IV. Health Status Indicators

Information about a community is crucial to understanding its health status. It is well known that disparities in health status exist between various ethnic and racial populations. In addition, poverty and near-poverty appear as underlying elements of many health problems. This section will examine various health status indicators for the region which are extracted from public use state data files. Most of these indicators will be compared with State rates to allow a broader context and understanding of the region’s health. Where there is a significant difference noted between the two, additional information by subarea will be provided. (Note: In Del Norte County, health data from zip code 95532, Pelican Bay State Prison, was excluded from calculations of health status indicators.)

A. Birth Characteristics

Birth Rate: Between 1990 and 1995, the Humboldt/Del Norte Region experienced a decline in the number of births, from a high of 2,196 in 1990 to a low of 1,882 in 1995, a 17% decrease. This mirrors the trend in declining numbers of births seen throughout California in this same time period. This drop in births in California is attributed to two factors: falling birth rates and a changing age structure of the population. As a large number of women associated with the baby boom cohort moved out of the child-bearing years, a smaller group followed, resulting in fewer births. These factors may also explain the decline in Humboldt/Del Norte. The numbers of births are expected to rise again in California around 2001, peaking in 2006, when a larger number of women reach primary child-bearing years.¹ Throughout this period, however, the Humboldt/Del Norte region has experienced a significantly lower rate of births per 1,000 population than for all of California. This in large part can be explained by the differing ethnic and racial composition of the region when compared with California. Table 4.1 and Exhibit 4.1, provide the specific data on birth and birth rates.

Exhibit 4.1: Births Trended

Source: Improved Perinatal Outcome Data Management 1990-1995, CA Vital Statistics, 1985

Table S.4.1 provides specific information about regional birth rates by subarea for the time period of 1990 to 1995. It is noted that the Eastern Humboldt sub-area and Southern Humboldt sub-area experienced the highest overall birth rates in the region while the Arcata/Northern Humboldt Subareas had the lowest birth rates. (Note: Births are reported by zip code. In 1995 a new zip code was introduced for the McKinleyville area resulting in a shift of the number of births which in previous years had been reported in the Arcata subarea to the Northern Humboldt subarea in 1995).

Births by Age of Mother: Table 4.2 compares births by age categories for the Humboldt/Del Norte region and California. While the large majority of births in both the region and California are to women between the ages of 20 and 34, Humboldt/Del Norte had a higher percentage of births to women under the age of 20 and a lower percentage of births to women over 35 years of age.

Births by Ethnicity/Race of Mother: The preponderance of births in the Humboldt/Del Norte region are to Non-Hispanic White women. In 1995, 77.3% of all women who gave birth were Non-Hispanic Whites. Table 4.3 on the following page provides a comparison between the region and California. Table S.4.3-1 compares not only the percentage of births but also the birth rate by ethnicity and race for both the region and the State.

Table S.4.3-1: Percentage of Births and Crude Birth Rate by Ethnicity/Race
Humboldt, Del Norte, and California, 1994

% of Births Crude Birth Rate per 1,000 population Race/Ethnicity Humboldt Del Norte California Humboldt Del Norte California Non-Hispanic White 78.5% 71.9% 36.0% 11.3 11.7 11.6 Hispanic 8.4% 12.0% 45.2% 14.5 7.0 26.3 African American 1.3% 0.6% 7.4% 10.7 1.1 18.4 Native American 8.2% 10.9% 0.5% 18.7 13.8 9.7 Southeast Asian 0.6% 0.3% 2.0% 16.2 10.7 24.3 Other Asian 1.9% 2.9% 4.3% 17.7 26.3 13.4 All Other 1.0% 1.5% 4.1% 63.1 23.4 24.5

Source: Improved Perinatal Outcomes Data Management, 1994

From this table, it appears that the lower birth rate in the region can be attributed in large part to the difference in its ethnic composition. Not only do Non-Hispanic White mothers account for 77% of all births in the area, compared to 36% of all California, but the crude birth rate for this group of mothers is only 11.3 for Humboldt County and 11.7 for Del Norte County. In contrast, the ethnic/racial group which accounts for the largest percentage of births in California are Hispanic women, who have a birth rate of 26.3 per 1,000 population. It is also noted that other ethnic/racial groups in the Humboldt/Del Norte region have birth rates which vary from the state averages. This includes lower birth rates for Hispanic mothers in Humboldt/Del Norte and higher birth rates for Native American women in the two county area.

Prenatal Care: Early prenatal care has been shown to improve birth outcomes and is thus considered an important marker of health status. The Year 2000 National Objective for this indicator (from the Healthy People National Health Promotion and Disease Prevention Objectives) is for no greater than 10% of women to begin prenatal care after the first trimester.

As illustrated in Table S.4.3-2, both Humboldt and Del Norte County had statistically significant rates of late entry into prenatal care when compared to the state. During this three year time period, Humboldt County ranked 28th when compared to all other California counties and Del Norte County ranked 47th.

Teenage Births: A major problem in California and throughout the nation is the problem of teen pregnancy and birth. The social and financial costs are high. Among the adverse consequences of teen births are lifelong loss of schooling, a higher risk of single motherhood and more likely dependency on welfare. Table 4.4 and Exhibit 4.2 illustrate the number of births to teenage mothers as a percentage of the total number of births in Humboldt/Del Norte Counties compared to California. Although the number of births to teenage mothers as a percentage of all births is higher in Humboldt/Del Norte than in California, it can be misleading when viewed by itself. Therefore, Table S4.4-1 illustrates the rate at which births are occurring to teenage mothers. The rate is calculated as births per 1,000 female teens under 20.

Exhibit 4.2: 1995 Teen Births as a Percentage of the Total

Source: Improved Perinatal Outcome Data Management, 1990-1995

Table S4.4-1: Humboldt/Del Norte Births and Birth Rates to Teenage Mothers by Region

1990 1992 1995 # Teen Births Rate # Teen Births Rate # Teen Births Rate Del Norte 64 42.3 66 37.2 63 27.8 Northern Humboldt 23 20.7 21 19.7 31 25.8 Eastern Humboldt 19 49.6 23 50.7 22 44.9 Arcata 34 21.3 29 19.9 24 14.3 Eureka 94 30.9 107 31.8 98 26.8 Eel River Valley 44 29.4 37 21.5 38 21.2 Southern Humboldt 8 24.1 10 23.9 6 14.2 Service Area 286 30.6 304 28.5 297 24.0 California 71,415 36.4 71,257 35.4 68,307 31.5

Source: Improved Perinatal Outcome Data Management

This table reveals that while Humboldt and Del Norte Counties have a higher percentage of births to teenage moms, they in fact have a significantly lower teenage birth rate when compared to California. However, there are several sub-areas in which higher teenage birth rates are recorded. These include the Eastern Humboldt sub-area, where the teen birth rate is significantly higher than both the region and the State, and Del Norte County. The Northern Humboldt/Arcata sub-areas demonstrate the lowest rates of teenage birth, with the same increase/decrease in 1995 rates presumably attributed to the introduction of a new zip code. Caution should be taken in interpretation of the data from some of the subareas with low numbers as they are too low to be statistically reliable. As a final note, the Year 2000 National Objective for teen birth rate is less than 50 births per 1,000 female teenagers, which this region already meets.

Table 4.5 illustrates the ethnic/racial distribution of teen births. Both percentages and rates are included in this table. Non-Hispanic White teen births account for 70% of all teenage births in the region. Humboldt/Del Norte Native American teenage mothers had a significantly higher birth rate at 32.0 per 1,000 population compared to California Native American teenage mothers at 14.8.

Out-of-Wedlock Births: Out-of-Wedlock births can be considered another risk factor for new mothers in terms of higher likelihood of single parenthood and association with welfare or poverty status. However, because marital status is not included as a data item on birth certificates, a baby is consider to be an "out-of-wedlock" birth when the mother and father have different last names on the birth certificate or the name of the father is not provided. Obviously, this procedure tends to overestimate the number of births which are truly out-of-wedlock. Thus, the following statistics should be used with caution.

In 1995, there were 609 births in Humboldt/Del Norte Counties which were designated as out-of-wedlock. This accounts for 32% of all births as depicted in Table 4.6. This is exactly the same percentage as the State average. The percentage of out-of-wedlock births decreased with age, as shown in Exhibit 4.3. Nearly one out of every three births to a Non-Hispanic White mother is designated as out-of-wedlock and account for 24.4% of all births in Humboldt/Del Norte as shown in Table 4.7.

Exhibit 4.3: 1995 Percentage of Births Out-of-Wedlock by Age of Mother

exhibits/ex.4.3.gif

Table 4.7: 1995 Out-of-Wedlock Births by Ethnicity/Race of Mother

Humboldt / Del Norte Counties California # of Births % of Total # of Births % of Total African American 6 42.9% 24,697 61.7% Asian 3 23.1% 2,964 23.9% Non Hispanic White 461 31.7% 44,950 22.9% Hispanic 47 29.0% 97,886 38.7% Native American 90 53.3% 1,366 49.2% Pacific Islander 2 9.5% 4,523 20.5%

Source: Improved Perinatal Outcome Data Management, 1995

Low-Birth Weight: The Year 2000 National Objective for low-birthweight babies is 5% for the total population of babies and with a target of 9% for African-American babies. Low birth weight is defined as weighing less than 2500 grams or approximately 5.5 pounds. The occurrence of low birth weight varies by maternal age, race and ethnicity, adequacy of prenatal care, and socioeconomic status, as well as by parity, the existence of complicating medical conditions and whether a birth is a single or multiple. Low birth weight is considered an important risk factor for poor birth outcomes.

As illustrated in Table 4.8, fewer percentages of babies are born with low birth-weight in Humboldt/Del Norte than in California. In 1995, 4.8% of all babies born in the two county area were classified as low-birth weight compared to 6% in California. When evaluated by the age of the mother,as shown in Exhibit 4.4, again the Humboldt/Del Norte area fares well. With the exception of mothers over 35 years of age, Humboldt/Del Norte has lower percentages of low-birthweight babies. With 73.2% of all births to mothers between the ages of 20-34, Humboldt/Del Norte significantly betters the state average of low birth-weight babies. Table 4.9 on the following page presents a breakdown of low birth-weight babies by ethnicity. Because the actual numbers in many of the categories are so low and represent only one year of data, it is not possible to draw any conclusions regarding significance.

Exhibit 4.4: 1995 Percentage of Low Birth Weight Babies by Age of Mother

Source: Improved Perinatal Outcome Data Management, 1990-1995

Table 4.9: Low Birth Weight Babies by Ethnicity/Race of Mother

Humboldt / Del Norte Counties California # of Births % of Total # of Births % of Total African American 1 7.1% 4,735 11.8% Asian 0 0.0% 2,047 16.6% Non Hispanic White 67 4.6% 10,870 5.5% Hispanic 13 8.0% 13,721 5.4% Native American 8 4.7% 182 6.6% Pacific Islander 2 9.5% 1,644 7.4%

Source: Improved Perinatal Outcome Data Management, 1990-1995

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