Lower Hudson Valley Community Health DashboardLower Hudson Valley Community Health Dashboard:...

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Lower Hudson Valley Community Health Dashboard: Maternal and Infant Health in Westchester, Rockland, and Orange counties Last Updated: 3/20/2019

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Overview

Planning for Pregnancy • Inter-pregnancy interval • Unintended pregnancy • Teen birth rate Prenatal Health • Diabetes during pregnancy • Hypertension during pregnancy • Tobacco use during pregnancy • Prenatal care Postpartum Health • Pre-term delivery • Low birth weight • Exclusive breastfeeding in the hospital • Newborn drug-related diagnosis rate • Infant mortality

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Planning for Pregnancy

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Intra-pregnancy interval Having a live birth within 24 months of a previous pregnancy increases risk of adverse maternal and infant health outcomes.

5

The percent of live births within 24 months of a previous pregnancy declined in Westchester, but increased in Rockland and Orange counties

29.3

23.4

35.0

38.2

32.4

37.6

33.5 32.6

0

10

20

30

40

2008 2009 2010 2011 2012 2013 2014 2015

Perc

ent o

f liv

e bi

rths

that

occ

ur w

ithin

24

mon

ths

of

a pr

evio

us p

regn

ancy

Westchester Rockland Orange New York State

Data sources: CDC WONDER Birth Data, 2008-2015; New York State Prevention Agenda, 2008-2015. Note: The denominator is all live births, excluding first births, as first births could not have a previous pregnancy to term.

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Unintended pregnancy Unintended pregnancy refers to current pregnancy indicated as ‘Wanted Later’ or ‘Wanted Never’. In this report, unintended pregnancy is only measured among live births, which excludes pregnancies that ended in miscarriages and induced abortions.

7

23.7

21.2 22.1

16.7

28.8

22.6

28.4

23.7

0

5

10

15

20

25

30

2008 2009 2010 2011 2012 2013 2014 2015

Perc

ent o

f uni

nten

ded

preg

nanc

y am

ong

live

birt

hs


The percent of unintended pregnancy among live births has declined throughout the region since 2008

Data source: New York State Prevention Agenda, 2008-2015.

8

21.1

14.6

49.8

43.0

38.0 36.8

0

20

40

60

2008 2009 2010 2011 2012 2013 2014 2015

Perc

enta

ge o

f uni

nten

ded

preg

nanc

y am

ong

live

birt

hs, O

rang

e C

ount

y Non-Hispanic White Non-Hispanic Black Hispanic

The percent of unintended pregnancy continues to be higher for Hispanic and non-Hispanic black women in Orange County


9

11.2

6.2

43.6

41.0

35.0

28.1

0

20

40

60

2008 2009 2010 2011 2012 2013 2014 2015

Perc

enta

ge o

f uni

nten

ded

preg

nanc

y am

ong

live

birt

hs, R

ockl

and

Cou

nty

Non-Hispanic White Non-Hispanic Black Hispanic


Non-Hispanic black and Hispanic women experienced a smaller decline in unintended pregnancy than non-Hispanic white women in Rockland County

10

10.2 9.6

44.8

36.5

31.9

27.9

0

10

20

30

40

50

2008 2009 2010 2011 2012 2013 2014 2015

Perc

enta

ge o

f uni

nten

ded

preg

nanc

y am

ong

live

birt

hs, W

estc

hest

er C

ount

y


The percent of unintended pregnancy continues to be lower for non-Hispanic white women in Westchester County


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38.6

32.5

25.8

17.7

38.4

27.3

36.4

30.5

0

10

20

30

40

50

2008 2009 2010 2011 2012 2013 2014 2015

Perc

ent o

f uni

nten

ded

preg

nanc

y am

ong

Med

icai

d liv

e bi

rths


Unintended pregnancy among Medicaid births is highest in Westchester and Orange counties, but has declined in each county


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Teen (age 15-19y) birth rates

13 Data source: CDC WONDER Births Data and Bridged-Race Population Estimates, 2003-2017.

18.7

7.1

16.5 13.5

25.4

14.9

23.2

12.4

41.1

18.8

0

5

10

15

20

25

30

35

40

45

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Teen

birt

h ra

te p

er 1

,000

Westchester Rockland Orange Rest of NYS excluding NYC United States

Teen birth rates have declined in Westchester, Rockland, and Orange counties since 2003; and remain highest in Orange County

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Prenatal Health

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Timely initiation of prenatal care Defined as starting prenatal care in the first 3 months of pregnancy

16 Data source: CDC WONDER Births Data, 2008-2017.

72.2

84.9

78.4

65.6

80.4

74.9

82.7

66.4

77.3

50

60

70

80

90

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent s

tart

ing

pren

atal

car

e in

the

first

trim

este

r


The proportion of women starting prenatal care in the first trimester has increased throughout the region

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The percent of women who start prenatal care late is lower in the Lower Hudson Valley and the rest of NYS excluding NYC than in the U.S. overall

0.4%

82.1%

14.3%

3.1%

No prenatal care 1st trimester 2nd trimester 3rd trimester

0.7%

82.7%

13.5%

3.2% Rest of NYS excluding NYC Lower Hudson

Valley

1.8%

77.3%

16.5%

4.5%

United States

Data source: CDC WONDER Births Data, 2017. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

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Teen women, non-Hispanic black women, and those with less education are least likely to start prenatal care in the first trimester

62.3

75.7 79.8 82.3 85.7 85.7

70.9 79.3 74.8 78.8

89.0

0

30

60

90

<20 20-24 25-29 30-34 35+ Non-Hispanic

White

Non-Hispanic

Black

Hispanic <HS HS/SomeCollege

≥College

Perc

ent s

tart

ing

pren

atal

ca

re in

the

first

trim

este

r

Data source: CDC WONDER Births Data, 2017. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

61.2 70.5

77.8 82.1 81.0 82.4

66.6 72.3

60.3

75.4 87.5

0

30

60

90

<20 20-24 25-29 30-34 35+ Non-Hispanic

White

Non-Hispanic

Black

Hispanic <HS HS/SomeCollege

≥College Perc

ent s

tart

ing

pren

atal

ca

re in

the

first

trim

este

r

United States

Lower Hudson Valley

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In the Lower Hudson Valley, disparities in the early initiation of prenatal care by race/ethnicity remain

77.8

85.7

56.8

71.3

62.3

79.3

0

20

40

60

80

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent s

tart

ing

pren

atal

car

e in

the

first

trim

este

r


Data source: CDC WONDER Births Data, 2008-2017. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

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The percent of teen mothers starting prenatal care in the first trimester has increased

38.8

58.9

39.3

57.7

44.5

60.2

55.0

68.3

50.5

0

10

20

30

40

50

60

70

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent s

tart

ing

pren

atal

car

e in

the

first

trim

este

r


Data source: CDC WONDER Births Data, 2008-2017.

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Hypertension during pregnancy

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0.9

1.5

0.9

1.2 1.1 1.2 1.3

2.0

0.0

0.5

1.0

1.5

2.0

2.5

2008-2009 2010-2011 2012-2013 2014-2015 2016-2017

Chr

onic

Hyp

erte

nsio

n du

ring

preg

nanc

y, %

Westchester Rockland Orange NYS Excluding NYC

Chronic hypertension during pregnancy is lower in the region than in New York State


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1.7

4.3

2.1

3.0

3.7

3.3

6.1

0

2

4

6

8

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Preg

nanc

y-as

soci

ated

hyp

erte

nsio

n, %


Pregnancy-associated hypertension is lower in the region than in New York State


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Pregnancy-associated hypertension is most common among older moms, non-Hispanic black moms and those with more education

Data source: CDC WONDER Births Data, 2015-2017. Data for those <20 years suppressed due to small sample size. Lower Hudson Valley Region is comprised of Westchester, Rockland, and Orange counties.

3.5 3.1

3.4 3.9

4.9

3.4

6.8

3.8

3.0

3.8

4.6

0

2

4

6

8

10Pe

rcen

t with

pre

gnan

cy-a

ssoc

iate

d hy

pert

ensi

on (%

)

25

Diabetes during pregnancy

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4.3

7.1

5.7 5.6

7.4

5.2

8.0

0

2

4

6

8

10

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Dia

bete

s du

ring

preg

nanc

y, %


Diabetes during pregnancy has increased in Westchester and Orange counties


Defined as gestational diabetes + established diabetes

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Diabetes during pregnancy is most common among older moms, Hispanic and non-Hispanic black moms and those with less education

Data source: CDC WONDER Births Data, 2015-2017. Lower Hudson Valley Region is comprised of Westchester, Rockland, and Orange counties.

Defined as gestational diabetes + established diabetes

2.0 2.5

4.5

6.7

9.9

4.7

7.5 7.6 7.6

6.1 6.2

0

2

4

6

8

10

12

14Pe

rcen

t with

dia

bete

s (%

)

28

Tobacco use during pregnancy

29

1.7 1.1

1.8

0.6

5.0

2.7

12.2

8.2

0

2

4

6

8

10

12

14

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Toba

cco

smok

ing

durin

g pr

egna

ncy

(%)


Although much lower than in NYS, tobacco smoking during pregnancy is higher in Orange than Westchester and Rockland counties


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Tobacco smoking during pregnancy is more common among younger moms, non-Hispanic black moms and those with less education

Data source: CDC WONDER Births Data, 2015-2017. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

1.8

2.3 2.1

1.2 1.1

1.6

3.7

1.0

2.6

2.3

0.3

0

1

2

3

4

15-19 20-24 25-29 30-34 35+ NHW NHB Hispanic <HS HS/SomeCollege

≥College

Toba

cco

smok

ing

durin

g pr

egna

ncy,

(%)

31

Cesarean Section

32

37.8

41.2

22.6

28.3 27.6

33.2 34.4

35.7

0

10

20

30

40

50

20172016201520142013201220112010200920082007

Ces

area

n de

liver

ies

per 1

,000

birt

hs

Westchester County Rockland County Orange County NYS Excluding NYC

A larger percentage of women give birth through cesarean section in Westchester County than in the rest of the region and NY State

Data source: CDC WONDER Births data, 2007-2017 Data includes both single and multiple births. Lower Hudson Valley Region is comprised of Westchester, Rockland, and Orange counties.

33

Cesarean sections are more common among older moms, non-Hispanic black moms and those with more education

Data source: CDC WONDER Births Data, 2017. Data includes single and multiple births. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

18.6 19.0

27.1

32.8

40.8

25.7

43.8

36.0

13.8

19.3

34.2

0

10

20

30

40

50

15-19 20-24 25-29 30-34 35+ NHW NHB Hispanic <HS HS/SomeCollege

≥College

Ces

area

n de

liver

ies

per 1

,000

birt

hs

34

Preterm delivery Defined as giving birth <37 weeks based on obstetrician/clinical estimate of gestational age, which has been shown to be a more reliable measurement than estimates by last menstrual period

Data are limited to single births because there is evidence that multiple pregnancies greatly increase the risk for preterm delivery. Sources: Dietz, Bombard, & Hutchings, 2014.

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The percent of preterm births has modestly decreased in the region and remains lower than in the rest of NYS and the United States

7.9

6.9

6.1 5.6

7.0 6.3

7.6 7.2

8.5

8.1

0

1

2

3

4

5

6

7

8

9

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent o

f tot

al b

irths

del

iver

ed p

rete

rm


Preterm defined as giving birth <37 weeks based on obstetrician/clinical estimate of gestational age

Data source: CDC WONDER Births Data, 2007-2017. Data limited to single births.

1.0%

5.4%

93.6%

<32 weeks

32-36 weeks

≥37 weeks

Gestational age distribution in the Lower Hudson Valley, 2017

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4.8

9.3

8.1

0

2

4

6

8

10


Perc

ent o

f tot

al b

irths

del

iver

ed p

rete

rm

2017

In the Lower Hudson Valley, non-Hispanic black vs. non-Hispanic white disparities in the percent of preterm births have narrowed

Data source: CDC WONDER Births Data, 2007-2017. Data limited to single births. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.


5.9

4.8

12.4

9.3

7.5 8.1

0

2

4

6

8

10

12

14

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017


37

In the Lower Hudson Valley, teens (and older women), as well as those with less education, tend to have higher preterm birth rates

8.1

5.3 5.5 5.9

7.5

6.8 6.5

5.7

0

2

4

6

8

10

<20 20-24 25-29 30-34 35+ <HS HS/Some Sollege ≥College

Perc

ent o

f tot

al b

irths

del

iver

ed p

rete

rm

Data sources: CDC WONDER Births Data, 2017. Data limited to single births. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.


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14.3

10.9

8.2

6.3

10.1

8.4

12.5 11.1

0

5

10

15

20

2008-10* 2009-11* 2010-12* 2011-13* 2012-14* 2013-15

Perc

ent o

f pre

term

birt

hs a

mon

g M

edic

aid

birt

hs

Westchester County Rockland County Orange County New York State

The percent of preterm births among Medicaid births has declined across all three counties since 2008

Data source: New York State Prevention Agenda, 2008-2015. Data includes both single and multiple births. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties. *Data points for New York State are three-year averages.

39

Low birth weight Defined as <2,500 grams

Data are limited to single births because there is evidence that multiple births are more likely to result in low birth weight. Source: Ventura et al., 1996.

40

The percent of total births with low birth weight has remained relatively stable in Westchester, Rockland, and Orange counties

6.1 5.9

4.5

4.7 5.3

4.5

5.6 5.9

6.5 6.6

0

1

2

3

4

5

6

7

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent o

f birt

hs th

at a

re lo

w b

irth

wei

ght


Data source: CDC WONDER Births Data, 2007-2017. Data limited to single births.

0.8% 4.5%

86.3%

8.4%

Very low birth weight (<1500g)

Low birth weight (1500-2499)

Normal birth weight (2500-3999)

Macrosomic (≥4000)

Birth weight distribution in the Lower Hudson Valley, 2016

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In the Lower Hudson Valley, the non-Hispanic black population has the highest burden of low birth weight

3.8

6.0

9.9

0

2

4

6

8

10

Non-Hispanic White Hispanic Non-Hispanic Black

Perc

ent o

f birt

hs th

at a

re lo

w b

irth

wei

ght

Data source: CDC WONDER Births Data, 2007-2016. Data limited to single births. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

4.3 3.8

11.4

9.9

5.4 6.0

0

2

4

6

8

10

12

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Non-Hispanic White Non-Hispanic Black Hispanic2017

42

In the Lower Hudson Valley, infants born to teen mothers are more likely to be low birth weight

6.1

5.3

4.6 4.6

5.6 5.3

5.8

4.6

0

1

2

3

4

5

6

7

<20 20-24 25-29 30-34 35+ <HS HS/Somecollege

College+

Perc

ent o

f birt

hs th

at a

re lo

w b

irth

wei

ght

Data source: CDC WONDER Births Data, 2017. Data limited to single births. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

43

Exclusive breastfeeding in the hospital Exclusive breastfeeding in the hospital is a good predictor of meeting breastfeeding recommendations after hospital discharge. The goal is exclusive breastfeeding for the first 6 months.

44

50.0

42.6

32.4

47.9

42.6

48.1

41.6

44.3

0

10

20

30

40

50

60

2008 2009 2010 2011 2012 2013 2014 2015

Perc

ent o

f inf

ants

exc

lusi

vely

bre

astfe

d in

the

hosp

ital


The percent of infants exclusively breastfed in the hospital has declined in Westchester county, but increased in Rockland and Orange counties

Data source: New York State Birth Records, New York State Prevention Agenda, 2008-2015.

45

47.5

56.3

30.5 33.1

41.5 39.1

0

20

40

60

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Perc

ent o

f inf

ants

exc

lusi

vely

bre

astfe

d in

the

hosp

ital

by ra

ce/e

thni

city

, Ora

nge

Cou

nty


Across racial/ethnic groups, a greater percentage of infants are exclusively breastfed in Orange county than in NY state, although disparities persist


46

49.1

57.8

15

25.8

15.6

22.1

0

20

40

60

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Perc

ent o

f inf

ants

exc

lusi

vely

bre

astfe

d in

the

hosp

ital

by ra

ce/e

thni

city

, Roc

klan

d C

ount

y


The racial/ethnic disparities in the percent of infants exclusively breastfed are larger in Rockland county than in New York State


47

52.8

59.5

32.5

36.4

49.7

43.9

0

20

40

60

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Perc

ent o

f inf

ants

exc

lusi

vely

bre

astfe

d in

the

hosp

ital

by ra

ce/e

thni

city

, Wes

tche

ster

Cou

nty



Across racial/ethnic groups, a greater percentage of infants are exclusively breastfed in Westchester county than in NY state, although disparities persist

48

45.2

42.2

37.3

47.9

39.9 41.8

30.2 31.3

0

10

20

30

40

50

2008-10* 2009-11* 2010-12* 2011-13* 2012-14* 2013-15

Perc

ent o

f inf

ants

exc

lusi

vely

bre

astfe

d in

the

hosp

ital a

mon

g M

edic

aid

birt

hs


Among Medicaid births, the percent of infants exclusively breastfed remained higher in the region than New York State

Data source: New York State Prevention Agenda, 2008-2015. *Data points for New York State are three-year averages.

49

Newborn drug-related diagnosis rate Defined as the number of newborns with a drug-related ICD-9 code per 10,000 newborn discharges

50

40.7

87.0

27.4

56.0

24.6

139.3

72.0

156.4

0

20

40

60

80

100

120

140

160

2008 2009 2010 2011 2012 2013 2014

New

born

dru

g-re

late

d di

agno

sis

rate

per

10,

000

new

born

dis

char

ges

Westchester Rockland Orange New York State (excluding NYC)

In each county, the newborn drug-related diagnosis rate has at least doubled since 2008, increasing over fivefold in Orange county

Data source: New York State Department of Health, Statewide Planning and Research Cooperative System (SPARCS), 2008-2014.

51

Infant mortality Defined as the death of an infant before his or her first birthday

52

In the Lower Hudson Valley, the infant mortality rate is highest in Orange County, but lower than in the rest of New York State and the U.S.

3.4 3.7

4.8 5.2

5.9

0

1

2

3

4

5

6

7

Westchester Rockland Orange Rest of NYSexcluding

NYC

UnitedStates

Infa

nt m

orta

lity

rate

per

1,0

00 li

ve b

irths

2016

26.8%

24.7%

6.6%

6.4%

6.3%

4.7%

3.3%

3.1%

3.0%

15.2%

Congenital problems

Disorders related topreterm/LBW

Respiratory distress

Sudden infant deathsyndrome

Bacterial sepsis

Maternal complications ofpregnancy

Diseases of the circulatorysystem

Necrotizing enterocolitis

Diarrhea andgasteroenteritis

Other

2007-2016

Percentages of deaths of children < 1 year old due to each cause are shown for the Lower Hudson Valley

Data source: CDC WONDER Linked Birth/Infant Death Records, 2016. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

53

4.8

3.6

5.4

3.7

6.5

4.9

6.4

5.2

7.2

5.9

0

1

2

3

4

5

6

7

8

9

1996-1998 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 2014-2016

Infa

nt m

orta

lity

rate

per

1,0

00 li

ve b

irths


Since 1995, infant mortality rates have declined throughout the region, but remain highest in Orange county

Data source: CDC WONDER Linked Birth/Infant Death Records, 1995-2016. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

54

Maternal age, race/ethnicity and education are strongly related to infant mortality rates

Data source: CDC WONDER Linked Birth/Infant Death Records, 2012-2016. Figure based on maternal race/ethnicity. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

Lower Hudson Valley

7.1

5.0 4.1 3.9 3.5

4.7

9.2

2.7

5.9 4.7

2.2

0

2

4

6

8

10

12

<20 20-24 25-29 30-34 35+ Hispanic Non-Hispanic

Black

Non-Hispanic

White

<HS HS/Somecollege

College+

Infa

nt m

orta

lity

rate

pe

r 1,0

00 li

ve b

irths

8.6 7.0

5.5 4.9

5.8 5.1

11.2

5.0

7.7 6.4

3.5

0

2

4

6

8

10

12

<20 20-24 25-29 30-34 35+ Hispanic Non-Hispanic

Black

Non-Hispanic

White

<HS HS/Somecollege

College+

Infa

nt m

orta

lity

rate

pe

r 1,0

00 li

ve b

irths

United States

55

In the Lower Hudson Valley, the infant mortality rate has declined by 12 percent, although racial/ethnic disparities persist

Data source: CDC WONDER Linked Birth/Infant Death Records, 1995-2016. Lower Hudson Valley is comprised of Westchester, Rockland, and Orange counties.

5.0

4.3

11.5

9.6

4.0

2.6

0

5

10

15

1996-1998 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 2014-2016

Infa

nt m

orta

lity

rate

per

1,0

00 li

ve b

irths

Hispanic Non-Hispanic Black Non-Hispanic White

7.5 7

56

Among teen mothers, Orange county has a higher infant mortality rate than Westchester and Rockland counties

7.0 7.6*

10.7

9.2 8.9

0

2

4

6

8

10

12

Westchester Rockland Orange Rest of NYS excludingNYC

United States

Infa

nt m

orta

lity

rate

per

1,0

00 te

en b

irths

Data source: CDC WONDER Linked Birth/Infant Death Records, 2007-2016. *Interpret with caution due to small numbers.

57

About the Lower Hudson Valley Community Health Dashboard Project

The goal of the project is to provide Lower Hudson Valley-specific data on risk factors and health outcomes with an emphasis on presenting data on trends, socio-demographic differences (e.g., by age, sex, race/ethnicity, etc.) and sub-county/neighborhood level data

Data will be periodically updated as new data becomes available.

Produced by Montefiore’s Office of Community & Population Health using publicly-available data sources

For more information please contact us at [email protected]

mailto:[email protected]

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Sources Links to Data Sources:

CDC WONDER Births Data and Bridged-Race Population Estimates: https://WONDER.cdc.gov/natality.html CDC WONDER Linked Birth/Infant Death Records: https://WONDER.cdc.gov/lbd.html New York State Prevention Agenda:

https://webbi1.health.ny.gov/SASStoredProcess/guest?_program=/EBI/PHIG/apps/dashboard/pa_dashboard&p=ch New York State Dept of Health, Statewide Planning and Research Cooperative System (SPARCS),

https://www.health.ny.gov/statistics/chac/indicators/sub.htm

Literature

Dietz PM, Bombard JM, Hutchings YL. Validation of obstetric estimate of gestational age on US birth certificates. Am J Obstet Gynecol 2014;210:335.e1-335.e5.

Ventura SJ, Martin JA, Curtin SC, Mathews TJ. Report of final natality statistics, 1996. Hyattsville, Maryland: US Department for Health and Human Services, CDC, National Center for Health Statistics. Monthly vital statistics reports (vol 46, no. 11).

https://wonder.cdc.gov/natality.html

https://wonder.cdc.gov/lbd.html

https://webbi1.health.ny.gov/SASStoredProcess/guest?_program=/EBI/PHIG/apps/dashboard/pa_dashboard&p=ch

https://www.health.ny.gov/statistics/chac/indicators/sub.htm

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