IV. Health Status Indicators

A first step in planning for a healthy community is to assess the current status of the health of its people. 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 factors of many health problems. Because of the marked demographic and economic characteristics identified in the Imperial County population, it was decided that it would be important to present various health status indicators broken down by race and ethnicity, whenever possible. Thus, in this section, information is first presented at a county-wide level, followed by a breakdown between the Imperial Hispanic population and the Imperial Non-Hispanic (all other) categories.

A. Birth Characteristics

Information in this section is taken from a new data base, Improved Perinatal Outcome Data Management. This data source is unique in that it integrates California hospital discharge data, California vital statistics linked birth and infant death files, socioeconomic data from the decennial U.S. Census, intercensal population updates from the California Department of Finance, and intercensal poverty updates from the U.S. Census Bureau. Starting with 1990 data and updated annually.

Birth Rate: Between 1990 and 1995, Imperial County experienced a slight decline in numbers of births, from a high of 2981 births to a low of 2637 in 1995 (11% decline). This mirrors the trend in declining numbers of births seen throughout California in this same time period.. Two factors are attributed to this drop in births in California: falling birth rates and a changing age structure of the population. As a large number of women associated with the baby boom cohort move out of primary child-bearing years a smaller cohort followed thus resulting in fewer births These factors may also explain the decline in Imperial. The number of births are expected to rise again in California around 2001, peaking in 2006 when a larger cohort of women reach primary child-bearing years. Table 4.1, Exhibit 4.1 and Exhibit S4.1.1 illustrate these trends.

Source: U.C. Census

Exhibit 4.1: Births Trended

Births by Age of Mother: Table 4.2 compares births by age categories for Imperial County and California. While 74% of all births are to mothers between the ages of 20 and 34 for both Imperial and California, Imperial has a higher percentage of mothers under the age of 20 (14.9% vs. 12.4%) and a lower percentage of mothers over the age of 35 (10.6% vs. 13.4%).

Births by Ethnicity/Race of Mother: The preponderance of births in Imperial County are to Hispanic mothers. In 1995, 85.4% of women who gave birth were Hispanic while only 12.6% of the births were to non-Hispanic women. This is congruent with the higher birth rate among Hispanic women in Imperial County compared to Non-Hispanic women. Table 4.3 provides a comparison between Imperial County and California.

Source: Improved Perinatal Outcome Data Management

Table 4.3: 1995 Births by Ethnicity/Race of Mother

Imperial County California   # Births % of Total Births # Births % of Total Births African American 24 0.9% 40,014 7.3% Asian 15 0.6% 35,634 6.5% Caucasian 333 12.6% 196,545 35.7% Hispanic 2,252 85.4% 253,071 46.0% Native American Indian 2 0.1% 2,774 0.5% Pacific Islander 10 0.4% 22,096 4.0% Other 1 0.0% 1,820 0.3%

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 (taken from Healthy People 2000, National Health Promotion and Disease Prevention Objectives, U.S. Department of Health and Human Services, Public Health Service) is no more than 10% begin prenatal care after the first trimester. In 1995, 32% of mothers who gave birth in Imperial County received prenatal care after the first trimester or had no prenatal care. Five percent received no prenatal care at all, significantly higher than the state average (Table S-4.3-1). Ordinarily this would be viewed as a key indicator of poor access to care. Anecdotally, we were told that many women begin prenatal care across the border in Mexico and then transfer to a physician in Imperial further through their pregnancy. However, there is no way of documenting the extent to which this pattern of care is followed.

Teenage Births: One of the major problems in California is the problem of teen pregnancy and teen 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 Imperial County compared to California.

Source: Improved Perinatal Data Outcome Management

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

In order to put the number of births in a clearer context, it is also important to look at the teen birth rate. The teen birth rate to 15 to under 18 year old teenagers is defined as the ratio of births to teens 15-under 18 years old divided by the number of teens 15 to under 18, and multiplied by 1,000. As a benchmark, the Year 2000 Objective is a teen birth rate of less than 50 births per 1,000 teenagers. Table 4.5 illustrates the ethnic/racial distribution of teen births. Hispanic teen births accounted for 90% of all teen births in 1995.

Out-of-Wedlock Births: Out-of-wedlock birth 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 considered 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. Furthermore, the extent to which this identification process is confused by the Hispanic tradition of carrying a surname from both families is unknown. Obviously, this methodology tends to overestimate the number of births which are truly out-of-wedlock. Thus, these statistics should be used with caution.

In 1995, there were 975 births in Imperial County which were designated as out-of-wedlock. This accounts for 37% of all births, as shown in Table 4.6. This is higher than the State average of 32%. Exhibit 4.3 shows that the percentage of out-of-wedlock births decreases with age. In Imperial, 38.7% of all births to Hispanics are classified as out-of-wedlock and account for 89% of all out-of-wedlock births in Imperial. The number of out-of-wedlock births by ethnicity/race of mother is roughly comparable to California, as depicted in Table 4.7.

Source: Improved Perinatal Data Outcome Management

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

Source: Improved Perinatal Data Outcome Management

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

Imperial County California   # Births % of Total Births # Births % of Total Births African American 15 12.4% 24,697 61.7% Asian 0 0.0% 2,964 23.9% Caucasian 86 25.8% 44,950 22.9% Hispanic 871 38.7% 97,886 38.7% Native American Indian 0 0.0% 1,366 49.2% Pacific Islander 3 30.0% 4,523 20.6%

Low Birth Weight: The Year 2000 goal for low birth weight babies is 5% for the population as a whole, with a target of 9% for African Americans. 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 (first born, second born, etc.), the existence of complicating medical conditions and whether a birth is a single or multiple (i.e. twin). Low birth weight is considered an important risk factor for poor birth outcomes.

In general, a smaller percentage of babies are born with low birth-weight in Imperial County than in California. In 1995, 5% of all babies born in Imperial County were classified as low-birth weight compared to 6% in California, as reflected in Table 4.8. When evaluated by the age of the mother, again Imperial County fares well. With the exception of mothers over 35 years of age, Imperial County mothers have lower percentages of low-birth weight babies. With 74.5% of all births to mothers between the ages of 20-34, Imperial significantly betters the state average of low-birth weight babies (4.4% vs. 5.6%). Exhibit 4.4 and Table 4.9 depict thathispanic ethnicity is known to be associated with fewer low-birth babies, and is probably a major reason why Imperial fares so well in this category. Likewise, it has been observed that mothers of Asian background, especially new immigrants, have smaller babies. Whether or not this represents a true risk factor for these babies is under study.

Source: Improved Perinatal Data Outcome Management

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

Source: Improved Perinatal Data Outcome Management

Table 4.9: 1995 Low Birth Weight Babies by Ethnicity/Race of Mother

Imperial County California   # Births % of Total Births # Births % of Total Births African American 2 8.3% 4,735 11.8% Asian 3 100.0% 2,047 16.6% Caucasian 16 4.8% 10,870 5.5% Hispanic 111 4.9% 13,721 5.4% Native American Indian 0 0.0% 182 6.6% Pacific Islander 0 0.0% 1,644 7.4%

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