Georgia Department of Public Health | OASIS Mapping Tools | PPOR Definitions

Perinatal Periods of Risk (PPOR) Definitions


Presentation Information

Confidentiality rule:
Numbers based on 0-4 events are classified as a separate static class when a sub-county level geography (Census Tract or County Commission District) is chosen. This, in addition to offering only non-overlapping 5-year aggregates is done to assure confidentiality.
Not Reportable
Rates (and Percents) based on 1-9 events are not reported due to statistical reliability reasons. If the total number of events across all periods for a given time and geography is less than 40 then all rates are suppressed.

Mapping Units:

Visible Layers:

Census Tracts
Census Tracts are small, relatively permanent statistical subdivisions of a county or equivalent entity that are updated by local participants prior to each decennial census.
Census tracts generally have a population size between 1,200 and 8,000 people.  A census tract usually covers a contiguous area; however, the spatial size of census tracts varies widely depending on the density of settlement.  Census tract boundaries are delineated with the intention of being maintained over a long time so that statistical comparisons can be made from census to census.  Census tracts occasionally are split due to population growth or merged as a result of substantial population decline.
Census tract boundaries generally follow visible and identifiable features.  They may follow nonvisible legal boundaries, such as minor civil division (MCD) or incorporated place boundaries in some states and situations, to allow for census-tract-to-governmental-unit relationships where the governmental boundaries tend to remain unchanged between censuses.  State and county boundaries always are census tract boundaries in the standard census geographic hierarchy. Reference Source: U.S. Commerce Department, United States Census Bureau, accessed July 2011
A mix of both incorporated places (legal entities) and census designated places or CDPs (statistical entities). An incorporated place is established to provide governmental functions for a concentration of people. Places always nest within a state, but may extend across county and county subdivision boundaries. An incorporated place usually is a city, town, village, or borough, but can have other legal descriptions. CDPs are delineated to provide data for settled concentrations of population that are identifiable by name, but are not legally incorporated under the laws of the state in which they are located. Each dot represents the centroid of the geographical area of the city/town. Click on the dot to get the city or town name. Reference Source: U.S. Census, January 1, 2013
County Commission Districts
For more information, see districts are current as of 2008, and were compiled by Office of Health Indicators for Planning (OHIP) staff in the Georgia Department of Public Health. History and role: In 1868 the state began creating the position of county commissioner to administer the general operations of the county. Today every county has a commissioner; many have a board of commissioners (BOC). As part of general county operations, the BOC must finance county programs. A BOC has the power to adopt ordinances, resolutions, or regulations relating to county property, county affairs, and the operation of local government ( ).
GA House Districts
Electoral districts from which State Representatives are elected. The Georgia Constitution requires not less than 180 Representatives apportioned by population from representative districts. Layer Source: Georgia Legislative and Congressional Reapportionment Office, 2012.
Senate Districts
Electoral districts from which State Senators are elected. The Georgia Constitution limits the number to not more than 56 single member districts. Senate districts are apportioned based on population. Layer Source: Georgia Legislative and Congressional Reapportionment Office, 2012.
Hospitals are the non-Federal acute-care inpatient medical facilities in Georgia. Click on the symbol to get the name. Reference Source: Georgia Hospital Assoociation, 2012
Interstates are the freeways that are part of the Interstate Highway System in Georgia. The Interstate Highway System connects major cities within the United States. Click on the line to get the Interstate number. Layer Source: Esri, March 1, 2012
Major Roads
Major roads are a combination of both federal and state highways connecting cities and towns. Click on the line to get the route number. Layer Source: Esri, March 1, 2012
Perinatal Regions
The Perinatal Regions were established by the Department of Public Health in cooperation with the six teaching hospitals located in Atlanta, Albany, Augusta, Columbus, Macon and Savannah. The Regions reflect the hospital referral patterns for high risk pregnant women and newborns Each of the six hospitals has a Regional Perinatal Center which has contracts with the state and receives funding to care for high risk pregnant women and infants as well as to train staff from other hospitals in perinatal care especially for high risk patients. Reference Source: Georgia Department of Public Health, March 2005
ZIP Code
Established by the U.S. Postal Service for distribution of mail. Zip codes do not generally respect political boundaries or census areas such as tracts. Zip codes usually do not have clearly identifiable boundaries, often serve a continually changing area, are changed periodically to meet postal requirements, and do not cover all land area in the U.S. Layer Source: Esri, June 1, 2013

Base Layers:

Base layers are background information to provide contextual references for local-level maps. They are especially suited for tract-level maps and give real-world reference to maps you create in OASIS. There are three toggle-able (on/off) base layers:
Demographic Clusters
Demographic Clusters refer to the socioeconomic status classifications created by OHIP, and are at the census block-group level. More information here:
Aerial Photography
Aerial Photography refers to ESRI's World Imagery.
Street Map
Street Map refers to ESRI's World Street Map with street-level data for North America.
Currently these Base Layers are not available when you Save/Print map.

Data Classification Methods:

Natural Breaks (Jenks)
This method minimizes within-class variance and maximizes between-class variance in an iterative series of calculations. This method seeks to partition data into classes based on natural groups in the data distribution. Natural breaks occur in the histogram at the low points of valleys. Breaks are assigned in the order of the size of the valleys, with the largest valley being assigned the first natural break.
George F. Jenks is considered a pioneer in GIS educational programs. Through an award from the Fund for Advancement of Science, Jenks identified four key objectives for cartographic training. Robert McMaster and Susanna McMaster; A History of Twentieth-Century American Academic Cartography
Source: Brewer and Pickle. Evaluation of Methods for Classifying Epidemiological Data on Choropleth Maps in a Series. Annals of the Association of American Geographers, 92(4), 2002, pp. 662-681.
  • Data values for each enumeration unit (e.g. county or census tract) are ranked from lowest to highest.
  • The total number of values is divided by the number of classes specified by the user to determine how many values each class will contain. The object is to obtain a roughly equal number of data values within each class. For example, if you have 100 census tracts and the tract data values are to be classed into 5 classes, each class will have 20 values (100/5 = 20).
  • In some cases, an equal number of values will not be placed into each class. For instance, if there are an odd number of enumeration units some classes will have a larger number of data values than others. If data values for the 159 counties of Georgia are divided into 4 classes, then some classes might have 39 data values while others have 40. In addition, identical data values are maintained within the same classes. Continuing the Georgia county example, if 45 of the lowest data values are 0, then the lowest class will have 45 data values all with a value of 0.
The quantiles method of classification is provided because:
  • Quantiles classification is one of the simplest methods of classification and is easy to understand and interpret.
  • Classes are usually centered on the median, a measure of central tendency, and "they group enumeration units above and below the median into classes with equal frequencies regardless of their values." This makes maps easier to compare with one another.
  • Many health-related measures are distributed normally (i.e. a large number of values falling near the middle of the data range with a smaller number of values on the low and high ends of the data range) making quantiles classification a logical classification method.
Source: Brewer and Pickle. Evaluation of Methods for Classifying Epidemiological Data on Choropleth Maps in a Series. Annals of the Association of American Geographers, 92(4), 2002, pp. 662-681.


Data Classes
Also referred to as "class breaks" or groupings of data.
A group of people sharing a common temporal demographic experience who are observed through time. For example, the birth cohort of 1940 is the people born that year. Another example is school class cohort. In this case, Birth Cohorts are used. This means that in a given cohort year, all fetal deaths and births are accounted for. However any infant deaths that are linked to live births may have occurred in the cohort year or up to one year after. E.g. the 2014 birth cohort will include linked infant deaths that occurred in both 2014 and 2015.
Early Fetal Death
A fetal death occurring between 20 and 27 weeks of gestation.
Early Neonatal Period
The period from birth to 6 days of age.
Educational Level
The last grade of formal education completed. A sample calculation is Percentage of Live Births to Females with Less than High School Education - The total number of live births to females with less than a high school education, per 100 total live births. Formula = [Total Number of Live Births to Females with Less than High School Education / Total Number of Live Births] * 100. Select both Less than 9th and 9-11th grade to obtain Less than High School education.
Hispanic or Latino includes persons of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. Non-Hispanic + Hispanic may not equal the total number of events due to persons of unknown ethnicity.
Fetal Death
Death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles
Feto-Infant Mortality Rate (FIMR) and Perinatal Periods of Risk (PPOR)
Feto-infant mortality rate (FIMR) is defined as the number of fetal deaths (>= 20 weeks gestation & 500+ grams) plus the number of infant deaths (500+ grams) divided by the total number of fetal deaths (>= 20 weeks gestation & 500+ grams) plus live births (500+ grams) and expressed as a rate per 1,000. Being a birth cohort measure, infant deaths are linked to live births of a given cohort year. This means that for example, the 2014 Rate of FIMR will have only 2014 Live Births and Fetal Deaths in the denominator, whereas the numerator has Infant Deaths from both 2014 and 2015 that were linked to 2014 Live Births (in addition to 2014 fetal deaths).
PPOR Examples of Suggested Causes Examples of Suggested Interventions
Women's Health Unintended Pregnancy, Poor Nutrition, No Prenatal Care, Substance Abuse/Smoking, First or 4th-or-higher birth, Untreated STD's, < 2 year birth interval. Pre-conceptual, peri-conceptual and early prenatal interventions which affect the mother's health and increase birthweight. Examples include assuring good nutritional status including folic acid intake.
Maternal Care Prenatal Care not matched to need. Prenatal, intra-partum and postpartum services which directly affect the maternal outcome by reducing excessive maternal and fetal mortality and morbidity. Assuring an appropriate match between need and content of prenatal care.
Newborn Care Group B Strep untreated. Intra-partum, early neonatal, and postpartum services which directly affect the newborn outcome by reducing excessive early neonatal mortality and morbidity. These are chiefly biomedical interventions.
Infant Care No Parenting Skills Education, No Immunizations, No breastfeeding, Injury: Falls, burns, etc, Child Abuse / neglect, No Monitoring Growth / Development. Post discharge services which directly affect the infant outcome by reducing excessive post discharge mortality and morbidity. For example, SIDS and injury prevention through health education.
PPOR Methodology
Women's Health = [Number of Feto-Infant deaths related to Women's Health / (Births 500+ grams + Fetal Deaths >= 20 weeks and 500+ grams)] * 1,000
Maternal Care = [Number of deaths occurring to fetuses related to Maternal Care / (Births 500+ grams + Fetal Deaths >= 20 weeks and 500+ grams)] * 1,000
Newborn Care = [Number of infant deaths related to Newborn Care / (Births 500+ grams + Fetal Deaths >= 20 weeks and 500+ grams)] * 1,000
Infant Care = [Number of infant deaths related to Infant Care / (Births 500+ grams + Fetal Deaths >= 20 weeks and 500+ grams)] * 1,000
Late Fetal Death
A fetal death occurring on or after 28 weeks of gestation.
Late Neonatal Period
The period after birth 7 through 27 days of age.
Neonatal Period
The period from birth to 27 days of age.
Perinatal Periods of Risk (PPOR)
Fetal death and infant death rates organized by intervention strategies in order to facilitate local health planning (see feto-infant mortality rate).
Postneonatal Period
The period after birth 28 through 364 days of age.
Per the Federal Office of Management and Budget, Directive 15 (1997),
  • White is a person having origins in any of the original peoples of Europe, the Middle East or North Africa;
  • Black or African-American is a person having origins in any of the black racial groups of Africa;
  • Asian is a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam;
  • American Indian/Alaska Native is a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment;
  • Native Hawaiian or Other Pacific Islander is a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands;
  • Multiracial is a person declaring 2 or more of these races.

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