Massachusetts Births 2005 Center for Health Information, Statistics, Research, and Evaluation Division of Research and Epidemiology Registry of Vital Records

Massachusetts Births 2005

Center for Health Information, Statistics, Research, and Evaluation

Division of Research and Epidemiology

Registry of Vital Records & Statistics

MassCHIPCenter for Community Health

Massachusetts Department of Public Health

Source: Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

I. Overview of 2005 Births and Comparison with U.S. indicators

II. Birth Trends

III. Selected Maternal Characteristics

IV. Infant & Fetal Mortality

V. Cesarean Section (C-Section) Deliveries

VI. Teen Births

VII. Selected Communities

VIII. Summary

Outline

Overview of 2005 Births and

Comparison with U.S. Births


2005 Massachusetts Birth Characteristics

On an average day

68 Cesarean sections

12 Teen births

17 Low birthweight

19 Preterm

10 Multiples16 Inadequate prenatal care

1 Infant death

210 births


MA U.S.

Fertility Rate (births /1000 ages 15-44) 55.6* 66.7 Teen Birth Rate (births/1000 ages 15-19) 21.7* 40.4

% Low Birthweight (< 5.5 lbs) 7.9 8.2

Infant Mortality Rate (IMR) 5.1* 6.82

(deaths per 1,000 live births) % Smoking during pregnancy 7.2* 10.22,3

% Prenatal Care 1st trimester 83.2* 83.92,3

% C-Section 32.3* 30.2

A Comparison of 2005 Birth IndicatorsMassachusetts v. U.S.1

1. National Vital Statistics Report, Preliminary Births for 2005. Released on November 22, 2006. 2. Preliminary 2004 data. National Vital Statistics Reports, Vol. 54, No. 19, June 28, 2006. Data for the U.S. for 2005 have not yet been released. 3. Based on a 40- or 41-state reporting area.

*Statistically Significant (p ≤ .05)

Birth Trends in Massachusetts


Massachusetts Births1995 & 2005

Number of Births 76,824 -6%*Teen Birth Rate (births/1000 ages 15-19) 21.7 -28%*% Smoking during pregnancy 7.2 -47%*

Infant Mortality Rate 5.1 - -(deaths per 1,000 live births)

- White non-Hispanic IMR 4.3 -2%- Black non-Hispanic IMR 9.4 -15%- Hispanic IMR 7.8 +8%

% Low Birthweight 7.9 +23%*% C-Section 32.3 +57%*% Multiple Births 4.6 +44%*

% change 2005 1995 and 2005

* Statistically Significant (p≤.05)


• A trend analysis tool developed by the National Cancer Institute

• Creates a “model” (graph) that best describes the trend in events

• Points where the trend turns around are called “joinpoints”

• Shows the Annual Percentage Change (APC) for each line segment in the model

Joinpoint Analysis (JPA)


70

75

80

85

90

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year

Nu

mb

er

of

Bir

ths i

n 1

000s

Trend in the Number of Births Massachusetts: 1990-2005

92,460

76,824

-1.9%* APC

-2.0%* APC

1996

0.2% APC

2002

* Statistically Significant (p ≤.05) APC = Annual Percentage Change


54,238

34,429

18,351

42,391

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

1980 1985 1990 1995 2000 2005

Year

Nu

mb

er

of

bir

ths

Number of Births by Mother’s Age (< 30 and 30+) Massachusetts: 1980-2005

Ages > 30

Ages < 30


107.7115.6

0

20

40

60

80

100

120

140

15-19 20-24 25-29 30-34 35-39 40-44

Mother's Age

Bir

th r

ate

(p

er

10

00

liv

e b

irth

s)

Age-specific Birth Rates Massachusetts vs. U.S.: 2005

MA

US

US Source: Births: Preliminary Data for 2005, NCHS. November 21, 2006


Percent of Births by Race and Hispanic Ethnicity

Massachusetts: 1990-2005

7.7

7.9

3.6

6.8

9.1

13.1

0

2

4

6

8

10

12

14

1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

bir

ths

Asian non-Hispanic

Black non-Hispanic

Hispanic


% Non-U.S. Born Mothers Massachusetts: 1990-2005

26.1%

14.7%

0%

10%

20%

30%

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

bir

ths

1995 +1.3% APC

+5.4%* APC



Ethnicity 2000 2005 % Change

Brazilian 1,033 2,058 +99%*African 689 1,197 +74%*

Ghanaian 112 188 Moroccan 64 149

Kenyan 47 110

Salvadoran 736 1,046 +42%*Haitian 1,026 1,136 +11%Cape Verdean 773 872 +13%

Births by Selected Mothers’ Ethnicities

* Statistically Significant (p ≤.05)


3,565

2,411

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

1990 1991 1992 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Nu

mb

er

of

Bir

ths

Number of Multiple Births Massachusetts: 1990-2005

1998

+3.8%* APC

1995

+8.0%* APC

+2.0% APC

2002

-2.0% APC



5.8

7.9

4

5

6

7

8

9

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

LB

W B

irth

s (

%)

Low Birthweight (<2500g or 5.5lbs)Massachusetts: 1990-2005

+2.2%* APC



Low Birthweight Adjusted by Plurality1 Massachusetts: 1990-2005

5.8

7.9

6.9

4

5

6

7

8

9

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

of

LB

W B

irth

s (

%)

LBW % Adjusted by plurality*

1 Plurality-adjusted LBW rate using 1990 plurality distribution as standard

Selected Maternal Characteristics


Births by Race and Hispanic Ethnicity Massachusetts: 2005

White non-Hispanic

69.6%

Unknown0.1%

Other2.4%

Asian6.8%

Hispanic13.1%

Black non- Hispanic

7.9%

BIRTHS(n=76,824)


9%

80%85%84%

26%

71%

19%

67%

2% 5%

33%28%

6%8%

0%

20%

40%

60%

80%

100%

LBW Smoking PubliclyFinanced

C-Section MultipleBirths

Breastfeed AdequatePrenatal

Care

Pe

rce

nt

(%)

Birth Characteristics by Maternal Education Massachusetts: 2005

Less than high school (age 20+) College graduate or higher


*

* *

*

* *


5%9%

69%69%

28%

75%

35%

89%

8%7%0.7%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Under 18years

LBW Not married Adequateprenatal care

Breastfeed C-section

Pe

rce

nt

Birth Characteristics by Funding Source of Prenatal Care, Massachusetts: 2005

Privately funded Medicaid


*

*

**

*

*

Infant & Fetal Mortality


4.6

5.1

7.0

0

1

2

3

4

5

6

7

8

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

IMR

(#

dea

ths/

1,00

0 liv

e b

irth

s)Infant Mortality Rate


1996

-5.3%* APC

-0.6% APC



0

2

4

6

8

10

12

14

16

18

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

IMR

(#

dea

ths/

1,00

0 liv

e b

irth

s)IMR by Race & Hispanic Ethnicity


White non-Hispanic

Black non-Hispanic

Hispanic


0

2

4

6

8

10

12

14

16

18

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year

IMR

(#

dea

ths/

1,00

0 liv

e b

irth

s)Black Non-Hispanic IMR


1992

19952003

+7.1% APC

-11.3% APC

+1.7% APC

-12.6% APC



0

2

4

6

8

10

12

14

16

18

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year

IMR

(#

dea

ths/

1,00

0 liv

e b

irth

s)Black Non-Hispanic IMR with

Linear TrendMassachusetts: 1990-2005

-1.8%* APC



0

1

2

3

4

5

6

7

8

9

10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year

IMR

(#

dea

ths/

1,00

0 liv

e b

irth

s)Hispanic IMR


1999

-5.7%* APC

+5.4% per year



Infant Mortality Rate Effect of Excluding <500g (1.1lb) Infants1


5.15.3

3.53.7

0

1

2

3

4

5

6

7

8

9

10

1997 1998 1999 2000 2001 2002 2003 2004 2005

IMR

(#

of

dea

ths

per

1,0

00 l

ive

bir

ths)

1 Calculated using birth-infant death linked files.

IMR all weights

IMR w/o < 500g

46%


4.5 4.54.9

5.85.1 5.3

10.4 10.310.0

9.49.1

10.3

9.510.1

4.54.64.65.15

4.64.85.35.35.3

0

2

4

6

8

10

12

1998 1999 2000 2001 2002 2003 2004 2005

Infa

nt,

Fet

al, a

nd

Fet

o-I

nfa

nt

Dea

ths

per

100

0 fe

tal d

eath

s an

d in

fan

t b

irth

s

Infant & Fetal Mortality RateMassachusetts: 1998-2005

Infant & Fetal Mortality

Fetal Mortality

Infant Mortality1

1 Infant Mortality = # of infant deaths/(fetal deaths + live births)

N=848 N=841 N=810 N=791 N=741 N=830 N=780 N=798

Deliveries by

Cesarean Section


30.2

22.2

32.3

22.5

18

22

26

30

34

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Per

cen

tInfants Delivered by C-Section

Massachusetts and the U.S. : 1990-2005

US

Massachusetts


18

22

26

30

34

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Per

cen

tInfants Delivered by C-Section


-2.0%* APC

+6.7%* APC

1997


Teen Births


White non-Hispanic 12.9* 26.0Black non-Hispanic 36.4* 60.9Asian2 15.3 16.9Hispanic 73.2 81.5

Massachusetts United States1

Teen Births 4,539 414,406

Teen Birth Rates 21.7* 40.4 (births per 1,000 females ages 15-19)

1 National Vital Statistics Report, Preliminary Births for 2005. Released November 22, 2006 2 For U.S. data, Asian category includes persons of Hispanic and non-Hispanic origins

Births to Teens (15-19 years)Massachusetts and U.S. : 2005

*Statistically Significant (p ≤.05)


40.4

51.0

21.7

28.7

0

10

20

30

40

50

60

70

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Bir

ths

pe

r 1

,00

0 W

om

en

Ag

es

15

-19 United States

Massachusetts

Teen Birth RatesMassachusetts and U.S. : 1985-2005


28.7

21.7

0

5

10

15

20

25

30

35

40

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Bir

ths

pe

r 1

,00

0 W

om

en

Ag

es

15

-19

Teen Birth RatesMassachusetts : 1985-2005

+5.6%* APC

-3.5%* APC


1990


Highest Teen Birth Rates (Among Communities with at Least 75 Teen Births)

Massachusetts: 2005

BirthRank1

Rate2

1 96.8 -23%2 75.0 -10%3 71.7 -38% *4 71.6 -14%5 58.9 -12%6 51.4 -39% *7 49.5 -19%8 47.3 -37% *9 40.7 -40% *

10 37.2 -34% *21.7 -28% *

% Change1995 & 2005

HOLYOKECHELSEALAWRENCESPRINGFIELD

LYNN

WORCESTER

Massachusetts

NEW BEDFORDLOWELLFALL RIVER

BROCKTON

1 Ranking by highest teen birth rates among communities with at least 75 teen births2 Births to females 15-19 per 1,000 females ages 15-19 * Statistically Significant (p ≤.05)


Central22.6

Southeast23.1

Northeast22.9

Western31.0

Boston29.4Metro

West8.3

Teen Birth Rates by DPH Regions, Massachusetts Births 2005

Region's Teen Birth Rateper 1,000 15-19 Female Population

Significantly higher than state rate

Not different from state rate

Significantly lower than state rate

MA Rate: 21.7

Teen Birth Rates by MDPH Regions Massachusetts: 2005

Birth Outcomes for Selected Communities


Highest Infant Mortality RatesAmong the 30 Largest Communities1

Massachusetts: 2005

1Selected among the 30 Massachusetts communities with the largest populations. IMR = infant deaths per 1,000 live births. 2A Confidence Interval for a population parameter is a range in which you are 95% certain that the true population estimate is within. It is a function of variability and the number of events.


IMR 95% CI2 Number of Deaths

State 5.1 [4.6, 5.6] 391

Worcester 13.9* [9.4,18.4] 36

Malden 11.4 [4.0, 18.7] 9Revere 10.9 [2.9, 18.9] 7Springfield 10.6* [6.4, 14.7] 25

New Bedford 8.6 [3.8, 13.5] 12


Infant Mortality RatesSpringfield: 1990-2005

11.0

4.6

10.610.2

0

2

4

6

8

10

12

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Infa

nt

Dea

ths

per

100

0 in

fan

t b

irth

s


Infant Mortality RatesWorcester: 1990-2005

7.0

12.1

4.3

7.7

13.9

0

2

4

6

8

10

12

14

16

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Infa

nt

Dea

ths

per

100

0 in

fan

t b

irth

s


Percent of Mothers Receiving Adequate Prenatal Care for 30 Largest Communities1

Massachusetts: 2005

Massachusetts 84.0%

Best Brookline 94.7%*Cambridge 89.5%*Fall River 85.7%Boston 84.1%

WorstPittsfield 61.0%*Lowell 68.2%*

1Selected among the 30 Massachusetts communities with the largest populations. *Statistically Significant (p ≤.05) Based on the Adequacy of Prenatal Care Utilization (APNCU) Index


Percent Low Birthweight for 30 Largest Communities1

Massachusetts: 2005

Massachusetts 7.9%

BestLeominster 5.5%*Barnstable 4.0%

WorstBrockton 11.5%*Revere 10.9%*New Bedford 10.6%*Springfield 9.8%*Lowell 9.2%

1Selected among the 30 Massachusetts communities with the largest populations. *Statistically Significant (p ≤.05)


Summary – Successes

Many Massachusetts perinatal health indicators are better than those of the U.S.

Continued decline in teen birth rates

Fewer women are smoking during pregnancy

4 out of 5 women receive adequate prenatal care


Trends that must be closely monitored:

Low birthweight & preterm births

Multiple births

C-Section deliveries

Decline in overall number of births

Slight up-tick in IMR from 2004 and increase in selected communities

Summary– Challenges


• Black non-Hispanic IMR is twice as high as the white non-Hispanic IMR

• Hispanic teen birth rate is almost 6 times that for white non-Hispanics

• Cambodian, Central American, and African mothers are less likely to receive prenatal care in their first trimester

• Low birthweight rates in Brockton, Revere, and New Bedford are at least 2 times the statewide rate

• Less educated mothers have worse birth outcomes than more educated mothers

Disparities Persist by Race, Geography, and SES


Infant Mortality Rate Massachusetts: 1842-2005

0

50

100

150

200

250

Year

De

ath

s p

er

1,0

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liv

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irth

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2005


How Can You Access theMassachusetts Births 2005 Report?

• Hard Copies: (617) 740-2670

• TDD/TTY: (617) 624-6001

• DPH Website:

mass.gov/dph/bhsre/resep/resep.htm#birth


Accessing Massachusetts Births 2005 Data on MassCHIP

• MassCHIP (DPH’s Internet-based public health information service)

•Website: http://masschip.state.ma.us

•Telephone: 1-888-MASCHIP (Mass only) (617) 624-5629

•New Release (Version 3.0 r 316)

- Massachusetts Births 2005

- Updated Data Sets

Thank You

Documents

Massachusetts Births 2005 Center for Health Information, Statistics, Research, and Evaluation Division of Research and Epidemiology Registry of Vital Records