northwest region 1 - maryland · college 16.8 16.5 11.1 15.1 high school diploma 16.9 14.8 12.0...
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Last updated: 11/21/2018Northwest Region includes Garrett, Allegany, and Washington counties.PPOR Notes: Minimum 60 fetal-infant deaths. Reference group: White NH mothers ages 20-34 with 13+ years of education in Maryland.
NORTHWEST REGION 1
____________________________________________________________________________________MATERNAL AND INFANT HEALTH PROFILE
BackgroundThe Office of Maternal and Child Health (MCH) Epidemiology in the MCH Bureau(MCHB) at the Maryland Department of Health created these health profiles to examinelocal maternal and infant health outcomes and risk factors compared to state averages. Localhealth departments should use these data and maps to identify and target population specificinterventions to reduce maternal health risks that contribute to increased fetal-infantmortality rates among minorities in Maryland.
While the statewide infant mortality rate (IMR) has decreased 32% since 1990, racial IMRdisparities persist. Infant mortality rates among Black non-Hispanic (NH) births areconsistently more than double the rates among White NH births. To eliminate this disparity,the IMR among Black NH births would have to decreased by approximately 60%. Theleading cause of infant deaths in Maryland are preterm birth/low birth weight and SuddenInfant Death Syndrome (SIDS) for both Black NH and White NH infants. Congenitalanomalies were the leading cause of death for Hispanic infants.
Perinatal periods of risk (PPOR) analysis is a method of examining all fetal and infant deathdata to identify opportunities to reduce perinatal mortality (Sappenfield, 2010). Results fromPhase 1 PPOR analysis suggests that half (49%) of excess, or preventable, fetal-infantmortality rates in Maryland during 2010-2017 was due to factors related to the maternalhealth and prematurity (MHP) period among Black NH births. Phase 2 analyses revealedthat the largest reductions in infant mortality and adverse pregnancy outcomes could beproduced by improving the social and economic environment of women which predisposesthem to poorer health and birth outcomes. Specifically, factors contributing most to racialdisparities in adverse pregnancy outcomes (APO: fetal or neonatal death, or very PTB andvery LBW births) include differences in marital status, education, insurance coverage,community socioeconomic disadvantage, hypertension, prior preterm birth or otherpregnancy outcomes, pre-pregnancy body mass index (BMI), and participation in theWomen, Infants and Children (WIC) program. Lack of prenatal care and tobacco use arealso associated with increased risks of APO, however, these factors do not appear to explainthe differences in APO rates between Black NH and White NH births in Maryland. Findingssuggest that eliminating the prevalence of hypertension could reduce APO’s by nearly 12%statewide. Drastic racial differences in marital status highlight the greater need for socialsupport and/or services for minority women to improve pregnancy outcomes (Salihu, 2014).For greater detail about preconception and prenatal risk factors, please visit the MarylandPRAMS website (PRAMS).
Programs should use these findings to develop evidence-based initiatives to improve the preconception and maternal health of women, and particularly Black NH women, to produce the greatest reductions in fetal and infant mortality in Maryland. For questions or comments, please contact the Maternal and Child Health Bureau at [email protected] or (410) 767-6713.
2017 Region Ranks
Indicator Rank*Fetal-Infant Mortality Rate(FIMR)
8th
Preterm Birth (PTB, <37weeks)
7th
Low Birth Weight (LBW,<2500 grams)
6th
Very PTB & Very LBW 2nd
Unmarried, no father listed 7th
Maternal Education: HighSchool Diploma or Less
8th
Maternal Hypertension(Chronic or Gestational)
4th
Medicaid Coverage 8th
Maternal Obesity 7th
Prior Preterm Birth 2nd
Maternal Age Under 20Years Old
10th
Third Trimester or NoPrenatal Care Initiation
3rd
Preconception or PrenatalSmoking
10th
Maternal Opioid UseDisorder
10th
Maternal Substance UseDisorder
10th
WIC Participation 3rd
*Ranks are relative to the other 10 regions. Lower is better. N/a:rank not available due to insufficient data.
Perinatal Period of Risk (PPOR): Excess, or preventable, fetal-infant mortality rates bypopulation group, Northwest Region, 2010-2017
Population Group
1.7 1.5
2.9
HealthInfant
0.80.9
1.3
CareInfant
0.9 0.81.0
CareMaternal
2.1
1.81.6
PrematurityHealth/
Maternal
AllW
hite NH
Black NH
Hispanic
Medicaid
AllW
hite NH
Black NH
Hispanic
Medicaid
AllW
hite NH
Black NH
Hispanic
Medicaid
AllW
hite NH
Black NH
Hispanic
Medicaid
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Dea
ths
per
1,00
0 pr
egna
ncie
s
22
13.6 14.1 14.1 14.4 13.8 13.4 13.0 13.111.1 13.2 9.4 13.0 13.4 10.8 12.5 16.0
0
5
10
15
20
preg
nanc
ies
Rat
e pe
r 1,
000
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONFetal-Infant Mortality RatesFetal-infant mortality rates (FIMR) represent the number of fetal (older than 20 weeks gestation) or infant deaths(younger than 365 days old) per 1,000 pregnancies in that year. NOTE: Source is linked infant birth and deathcertificate records which exclude records not linked due to certificate errors or migration and results in lowerFIMRs than those in Maryland VSA reports.
Of the 2,561 pregnancies in Northwest Region in 2017 there were 16 fetal or infant deaths for every 1,000pregnancies.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
by Maternal Race and Year
10.7 11.7
* *
Other NH
11.1 10.3
14.7 15.9
Hispanic
22.9 20.9
21.2 14.9
Black NH
9.1 9.1
10.8 12.9
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
33
by Maternal Age and Year
Fetal-Infant Mortality RatesNORTHWEST REGION
16.5 15.3
12.5 15.6
35+
11.8 12.0
10.7 12.0
25-34
15.9 14.2
11.8 13.0
20-24
20.4 19.2
15.2 17.9
<20
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
by Maternal Age and Race, 2010-2017
10.4 26.6 14.6 11.8
14.3 * * 0.0
35+ years
7.8 20.3 9.4 10.7
10.7 21.3 13.3 *
25-34 years
12.1 21.9 10.5 13.3
12.8 15.6 14.4 *
<25 years
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
44
by Insurance Coverage and Year
Fetal-Infant Mortality RatesNORTHWEST REGION
16.4 16.0
18.5 19.6
Other
16.6 15.2
11.3 15.1
Medicaid
11.8 11.1
10.6 9.5
Private
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
by Insurance Coverage and Race, 2010-2017
10.1 25.0 13.1 19.8
19.7 * * 0.0
Other
12.2 21.2 9.2 12.7
13.5 13.4 10.4 *
Medicaid
7.9 21.4 10.6 9.0
8.6 26.3 24.9 *
Private
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
55
by Maternal Educational Attainment and Year
Fetal-Infant Mortality RatesNORTHWEST REGION
10.5 10.0
10.7 9.8
College
16.8 16.5
11.1 15.1
High School Diploma
16.9 14.8
12.0 19.7
<High School
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
by Maternal Educational Attainment and Race, 2010-2017
6.9 17.4 8.0 8.1
9.7 16.0 18.3 *
College
12.3 22.0 11.3 14.8
12.9 15.8 * *
High School Diploma
16.6 26.1 10.2 14.5
15.4 20.8 * *
<High School
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
66
by Pre-Pregnancy Body Mass Index (BMI) and Year
Fetal-Infant Mortality RatesNORTHWEST REGION
17.5 17.1
9.8 13.6
Obese
13.5 12.0
13.1 12.8
Overweight
10.2 9.6
9.3 11.4
Normal
11.0 10.8
10.1 19.0
Underweight
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
by Pre-Pregnancy Body Mass Index (BMI) and Race, 2010-2017
10.9 24.3 11.6 15.8
11.5 17.5 * *
Obese
8.9 19.1 9.8 10.5
11.5 18.4 28.9 *
Overweight
7.3 17.3 8.5 7.7
10.2 13.0 13.2 *
Normal
9.9 15.4 5.9 8.7
15.1 * 0.0 0.0
Underweight
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
77
by Marital Status and Year
Fetal-Infant Mortality RatesNORTHWEST REGION
22.4 19.1
13.2 17.7
Unmarried, No FL
16.6 9.5
12.6 10.3
Unmarried, FL
10.2 5.9
9.8 5.3
Married
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
FL: father listed on the birth certificateNorthwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
by Marital Status and Race, 2010-2017
16.2 23.7 15.0 21.8
14.2 19.7 * 0.0
Unmarried, No FL
9.9 17.9 7.7 12.0
11.9 11.3 * *
Unmarried, FL
5.9 14.6 6.8 7.6
6.9 14.3 16.3 *
Married
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
Rat
e pe
r 1,
000
preg
nanc
ies
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration Linked Infant Birth-Death Certificate File
NORTHWEST REGION 8
Fetal-Infant Mortality Rates by Maternal Residence CensusTract, 2010-2017
Rate per 1,000 pregnancies
Suppressed (<5 events) No events 7.0 - 11.5
11.6 - 16.0 16.1 - 20.9 21.0 - 22.9
23.0 - 35.9
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
99
10.4 10.2 10.2 9.8 10.1 10.0 10.1 10.510.4 8.8 9.8 9.0 9.7 10.7 10.0 10.9
0
2
4
6
8
10
12
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONPreterm Birth (PTB, <37 weeks)Preterm birth describes infants born prior to 37 weeks gestation and is a leading cause of LBW and VLBW, andinfant death. Preterm-related causes of death accounted for 35% of all infant deaths in the U.S. in 2010, morethan any other single cause.
Of the 2,540 live births in Northwest Region in 2017, 10.9% were born preterm (<37 weeks gestation).
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
9.1 8.7
8.9 9.1
Other NH
8.8 9.3
8.4 13.0
Hispanic
12.7 12.8
12.5 13.1
Black NH
8.9 8.8
9.3 9.8
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1010
by Maternal Age and Year
Preterm Birth (PTB, <37 weeks)NORTHWEST REGION
12.4 12.1
12.4 12.9
35+
9.5 9.5
9.9 10.2
25-34
9.9 9.8
7.8 9.1
20-24
10.3 11.0
9.2 11.0
<20
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Age and Race, 2010-2017
10.6 15.6 11.2 11.2
11.8 21.5 9.6 11.1
35+ years
8.3 12.3 8.6 8.0
9.9 12.0 11.9 8.8
25-34 years
8.7 11.9 8.4 8.0
8.4 11.1 10.2 *
<25 years
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1111
by Insurance Coverage and Year
Preterm Birth (PTB, <37 weeks)NORTHWEST REGION
10.7 10.3
16.4 16.6
Other
11.3 11.3
9.4 10.2
Medicaid
9.3 9.3
8.1 8.9
Private
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Insurance Coverage and Race, 2010-2017
9.4 13.2 8.9 9.6
17.1 13.7 12.6 12.0
Other
10.2 13.2 9.2 8.3
9.4 12.6 10.5 8.1
Medicaid
8.3 12.0 8.9 9.0
8.1 13.2 10.8 9.0
Private
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1212
by Maternal Educational Attainment and Year
Preterm Birth (PTB, <37 weeks)NORTHWEST REGION
9.6 9.6
9.1 10.0
College
11.1 11.4
10.2 10.9
High School Diploma
10.8 10.9
9.2 10.0
<High School
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Educational Attainment and Race, 2010-2017
8.4 12.0 9.1 8.9
9.3 12.3 10.8 8.4
College
9.9 13.4 9.1 8.8
10.2 13.2 10.6 12.7
High School Diploma
11.0 14.5 9.0 9.2
8.8 13.1 11.5 *
<High School
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1313
by Pre-Pregnancy Body Mass Index (BMI) and Year
Preterm Birth (PTB, <37 weeks)NORTHWEST REGION
11.8 12.1
10.6 11.4
Obese
10.0 9.9
7.7 9.9
Overweight
9.0 9.0
7.9 9.6
Normal
10.9 10.5
10.1 12.7
Underweight
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Pre-Pregnancy Body Mass Index (BMI) and Race, 2010-2017
10.4 14.0 9.9 11.2
10.6 13.7 13.4 8.9
Obese
8.8 11.9 8.9 10.3
8.5 11.2 8.4 11.1
Overweight
8.1 11.7 8.4 8.1
8.4 11.9 10.1 7.2
Normal
9.9 15.0 8.6 7.0
10.3 21.6 * *
Underweight
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1414
by Marital Status and Year
Preterm Birth (PTB, <37 weeks)NORTHWEST REGION
13.7 14.1
10.7 16.5
Unmarried, No FL
10.6 10.9
9.2 10.1
Unmarried, FL
9.2 9.1
9.0 9.0
Married
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
FL: father listed on the birth certificateNorthwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Marital Status and Race, 2010-2017
13.3 14.9 10.9 10.3
13.3 15.5 9.6 *
Unmarried, No FL
9.5 12.6 8.8 10.0
9.3 11.2 12.0 11.8
Unmarried, FL
8.3 11.7 8.9 8.8
8.8 12.1 10.6 8.8
Married
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 15
Preterm Birth (PTB, <37 weeks) by Maternal Residence CensusTract, 2010-2017
% of live births
Suppressed (<5 events) No events 6.7 - 8.2
8.3 - 9.2 9.3 - 10.4 10.5 - 11.4
11.5 - 16.1
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
1616
8.8 8.9 8.8 8.5 8.6 8.6 8.6 8.99.3 7.8 8.5 7.6 8.8 9.5 9.3 8.9
0
2
4
6
8
10
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONLow Birth Weight (LBW, <2500 grams)Low birth weight describes infants weighing less than 2500 grams, or 5.5 pounds, at birth and is a leading causeof neonatal mortality. Since low birth weight is typically associated with a preterm birth, many public healthinterventions focus on ways to reduce the rates of low birth weight, very low birth weight, and preterm birth asstrategies to reduce infant mortality.
Of the 2,540 live births in Northwest Region in 2017, 8.9% were low birth weight (<2500 grams).
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
8.5 8.3
8.0 6.0
Other NH
7.0 7.2
6.2 9.4
Hispanic
12.3 12.3
12.6 14.6
Black NH
6.8 6.6
8.0 8.5
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1717
by Maternal Age and Year
Low Birth Weight (LBW, <2500 grams)NORTHWEST REGION
10.1 9.7
10.1 10.9
35+
7.9 7.9
8.3 8.9
25-34
9.3 9.4
7.5 8.4
20-24
10.9 10.9
8.7 9.7
<20
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Age and Race, 2010-2017
7.9 13.9 8.2 9.7
9.9 18.2 9.6 6.1
35+ years
6.2 11.5 6.6 7.8
8.3 13.1 8.9 6.9
25-34 years
7.1 12.7 7.3 9.2
7.7 13.1 6.1 8.8
<25 years
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1818
by Insurance Coverage and Year
Low Birth Weight (LBW, <2500 grams)NORTHWEST REGION
9.0 8.7
14.4 14.9
Other
10.5 10.3
8.8 9.9
Medicaid
7.7 7.5
6.5 6.8
Private
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Insurance Coverage and Race, 2010-2017
7.1 12.6 6.9 8.6
15.3 13.7 9.3 12.0
Other
8.8 13.0 7.3 8.3
8.8 14.3 6.5 7.4
Medicaid
6.0 11.3 6.9 8.4
6.2 12.3 9.7 5.8
Private
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
1919
by Maternal Educational Attainment and Year
Low Birth Weight (LBW, <2500 grams)NORTHWEST REGION
8.0 7.9
7.4 8.3
College
10.0 10.5
9.7 10.0
High School Diploma
9.8 9.7
8.7 10.0
<High School
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Educational Attainment and Race, 2010-2017
6.1 11.3 7.1 8.4
7.5 12.7 8.5 6.4
College
8.2 13.0 7.4 8.9
9.6 14.1 6.8 8.5
High School Diploma
10.0 15.0 6.9 8.0
8.6 14.9 7.8 *
<High School
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2020
by Pre-Pregnancy Body Mass Index (BMI) and Year
Low Birth Weight (LBW, <2500 grams)NORTHWEST REGION
9.4 9.5
6.9 8.7
Obese
8.2 8.2
6.4 9.0
Overweight
8.2 8.2
7.9 8.8
Normal
12.0 11.6
13.8 15.3
Underweight
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Pre-Pregnancy Body Mass Index (BMI) and Race, 2010-2017
7.0 12.3 6.9 8.9
7.1 13.2 8.8 *
Obese
6.2 11.2 6.6 9.0
7.2 12.2 6.8 10.1
Overweight
6.5 12.5 7.2 8.0
8.0 13.7 8.0 4.7
Normal
9.9 17.4 8.8 9.0
13.6 24.3 * 14.7
Underweight
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
25
30
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2121
by Marital Status and Year
Low Birth Weight (LBW, <2500 grams)NORTHWEST REGION
13.4 13.6
12.1 16.5
Unmarried, No FL
9.7 10.0
8.9 9.4
Unmarried, FL
7.4 7.2
6.6 7.2
Married
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
FL: father listed on the birth certificateNorthwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Marital Status and Race, 2010-2017
12.6 15.0 8.7 9.4
14.1 15.5 10.4 *
Unmarried, No FL
7.9 12.5 7.1 8.7
8.7 13.9 6.0 9.8
Unmarried, FL
5.9 10.5 6.7 8.4
6.6 11.4 8.9 6.0
Married
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
5
10
15
20
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 22
Low Birth Weight (LBW, <2500 grams) by Maternal ResidenceCensus Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 4.8 - 6.8
6.9 - 8.0 8.1 - 9.0 9.1 - 10.4
10.5 - 15.0
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
2323
1.5 1.6 1.5 1.4 1.4 1.4 1.5 1.51.6 0.9 0.9 0.9 0.8 1.1 1.2 1.0
0.0
0.5
1.0
1.5
2.0
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONVery LBW (<1500 grams) & Very PTB (<32 weeks)Approximately 1 in 4 infants born very PTB & very LBW die before their first birthday. Very PTB & very LBWinfants also have an increased risk of developmental delays.
Of the 2,540 live births in Northwest Region in 2017, 1% were born very premature.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
1.1 1.0
* *
Other NH
1.1 1.1
* *
Hispanic
2.7 2.6
1.7 2.1
Black NH
0.9 0.9
1.1 0.9
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2424
by Maternal Age and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)NORTHWEST REGION
1.9 1.8
1.5 1.6
35+
1.3 1.3
1.0 0.8
25-34
1.6 1.5
0.9 1.0
20-24
2.0 1.8
1.8 1.4
<20
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Age and Race, 2010-2017
1.1 3.2 1.5 1.3
1.3 3.7 * *
35+ years
0.8 2.5 1.1 0.9
0.9 1.1 * *
25-34 years
1.0 2.5 0.9 1.0
1.0 2.2 0.0 *
<25 years
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2525
by Insurance Coverage and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)NORTHWEST REGION
1.8 1.6
4.0 3.0
Other
2.0 1.7
1.0 0.9
Medicaid
1.2 1.3
0.6 0.6
Private
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
1
2
3
4
5
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. Other insurance includes self-pay and unknown. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Insurance Coverage and Race, 2010-2017
1.1 3.1 1.0 1.1
3.8 * 0.0 *
Other
1.1 2.6 1.2 1.1
0.8 1.9 * 0.0
Medicaid
0.8 2.4 1.1 1.0
0.5 1.5 * *
Private
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2626
by Maternal Educational Attainment and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)NORTHWEST REGION
1.3 1.3
0.8 1.0
College
1.8 1.8
1.6 1.1
High School Diploma
1.6 1.6
0.9 1.1
<High School
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Educational Attainment and Race, 2010-2017
0.8 2.4 1.1 1.0
0.8 1.3 * *
College
1.1 2.7 1.2 1.0
1.3 2.2 * *
High School Diploma
1.2 2.9 1.0 1.2
0.8 2.7 0.0 *
<High School
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2727
by Pre-Pregnancy Body Mass Index (BMI) and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)NORTHWEST REGION
2.0 2.0
0.7 1.3
Obese
1.4 1.4
0.8 1.2
Overweight
1.1 1.1
0.7 0.7
Normal
1.3 1.4
* *
Underweight
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Pre-Pregnancy Body Mass Index (BMI) and Race, 2010-2017
1.2 3.0 1.4 1.5
1.0 1.6 * 0.0
Obese
0.8 2.4 1.0 1.2
1.0 1.9 0.0 *
Overweight
0.7 2.1 0.9 0.9
0.7 1.7 * *
Normal
1.0 2.4 0.7 0.7
* * 0.0 0.0
Underweight
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
2828
by Marital Status and Year
Very LBW (<1500 grams) & Very PTB (<32 weeks)NORTHWEST REGION
2.9 2.7
1.7 2.7
Unmarried, No FL
1.7 1.7
0.9 0.9
Unmarried, FL
1.2 1.2
0.8 0.7
Married
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
0.5
1.0
1.5
2.0
2.5
3.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
FL: father listed on the birth certificateNorthwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Marital Status and Race, 2010-2017
1.9 3.4 1.7 2.4
2.1 2.7 * *
Unmarried, No FL
0.9 2.5 1.1 1.2
0.9 1.1 0.0 *
Unmarried, FL
0.8 2.3 1.0 1.0
0.7 1.8 * *
Married
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
NHWhite
NHBlack Hisp
NHOther
0
1
2
3
4
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 29
Very LBW (<1500 grams) & Very PTB (<32 weeks) by MaternalResidence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 0.8 - 1.0
1.1 - 1.2 1.3 - 1.3 1.4 - 1.8
1.9 - 3.2
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
3030
30.2 30.2 30.1 30.0 27.8 30.4 28.1 30.233.4 32.1 33.8 35.6 36.3 36.6 36.1 37.2
0
10
20
30
40
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Unmarried, No Father ListedBirths to unmarried women with no father listed on the birth certificate have an increased risk of adverse birthoutcomes. (Ngui, 2009; Luo, 2004; Alio, 2010). Mothers with a lack of paternal involvement are more likely toexperience greater psychosocial stress due to insufficient economic and social support which can lead to poorhealth behaviors and adverse birth outcomes.
Of the 2,540 live births in Northwest Region in 2017, 37.2% were to unmarried women with no father listedon the birth certif icate.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. FL: father listed on the birth certificate. NH: non-Hispanic.Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
7.1 7.1
12.1 9.5
Other NH
45.9 42.9
38.8 38.7
Hispanic
42.4 40.4
39.8 43.5
Black NH
20.2 19.7
33.5 36.3
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
50
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 31
Risk Factor: Unmarried, No Father Listed by MaternalResidence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 18.0 - 27.8
27.9 - 31.6 31.7 - 35.9 36.0 - 45.3
45.4 - 53.7
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
3232
36.9 35.5 35.0 34.1 33.0 33.4 33.0 32.845.1 43.8 43.3 43.0 42.6 42.4 42.6 42.8
0
10
20
30
40
50
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Maternal Education: High School Diploma or LessLow educational attainment serves as a proxy for lower socioeconomic status and is associated with increasedadverse birth outcome risks.
Of the 2,540 live births in Northwest Region in 2017, 42.8% were to women with a high school education orless.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
16.3 16.1
25.4 24.2
Other NH
69.9 67.1
57.3 56.1
Hispanic
41.9 37.8
49.5 52.1
Black NH
23.0 20.2
43.2 41.2
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
20
40
60
80
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 33
Risk Factor: Maternal Education: High School Diploma or Lessby Maternal Residence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 25.8 - 31.9
32.0 - 38.5 38.6 - 44.4 44.5 - 51.5
51.6 - 72.1
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
3434
6.5 6.6 6.9 7.7 8.2 9.2 9.2 10.28.7 7.3 8.7 8.6 10.6 10.1 10.4 9.8
0
2
4
6
8
10
12
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Maternal Hypertension (Chronic or Gestational)Hypertension before and during pregnancy puts women at higher risk for preeclampsia, cesarean section, pretermbirth, and a low birth weight baby.
Of the 2,540 live births in Northwest Region in 2017, 9.8% were to women who had chronic or pregnancy-associated hypertension.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
3.9 4.9
8.0 6.7
Other NH
4.8 6.7
4.7 7.2
Hispanic
9.0 12.3
7.7 11.0
Black NH
6.6 8.7
8.6 10.4
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 35
Risk Factor: Maternal Hypertension (Chronic or Gestational) byMaternal Residence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 5.3 - 7.6
7.7 - 9.0 9.1 - 9.9 10.0 - 10.8
10.9 - 15.0
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
3636
26.2 29.5 31.0 32.1 34.1 36.6 36.4 38.245.7 46.9 46.2 47.3 44.6 48.3 47.7 49.6
0
10
20
30
40
50
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Medicaid CoverageMedicaid paid births serve as a proxy for lower socioeconomic status and is associated with increased adversebirth outcome risks.
Of the 2,540 live births in Northwest Region in 2017, 49.6% were Medicaid paid births.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
16.3 22.9
31.3 31.3
Other NH
36.7 53.0
49.9 55.5
Hispanic
43.8 50.6
63.9 68.9
Black NH
19.5 22.1
45.2 44.9
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
20
40
60
80
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 37
Risk Factor: Medicaid Coverage by Maternal Residence CensusTract, 2010-2017
% of live births
Suppressed (<5 events) No events 23.3 - 35.6
35.7 - 42.5 42.6 - 48.7 48.8 - 58.7
58.8 - 79.8
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
3838
22.3 22.4 23.3 23.2 23.8 24.8 25.0 25.825.1 24.6 26.2 25.3 28.2 28.6 29.7 30.1
0
10
20
30
40
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Maternal ObesityObesity during pregnancy is associated with maternal risks such as gestational diabetes, preeclampsia, stillbirthand congenital anomalies (Leddy, 2008).
Of the 2,540 live births in Northwest Region in 2017, 30.1% were to obese women.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. Obesity defined as a pre-pregnancy body mass index (BMI)score of 30 or greater. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
8.8 10.7
8.9 14.3
Other NH
19.1 22.6
28.9 29.1
Hispanic
32.2 34.6
29.8 35.4
Black NH
19.5 21.1
25.1 28.8
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 39
Risk Factor: Maternal Obesity by Maternal Residence CensusTract, 2010-2017
% of live births
Suppressed (<5 events) No events 16.8 - 23.6
23.7 - 26.1 26.2 - 27.7 27.8 - 29.3
29.4 - 34.7
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
4040
2.6 2.7 2.9 3.3 3.7 4.0 3.6 4.13.6 2.4 2.8 3.0 3.3 4.0 3.0 3.2
0
1
2
3
4
5
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Prior Preterm BirthWomen with a prior preterm birth are more likely to have a repeat preterm birth (Adams, 2000). Repeat PTB'smay also serve as a marker for persistent physiological risks to maternal health and is associated with greaterrisks to infant survival.
Of the 2,540 live births in Northwest Region in 2017, 3.2% were to women with a prior preterm birth.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
1.8 2.4
* 2.4
Other NH
2.2 3.5
3.0 3.4
Hispanic
3.8 5.3
5.4 5.4
Black NH
2.6 3.2
2.8 3.2
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
1
2
3
4
5
6
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 41
Risk Factor: Prior Preterm Birth by Maternal Residence CensusTract, 2010-2017
% of live births
Suppressed (<5 events) No events 1.5 - 2.3
2.4 - 2.9 3.0 - 3.4 3.5 - 3.9
4.0 - 5.8
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
4242
7.5 6.7 6.0 5.2 4.7 4.4 4.2 3.810.4 11.1 9.2 8.2 7.7 7.4 7.1 7.3
0
2
4
6
8
10
12
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Maternal Age Under 20 Years OldTeen childbearing often limits the educational and economic opportunties for young women and is associatedwith a greater risk of adverse birth outcomes. (Ventura, 2014) Approximately, 8 in 10 births to women under 20years old are unintended. (MD PRAMS, 2018)
Of the 2,540 live births in Northwest Region in 2017, 7.3% were to women under 20 years old.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
1.0 0.9
2.2 2.0
Other NH
8.1 7.1
7.9 8.4
Hispanic
10.1 6.1
13.9 13.8
Black NH
4.0 2.6
9.6 6.7
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 43
Risk Factor: Maternal Age Under 20 Years Old by MaternalResidence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 3.3 - 5.9
6.0 - 6.9 7.0 - 9.3 9.4 - 11.4
11.5 - 15.8
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
4444
7.7 8.5 8.8 9.4 9.2 9.0 8.6 7.55.9 5.5 6.8 6.7 6.3 5.9 5.8 5.2
0
2
4
6
8
10
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Third Trimester or No Prenatal Care InitiationBabies born to women who do not receive prenatal care are three times more likely to be born at a low birthweight and five times more likely to die than babies born to mothers receiving prenatal care.
Of the 2,540 live births in Northwest Region in 2017, 5.2% were to women who initiated prenatal care in thethird trimester or had no prenatal care.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. Note: percentages are calculated excluding missing or unknownvalues of PNC initiation. NH: non-Hispanic. Other NH includes American Indian and Asian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
7.9 7.7
5.9 10.0
Other NH
11.6 11.2
9.8 8.7
Hispanic
12.3 12.0
13.5 9.6
Black NH
5.4 5.4
5.4 5.1
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0.0
2.5
5.0
7.5
10.0
12.5
15.0
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 45
Risk Factor: Third Trimester or No Prenatal Care Initiation byMaternal Residence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 2.5 - 4.6
4.7 - 5.3 5.4 - 6.1 6.2 - 7.0
7.1 - 12.9
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
4646
12.8 12.8 12.6 12.8 11.2 10.4 9.5 8.828.8 32.1 30.1 29.2 28.7 27.3 27.6 24.1
0
10
20
30
40
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Preconception or Prenatal SmokingTobacco is the most commonly used substance during pregnancy and is associated with adverse birth outcomessuch as miscarriage, placental abruption, placental insufficiency, and low birth weight.
Of the 2,540 live births in Northwest Region in 2017, 24.1% were to women who reported smoking before orduring their pregnancy.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
5.0 2.6
11.2 7.1
Other NH
4.0 2.8
16.8 11.8
Hispanic
10.9 9.4
27.7 24.6
Black NH
18.0 14.4
31.3 28.7
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
10
20
30
40
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 47
Risk Factor: Preconception or Prenatal Smoking by MaternalResidence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 16.3 - 21.5
21.6 - 26.3 26.4 - 28.9 29.0 - 36.6
36.7 - 53.1
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
4848
11.3 12.4 14.7 14.8 14.2 16.1 16.7 17.124.7 28.6 44.7 49.6 51.1 49.0 62.0 66.6
0
20
40
60
80
hosp
italiz
atio
nspe
r 1,
000
mat
erna
l
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Maternal Opioid Use Disorder (OUD)Opioids include heroin, morphine, codeine, oxycodone, hydrocodone, etc. Maternal opioid use disorder has beenassociated with preterm labor, stillbirth, birth defects, neonatal abstinence syndrome, and maternal mortality(Patrick, 2015; Maeda, 2014). Nationally, the rate of opioid use disorder during delivery hospitalizationsincreased 67% from 2010-2014 (Haight, 2017).
Of the 2,431 maternal hospitalizations in Northwest Region in 2017, there were 66.6 with an OUDdiagnosis for every 1,000 maternal hospitalizations.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 11 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal,delivery, or postpartum) hospitalizations. Please note, diagnosis coding transitioned from ICD-9 to ICD-10beginning October 2015. Note, OUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Heslin,2017).
by Maternal Race and Year
2.2 2.6
* *
Other NH
1.6 1.9
* *
Hispanic
5.6 6.7
17.1 20.6
Black NH
24.6 30.7
40.5 66.7
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
20
40
60
80
per
1,00
0 m
ater
nal h
o...
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal, delivery, or postpartum) hospitalizations. Please note, diagnosiscoding transitioned from ICD-9 to ICD-10 beginning October 2015. Note, OUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Heslin, 2017).
NORTHWEST REGION 49
Risk Factor: Maternal Opioid Use Disorder (OUD) by MaternalResidence Census Tract, 2013-2016
per 1,000 maternal hospitalizations
Suppressed (<11 events) No events 25.6 - 54.1
54.2 - 71.4 71.5 - 80.2 80.3 - 96.3
96.4 - 133.3
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
5050
27.1 27.3 30.4 30.6 30.8 33.8 36.3 40.953.2 56.0 71.4 73.7 80.5 82.1 103.8 117.6
0
40
80
120
hosp
italiz
atio
nsm
ater
nal
per
1,00
0
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONRisk Factor: Maternal Substance Use Disorder (SUD)In addition to opioid, other substances can lead to adverse birth outcomes. Cocaine use during pregnancy canlead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Alcohol use duringpregnancy can lead to spontaneous abortion, growth restriction, birth defects, and mental retardation (Keegan,2010). This indicator represents a SUD diagnosis during a maternal hospitalization for the following substances:Opioids, Cocaine, Cannabis, Alcohol, Sedatives, and Hallucinogens.
Of the 2,431 maternal hospitalizations in Northwest Region in 2017, there were 117.6 with an SUDdiagnosis for every 1,000 maternal hospitalizations.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 11 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal,delivery, or postpartum) hospitalizations. Please note, diagnosis coding transitioned from ICD-9 to ICD-10beginning October 2015. Note, SUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Fingar,2015; Heslin, 2017).
by Maternal Race and Year
6.4 7.0
41.2 46.5
Other NH
4.3 6.6
* *
Hispanic
32.7 42.2
73.0 91.4
Black NH
37.3 46.6
65.3 102.5
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
25
50
75
100
125
per
1,00
0 m
ater
nal h
o...
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
Source: Maryland Health Services Cost Review Commission (HSCRC) Inpatient Files for maternal (prenatal, delivery, or postpartum) hospitalizations. Please note, diagnosiscoding transitioned from ICD-9 to ICD-10 beginning October 2015. Note, SUD diagnoses based on AHRQ recommended ICD-9 and ICD-10 codes (Fingar, 2015; Heslin,2017).
NORTHWEST REGION 51
Risk Factor: Maternal Substance Use Disorder (SUD) byMaternal Residence Census Tract, 2013-2016
per 1,000 maternal hospitalizations
Suppressed (<11 events) No events 33.7 - 66.6
66.7 - 89.7 89.8 - 106.6 106.7 - 142.1
142.2 - 216.7
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
5252
40.9 41.1 40.8 39.7 38.6 38.2 36.8 35.551.6 51.6 53.8 54.3 50.7 52.2 49.7 49.1
0102030405060
% o
f liv
e bi
rths
2010 2011 2012 2013 2014 2015 2016 2017
MarylandNorthwest Region
Northwest RegionMaryland
NORTHWEST REGIONCharacteristic: Women, Infants and Children (WIC) ProgramParticipationPrenatal WIC participation is associated with lower infant mortality rates. WIC prenatal care benefits reduce therate of LBW babies by 25% and VLBW babies by 44%. Women participating in WIC have been found to havelonger pregnancies and are more likely to receive adequate prenatal care.
Of the 2,540 live births in Northwest Region in 2017, 49.1% were to women who were enrolled in WIC.
by Year
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.
*Rates based on less than 5 events are suppressed. NH: non-Hispanic. Other NH includes American Indian andAsian or Pacific Islander.
Source: Maryland Vital Statistics Administration
by Maternal Race and Year
20.0 19.7
29.9 27.8
Other NH
68.1 63.1
65.9 65.3
Hispanic
57.1 52.6
71.9 69.7
Black NH
23.7 19.8
51.1 47.9
White NH
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
20132010-
20172014-
0
20
40
60
80
% o
f liv
e bi
rths
Maryland
RegionNorthwest
Northwest Region includes the following jurisdictions: Garrett, Allegany, and Washington.Source: Maryland Vital Statistics Administration
NORTHWEST REGION 53
Characteristic: Women, Infants and Children (WIC) ProgramParticipation by Maternal Residence Census Tract, 2010-2017
% of live births
Suppressed (<5 events) No events 24.0 - 39.8
39.9 - 48.1 48.2 - 56.0 56.1 - 64.3
64.4 - 83.3
HagerstownCumberland
CresaptownSt. James
Friendsville
Deer Park
Source: Maryland Vital Statistics Administration and Office of MCH Epidemiology. Risk represents weighted mean predicted probability of fetal deaths, neonatal deaths, orvery PTB and very LBW births (<1,500g & <32 weeks) adjusted for maternal, hospital, and community characteristics stratified by jurisdiction among singleton pregnancies.Lowest and Highest indicate areas whose estimated risk is in the lower 5th and upper 95th percentile of the jurisdiction grouping, respectively. Data based on fewer than 5pregnancies has been suppressed.
Northwest Region Adverse Pregnancy OutcomeRisks
54
All Races
No data Suppressed Lowest
Highest
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
Black non-Hispanic
No data Suppressed Lowest
Highest
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
White non-Hispanic
No data Suppressed Lowest
Highest
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
Hispanic
No data Suppressed Lowest
Highest
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
Source: US Census American Community Survey 2016 Five-year Census Tract Estimates
Northwest Region Social Determinants of Health55
Adult Poverty Rates (ages 18-59)
% of adult residents
No data 0.0 2.5 - 7.7
7.8 - 10.4 10.5 - 13.6 13.7 - 22.1
22.2 - 44.7
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
Median Household Income
Income in 2016 inflation-adjusted dollars ($)
No data 0.0 19,914 - 40,599
40,599 - 43,773 43,773 - 49,844 49,844 - 61,094
61,094 - 93,875
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
No Health Insurance Coverage
% of adult residents, ages 18-64
No data 0.0 1.3 - 4.7
4.8 - 7.0 7.1 - 9.8 9.9 - 14.3
14.4 - 21.0
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
Houses Built Before 1950
% of households
No data 0.0 3.9 - 18.2
18.3 - 25.9 26.0 - 37.7 37.8 - 51.1
51.2 - 74.9
HagerstownCumberland
Cresaptown St. James
Friendsville
Deer Park
5656
REFERENCESr
Alio AP, Kornosky JL, Mbah AK, et al. (2010). The impact of paternal involvement on feto-infant morbidity among Whites, Blacks andHispanics. Maternal and Child Health Journal, 14(5), 735–741. doi:10.1007/s10995-009-0482-1.
Adams MM, Elam-Evans LD, Wilson HG, Gilbertz DA (2000). Rates of and factors associated with recurrence of preterm delivery. JAMA,283(12):1591-6. 10.1001/jama.283.12.1591.
Fingar KR, Stocks C, Weiss AJ, Owens PL (2015). Neonatal and Maternal Hospital Stays Related to Substance Use, 2006–2012. HCUPStatistical Brief #193. July 2015. Agency for Healthcare Research and Quality, Rockville, MD.http://www.hcup-us.ahrq.gov/reports/statbriefs/sb193-Neonatal-Maternal-Hospitalizations-SubstanceUse.pdf.
Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization - United States,1999–2014. MMWR Morb Mortal Wkly Rep 2018;67:845-849.
Heslin KC, Owens PL, Karaca Z, Barrett ML, Moore BJ, Elixhauser A (2017). Trends in Opioid-related Inpatient Stays Shifted After the USTransitioned to ICD-10-CM Diagnosis Coding in 2015. Medical Care, 55(11):918-923.
Keegan J, Parva M, Finnegan M, Gerson A, Belden M (2010). Addiction in pregnancy. Journal of Addictive Diseases, 29(2):175-191.
Leddy MA, Power ML, Schulkin J (2008). The impact of maternal obesity on maternal and fetal health. Reviews in Obstetrics & Gynecology,1:170-178.
Luo ZC, Wilkins R, Kramer MS (2004). Disparities in pregnancy outcomes according to marital and cohabitation status. Obstetrics andGynecology, 103(6), 1300–1307. doi:10.1097/01. AOG.0000128070.44805.1f.
Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetricaloutcomes. Anesthesiology 2014;121:1158–65. https://doi.org/10.1097/ALN.0000000000000472.
Maryland (MD) PRAMS Report, 2012-2015 Births. January 2018. Available at:https://phpa.health.maryland.gov/mch/Documents/2012-2015%20PRAMS%20report_rev.pdf
Ngui E, Cortright A, & Blair K (2009). An investigation of paternity status and other factors associated with racial and ethnic disparities inbirth outcomes in Milwaukee, Wisconsin. Maternal and Child Health Journal, 13(4), 467–478. doi:10.1007/s10995-008-0383-8.
Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome:United States 2009 to 2012. J Perinatol 2015;35:650–5. https://doi.org/10.1038/jp.2015.36.
Salihu HM, Salemi JL, Nash MC, et al. (2014). Assessing the Economic Impact of Paternal Involvement: A Comparison of the GeneralizedLinear Model Versus Decision Analysis Trees. Maternal Child Health Journal, 18:1380–1390.
Sappenfield WM, Peck MG, Gilbert CS, et al (2010). Perinatal Periods of Risk: Analytic Preparation and Phase 1 Analytic Methods forInvestigating Feto-Infant Mortality. Maternal and Child Health Journal, 14:838-850.
Sappenfield WM, Peck MG, Gilbert CS, et al (2010). Perinatal Periods of Risk: Phase 2 Analytic Methods for Further InvestigatingFeto-Infant Mortality. Maternal and Child Health Journal, 14:851-863.
Ventura SJ, Hamilton BE, Mathews TJ (2014). National and state patterns of teen births in the United States, 1940–2013. National vitalstatistics reports; vol 63 no 4. Hyattsville, MD: National Center for Health Statistics.
More information about maternal preconception and prenatal risk factors and trends are available in Maryland Pregnancy Risk AssessmentMonitoring System (PRAMS) Reports and Focus Briefs available here: https://phpa.health.maryland.gov/mch/Pages/prams_report.aspx