, and other diseases of the arteries or heart muscle

• Cardiovascular Disease in Georgia CVD is the leading cause of death 29 women die each day from CVD 4,012 women die annually from heart

disease 2,185 women die annually from

stroke Source: BRFSS 2013

Cost of Cardiovascular Disease in Georgia

• $6.1 billion annually $4.2 billion for heart disease

o Average charge per heart-related hospitalization $45,700

$940 million for strokeso Average charge per stroke-

related hospitalization $39,453

Obesity in Georgia• 3 million Georgians

are obese• Georgia's adult

obesity rate is 30%, up from 10% in 1990

• 66% of adults are either overweight or obese 73% males 59% females

• Obesity in women has increased 2.2% since 2011

Cost of Obesity in Georgia$2.5 billion annually

Direct healthcare costs Lost productivity Disability Death

• Estimated $10.8 billion by 2018 if

obesity rate continues to increase• Average hospital stay for obese individuals is 60% longer than for healthy weight individuals

Obesity in GeorgiaInterventions• Promote and

adopt healthy eating habits

• Increase physical activity

• Increase access to healthy food and physical activity in work place

• GA Shape• Power Up for 30

Diabetes in Georgia • Diagnosed diabetes is

9.7% compared to prevalence of undiagnosed diabetes at 6.5%

• Between 2000-2010 prevalence of diabetes increased from 6.8% to 9.7%

• 11.7% of Georgia women are diagnosed with diabetes

• Gestational diabetes during pregnancy causes increased blood sugar levels and risk of complication for mother and baby

Diabetes in GeorgiaDISTRICT TOTAL % FEMALE

%7-0 West Central (Columbus) 15.9 20.43-3 Clayton (Morrow) 14.5 16.79-2 Southeast (Waycross) 13.9 16.26-0 East Central (Augusta) 15.1 15.49-1 Coastal (Savannah) 11.8 15.21-1 Northwest (Rome) 13.5 14.58-2 Southwest (Albany) 11.6 14.43-5 DeKalb 11.0 13.58-1 South (Valdosta) 13.3 13.35-1 South Central (Dublin) 9.3 13.24-0 La Grange 11.6 12.2

Cost of Diabetes in Georgia

• $5.1 billion annually $3.3 billion direct medical

cost $1.8 billion loss of

productivity and sick days Does not account for

undiagnosed diabetes or those with prediabetes

Diabetes in GeorgiaInterventions• Increase the number of accredited

Diabetes Self-Management Education (DSME) sites in the state

• Increase the number of telehealth sites offering DSME programs

• Educate providers on the importance of referring patients DSME and diabetes prevention programs

Tobacco Use in Georgia Women 2011-2013

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

2011 2012 20130

5

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15

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21.4 20.218.5

14.0 14.3 12.8

White Females Black Females

Perc

ent

(%)

• Early death• Cancer

Women who smoke are 26 times more likely than non-smokers to develop lung cancer

Risk factor for cancer of the cervix, ovary, colon, kidney

• Increased risk of heart disease and stroke• Lung Damage

Chronic coughing, wheezing, trouble breathing, and long-term lung disease

• Reproductive health problems Trouble getting pregnant Bleeding, premature birth, and emergency C-

section Miscarriages, stillbirths, and low birth-weight

babies

Health Effects of Tobacco Use

Cost of Tobacco Use in Georgia

• $5.0 billion annually $1.8 billion direct medical

cost $3.2 billion loss of

productivity and sick days Tobacco use is the number

one preventable cause of death in Georgia

Tobacco Use in GeorgiaInterventions• Establish smoke free policies and social norms• Promote cessation and assist tobacco users to

quit• Prevent initiation of tobacco use• Enacting comprehensive smoke free policies• Fund hard hitting mass-media campaigns• Making cessation services fully accessible to

tobacco users

Georgia Tobacco Quitline• 24 hours a day, 7

days a week

• English: 1.877.270.STOP (1.877.270.7867)

• Spanish: 1.877.2NO.FUME (1.877.266.3863)

• Hearing Impaired, TTY Services: 1.877.777.6534

Cancer in Georgia • 44,000 new cases annually (all

sites) 23,000 men 21,000 women

• Breast cancer is the leading cause of cancer in Georgia women 6,410 new cases annually

• 400 new cases of cervical cancer annually

Cancer in Georgia2014 New Cancer Cases FemaleBreast 7,050Lung and Bronchus 3,130Colon and Rectum 2,080Uterine 1,200Melanoma 970Thyroid 850Non-Hodgkin Lymphoma 810Ovary 680Kidney and Renal Pelvis 620Pancreas 610Leukemia 480Cervical 400All Sites 23,170

Localized Regional Distant0

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Five-Year Survival by Stage at Di-agnosis, Breast Cancer, Females,

Georgia, 2005-2011NH Black NH White

% S

urvi

ving

5 Y

ears

% of tumors found at this stage

 Localize

dRegion

alDistan

tNH Black 52% 37% 9%

NH White 63% 30% 5%

Cancer Cost in Georgia• $3.7 billion annually

Direct medical costs• $243 million annually

Lost productivity and sick days

More than one million days • 15,150 cancer deaths in

Georgia annually 8,013 males 7,135 females

2012 BRFSS State Summary

Alzheimer’s Disease in Georgia• 120,000 Georgians currently

with Alzheimer’s disease• 160,000 Georgians by 2025

with Alzheimer’s disease • 63% of Georgians age 65+

with Alzheimer’s disease are women

• Women are twice as likely to develop Alzheimer's as breast cancer

• 12.6% of Georgia women age 45+ reported increased confusion or memory loss in the past year

2014 Alzheimer’s DiseaseFacts and Figures

Alzheimer’s Disease and Related Dementias Registry

Goals for Registry• Usable data in the preparation and

planning for aging population• Identify epidemiological trends• Bring awareness at state level to issues

that affect healthy aging• Inform stakeholders for planning and

future implementation needs• Improve urban and rural parity