Abstract
The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention released a comprehensive report on final birth data for 2016. Trends in fertility patterns and maternal and infant characteristics are described and interpreted in this latest annual report. NCHS analyzed and published data on state variations in infant mortality by race and Hispanic origin for 2013-2015. NCHS announced newly appointed directors of its Division of Health Interview Statistics and Division of Research Methodology. Readers can sign up for updates on the 2019 National Conference on Health Statistics sponsored by NCHS and check the 2018 exhibit on the NCHS website.
2016 Data on Births Released
The latest annual report on final natality data for the United States is now available. 1 The 2016 data are based on birth certificates filed in state vital statistics offices and reported to NCHS through the National Vital Statistics System. Data are presented by race and Hispanic origin, maternal age, live-birth order, marital status, gestational age, birth weight, and plurality. Also, for the first time, the annual report contains national data on tobacco use before and during pregnancy, usage and timing of prenatal care, and source of payment for the delivery.
The report covers a total of 3 945 875 births in 2016, down 1% from 3 978 497 births in 2015. The general fertility rate per 1000 females aged 15-44 declined from 62.5 births in 2015 to 62.0 births in 2016. The birth rate per 1000 population also declined from 12.4 births in 2015 to 12.2 births in 2016. The report presents trends in fertility patterns and various maternal and infant characteristics. In 2016, the birth rate per 1000 population varied by race for non-Hispanic single-race categories: 10.5 for white women, 14.0 for black women, 13.3 for American Indian/Alaska Native women, 14.6 for Asian women, and 16.8 for Native Hawaiian/other Pacific Islander women. By ethnicity, the 2016 birth rate for Hispanic women was 16.0 births per 1000 population.
The birth rates per 1000 women for those aged 15-19 decreased from 22.3 in 2015 to 20.3 in 2016. The number of births to teenaged girls aged 15-19 decreased 9%, from 229 715 in 2015 to 209 809 in 2016. By race and Hispanic origin, the birth rates per 1000 women for teenaged girls aged 15-19 ranged from 3.9 for non-Hispanic Asian teenagers to 35.1 for non-Hispanic American Indian/Alaska Native teenagers in 2016. Birth rates per 1000 population for other racial/ethnic groups were 14.2 for non-Hispanic white, 29.3 for non-Hispanic black, and 31.9 for Hispanic teenagers in 2016. Birth rates for women in their 20s also declined in 2016. The birth rate per 1000 population for women aged 20-24 was down 4%, from 76.8 in 2015 to 73.8 in 2016. The birth rate for women aged 25-29 was down 2%, from 104.3 in 2015 to 102.1 in 2016. In contrast, 2016 birth rates for women in their 30s and 40s were up from 2015. The birth rate per 1000 population for women aged 30-34 was up 1%, from 101.5 in 2015 to 102.7 in 2016. The birth rate for women aged 35-39 was up 2%, from 51.8 in 2015 to 52.7 in 2016. For women aged 40-44, the birth rate was up 4%, from 11.0 in 2015 to 11.4 in 2016. For women aged 45-49, the birth rate rose 12.5%, from 0.8 in 2015 to 0.9 in 2016.
In 2016, the mean age of mothers at first birth was 26.6 years, an increase from 26.4 years in 2015, and another record high for the nation. For unmarried women aged 15-44, the birth rate per 1000 unmarried women was down 2%, from 43.4 in 2015 to 42.4 in 2016.
First-time national estimates of tobacco use before and during pregnancy in 2016 showed that 7.2% of women reported smoking tobacco at some point while pregnant, and 9.4% of women reported smoking during the 3 months before becoming pregnant. Smoking was more common among younger women: 10.7% of women aged 20-24 and 8.5% of women aged <20 reported smoking 3 months before pregnancy and during pregnancy. Of 3 945 975 women who gave birth in 2016, 7.1% began prenatal care during the first trimester of pregnancy, 16.7% began prenatal care during the second trimester, and 6.2% began prenatal care during the third trimester or had no prenatal care. The cesarean delivery rate declined from 32.0% of US births in 2015 to 31.9% of births in 2016. The principal source of payment for the delivery of most births in 2016 was either private insurance (49.4%) or Medicaid (42.6%).
Key indicators of infant health status are period of gestation and birth weight. In 2016, the US preterm birth rate rose by 3.1%, from 9.6% in 2015 to 9.9% in 2016. The percentage of infants born with a low birth weight (<2500 g) rose 1%, from 8.1% in 2015 to 8.2% in 2016. The 2016 twin birth rate per 1000 births was down slightly, from 33.5 in 2015 to 33.4 in 2016. The triplet and high-order multiple birth rate was unchanged at 101.4 per 100 000 births for 2016.
State Variation in Infant Mortality
A new NCHS report used data sets that linked birth records and infant death records for 2013-2015 to describe infant mortality rates by state and differences by race and Hispanic origin. 2 The data sets link a combined 3 years of data to increase the accuracy of the data analyzed. The average US infant mortality rate for 2013-2015 was 5.9 deaths per 1000 live births for infants aged <1 year. The report shows a range of infant mortality rates by state, from 4.3 in Massachusetts to 9.1 in Mississippi. Seventeen states had an infant mortality rate that was significantly lower than the overall US rate: California, Colorado, Connecticut, Idaho, Iowa, Massachusetts, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Utah, Vermont, and Washington State. Twenty-one states had an infant mortality rate that was significantly higher than the overall US rate: Alabama, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, and West Virginia. Washington, DC, had an infant mortality rate of 7.7 deaths per 1000 live births, which was significantly higher than the overall US rate.
Examining differences by race/ethnicity revealed varying state patterns for infant mortality among non-Hispanic white, non-Hispanic black, and Hispanic women. Among the 50 states and Washington, DC, the mortality rate per 1000 live births for non-Hispanic white women ranged from 2.5 in Washington, DC, to 7.0 in Arkansas. In 2013-2015, the lowest mortality rates for infants of non-Hispanic white women occurred mostly in states in the West and Northeast. For infants born to non-Hispanic black women, the infant mortality rate ranged from 8.3 in Massachusetts to 14.3 in Wisconsin. For infants born to Hispanic women, the infant mortality rate ranged from 3.9 in Iowa to 7.3 in Michigan.
New Division Directors
Jennifer Parker, PhD, was named director of the Division of Research Methodology at NCHS. This division is the central methodological research, development, and collaborating unit for NCHS. It provides leadership to NCHS and the statistical community to advance the state of knowledge and application of that knowledge in the core areas of measurement, collection, analysis, and dissemination of data, and in the research design for those areas. Dr Parker received a PhD in biostatistics from the University of California at Berkeley and has more than 20 years of experience in a range of methodological and applied health statistics research at NCHS. Her innovative research includes methods for developing single-race population estimates from multiple-race categories and health studies that integrate data and assess methodological issues. She was recently named a fellow of the American Statistical Association.
Another new division director at NCHS is Stephen Blumberg, PhD, who will lead the Division of Health Interview Statistics and direct the National Health Interview Survey, a large-scale general-purpose household interview survey that has produced objective, high-quality data for monitoring the health of the nation since 1957. The National Health Interview Survey is the principal source of information on the health of the US civilian noninstitutionalized population. National Health Interview Survey data are used widely throughout the US Department of Health and Human Services to monitor trends in illness and disability and to track progress toward achieving national health objectives. The data are also used by the public health research community for epidemiologic and policy analysis of such timely issues as characterizing people with various health problems, determining barriers to accessing and using appropriate health care, and evaluating federal health programs. Dr Blumberg leads the survey at a critical time when it is being redesigned and reengineered to continue to meet current data needs.
Dr Blumberg received his PhD from the University of Texas at Austin and then joined NCHS to help build the State and Local Area Integrated Telephone Survey program. In 2003, this random-digit-dial survey mechanism began fielding the world’s largest telephone surveys on the health, health care, and well-being of children and their families, including the National Survey of Children With Special Health Care Needs and the National Survey of Children’s Health.
NCHS Conference Schedule
NCHS sponsors a biennial conference on health statistics, covering methodology, analysis, dissemination, application, and use of the findings collected in its national vital and health data systems. The conference features workshops, presentations, poster sessions, displays, and exhibits. Information on the spring 2019 conference is available at https://www.cdc.gov/nchs/events/2019nchs/index.htm.
To see where NCHS will be exhibiting during 2018, check the NCHS website at https://www.cdc.gov/nchs/events/index.htm.