 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Cynthia Ferre, MPH1, Jason Hsia, PhD2, Tonji Durant, PhD2, Vijaya K. Hogan, DrPH3, Indu Ahluwalia, MPH, PHD4, and Hal Morgenstern, PhD5. (1) Division of Reproductive Health, Centers for Disease Control & Prevention, 4770 Buford Highway, K-23, Atlanta, GA 30341, 770-488-6268, cdf1@cdc.gov, (2) Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., Mailstop K-21, Atlanta, GA 30341, (3) Division of Reproductive Health, CDC, 4770 Buford Hwy, NE MS K23, Atlanta, GA 30031, (4) Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K66, Atlanta, GA 30341-3717, (5) Department of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772
Public health surveillance data are designed for monitoring public health outcomes and associated risk factors. However, because surveillance data are not from longitudinal cohorts, new methods are needed for multivariate attributable risk analysis of changes in outcome prevalence and risk factor distributions over time. For example, between 1990 (n=40,412) and 1999 (n=41532), the preterm delivery (PTD, < 37 weeks gestation) rate decreased approximately 27% (from 18.3% to 13.4%) among singleton live births to non-Hispanic Black women in the state of Georgia. We used public use live birth data to estimate the impact of changes in selected risk factors on this trend. We calculated an adjusted attributable fraction for covariates (AFC) of the proportion of the difference in PTD rates between 1990 and 1999 attributable to the difference in the distribution of one or more PTD risk factors (demographic, maternal, and pregnancy factors). Multivariate results suggest that changes in maternal age and parity did not contribute to the decline in PTD. The adjusted AFCs indicate that changes in 1st trimester prenatal care entry explained 9.2% of the trend, smoking explained 2.2%, and maternal education explained 1.8%. These results should be interpreted with several limitations, such as small numbers, missing values, and the availability of PTD risk factors on birth certificates. AFC measures improve our understanding of how changes in risk factors, such as those related to health behaviors and care, may affect observed changes in health outcome prevalence and can be used to enhance prevention programs.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.