Dr. Brenda Fitzgerald, Commissioner and State Health Officer, Georgia Department of Public Health Presentation to the Senate Women's Adequate Healthcare Study Committee www.gacommissiononwomen.org

1. 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

2. AWHONN 2013

3. 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

4. Maternal Mortality Case Reviews
2012 Case Reviews
• 122 cases
• 60 pregnancy-
associated deaths
• 25 pregnancy-
related deaths
• 37 not pregnant

5. Leading Causes of
Pregnancy-Associated Death
0
1
2
3
4
5
6
7
8
9
10
Motor Vehicle
Accidents (MVA)
Homicides Suicides Drug Overdose
Numberofdeaths

6. Leading Causes of
Pregnancy-Related Death
0
1
2
3
4
5
6
7
8
9
10
Hemorrhage Hypertension Cardiac events Embolisms
Numberofdeaths

7. 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

8. Georgia Infant Mortality Clusters
2002-2006

9. 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

10. Leading Causes of Infant Death
by Cluster
A 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

11. Objective 1:
Strengthen the
Regional Perinatal
System
Objective 2:
Develop targeted
educational
campaigns
Objective 3:
Develop external
collaborations to
support initiatives
RPC standards of care
17-Hydroxy P Registry
Fetal/Infant mortality
review committee
Maternal mortality
review committee
Community-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

12. Obstetric Care
Provider
Shortage
• 38 Georgia
counties with NO
OB services
• 20 Georgia
counties with a
deficit of OB
services

14. 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

15. 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%

16. Georgia Early Elective Deliveries
* As of October 1, 2013
Medicaid in Georgia no
longer pays for early elective
deliveries
Source: Georgia Hospital Association
Quarter Rate
1Q12 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%

17. 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

18. Georgia Infant Mortality Rate
America’s Health Rankings
Georgia
IMR
U.S.
Rank
2012 7.7 44
2013 6.93 34
2014 6.6 31
Source: America’s Health Rankings 2014
48% DECREASE SINCE 1990

19. 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

20. 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 strokes
o Average charge per stroke-
related hospitalization $39,453

21. 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

22. 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

23. Obesity in Georgia
Interventions
• 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

24. 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

25. Diabetes in Georgia
DISTRICT TOTAL % FEMALE %
7-0 West Central (Columbus) 15.9 20.4
3-3 Clayton (Morrow) 14.5 16.7
9-2 Southeast (Waycross) 13.9 16.2
6-0 East Central (Augusta) 15.1 15.4
9-1 Coastal (Savannah) 11.8 15.2
1-1 Northwest (Rome) 13.5 14.5
8-2 Southwest (Albany) 11.6 14.4
3-5 DeKalb 11.0 13.5
8-1 South (Valdosta) 13.3 13.3
5-1 South Central (Dublin) 9.3 13.2
4-0 La Grange 11.6 12.2

26. 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

27. Diabetes in Georgia
Interventions
• 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

28. Tobacco Use in Georgia
Women 2011-2013
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
21.4 20.2
18.5
14.0 14.3
12.8
0
5
10
15
20
25
2011 2012 2013
Percent(%)
White Females Black Females

29. • 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

30. 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

31. Tobacco Use in Georgia
Interventions
• 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

32. 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

33. 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

34. Cancer in Georgia
2014 New Cancer Cases Female
Breast 7,050
Lung and Bronchus 3,130
Colon and Rectum 2,080
Uterine 1,200
Melanoma 970
Thyroid 850
Non-Hodgkin Lymphoma 810
Ovary 680
Kidney and Renal Pelvis 620
Pancreas 610
Leukemia 480
Cervical 400
All Sites 23,170

35. 94
76
19
97
83
24
0
10
20
30
40
50
60
70
80
90
100
Localized Regional Distant
%Surviving5Years
Five-Year Survival by Stage at Diagnosis,
Breast Cancer, Females, Georgia, 2005-2011
NH Black NH White
% of tumors
found at this
stage
Localized Regional Distant
NH Black 52% 37% 9%
NH White 63% 30% 5%

36. 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

37. 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

38. 2014 Alzheimer’s Disease
Facts and Figures

40. 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