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Birth Trends in Los Angeles County and Potential Public Health Impacts Louise RollinAlamillo, MS Alex Ho, MD, MPH Margaret Shih, MD, PhD Chief Science Office

Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

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Page 1: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Birth Trends in Los Angeles County and Potential Public Health Impacts

Louise Rollin‐Alamillo, MSAlex Ho, MD, MPHMargaret Shih, MD, PhDChief Science Office

Page 2: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Objectives

• Show trends in births in LAC, 1990 ‐ 2011– Mother’s race/ethnicity – Mother’s nativity– Mother’s age

• Review factors possibly associated with trends– Demographic (migration)– Behavioral– Economic

• Public Health Impacts1

Page 3: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

MethodsCalculation of rates and other statistics:

– Total fertility rates and age‐specific birth rates

–Mean age at first birth 

2

Page 4: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Total fertility rates ‐ defined• A measure of completed family size.• Average number of children a woman would bear if today’s age‐specific rates of fertility prevailed throughout her lifetime. 

• Best for making comparisons over time or between groups.

• The replacement rate is a TFR of 2.1 birth per woman.

3

Page 5: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Data Sources

–Birth data: Birth Statistical Master File (BSMF)

–Population denominators and statistics: • Public Use Microdata file (PUMS)• Summary File 1 from 1990 and 2000 Census

• American Community Survey (ACS)

4

Page 6: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Births, Los Angeles County, 1990‐2020.

5

Source:  California Department of Public Health, Birth Statistical Master Files for Los Angeles County Residents.  California Department of Finance ‘Historical and Projected State and County Births, 1970‐2022, with Actual and Projected Fertility Rates by Mother’s Age and Race/Ethnicity, 2000‐2022 released November 2013. 

204,124

174,862157,391 150,377

133,160 134,145 138,873

0

50,000

100,000

150,000

200,000

250,000

1990 1995 2000 2005 2010 2015 2020

Num

ber o

f Births in

 thou

sand

s

year

Projected

Page 7: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Total fertility rates, Los Angeles County, CA, and US, 1990‐2020.

6

Data source: Birth Statistical Master File, California Department of Public Health and.Source: California Department of Finance ‘Historical and Projected State and County Births, 1970‐2022, with Actual and Projected Fertility Rates by Mother’s Age and Race/Ethnicity, 2000‐2022 released November 2013. 

2.7

2.4

2.2 2.2

1.8

2.5

2.32.1

2.02.1

2.02.1 2.1

1.9

1.5

1.7

1.9

2.1

2.3

2.5

2.7

2.9

1990 1995 2000 2005 2010 2015 2020

Total fertility

 rate per wom

an

year

LAC Rate CA proj US Rate Replacement Rate

Page 8: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Total fertility rates by mother’s race/ethnicity, Los Angeles County, 1990‐2010

7

3.6

2.2

2.6

1.71.8

1.31.7

1.31.0

1.5

2.0

2.5

3.0

3.5

4.0

1990 1995 2000 2005 2010

Total Fertility

 Rate pe

r wom

an

year

Hispanic African American (NH)White (NH) Asian (NH)Replacement Rate

Page 9: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Total fertility rates by mother’s nativity, Los Angeles County, 1990, 2000, and 2010.

8

2.0

3.6

2.1

4.3

1.2

2.1

1.5

2.3

1.7

2.7

1.0

1.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Total NB Total FB Hispanic NB Hispanic FB Asian NB Asian FB

Total Fertility

 Rate pe

r wom

an

1990 2000 2011

Page 10: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Age‐specific rates, Los Angeles County, 1990, 2000, 2010.

9

78

144 139

105

52

1232

7490 95

58

15

0

50

100

150

200

15‐19 20‐24 25‐29 30‐34 35‐39 40‐44

Age‐Specific ate (per 1000)

Mother’s age

199020002010

Page 11: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Factors likely associated with fertility• Migration • Behavioral

–Contraceptive use/abortion–Mean age at first birth and first marriage–Children ever born

• Economic–Unemployment and educational attainment

10

Page 12: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Changes in Migration

11

Data source: U.S. Census Bureau, 1990 Census, Summary File 1.  2000 Census Summary File 1, American Community Survey 2011 1‐year Survey.

• LA County has had declining in‐migration in the past 20 years

• Recession curtailed in‐migration even further• Out‐migration has been high since 2001

Changes in migration partially responsible for :70,000 fewer 25‐39 women in 2010 than in 2000 in LAC.

Page 13: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Changes in Migration• LA County has had declining in‐migration in the past 20 years

• Recession curtailed in‐migration even further• Out‐migration has been high since 2001

Changes in migration partially responsible for :70,000 fewer 25‐39 women in 2010 than in 2000 in LAC.

12

Page 14: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Behavioral Factors• Contraception – sterilization becoming increasingly common

• Abortion –Decreased to lowest level since 1973 • Later age at first marriage

– From 23.9 in 1990 to 26.5 in 2011 (women) – For CA 27.6 for women  in 2011

• Later age a first birth • Childlessness

13

Page 15: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Mean age at first birth by mother’s race/ethnicity, Los Angeles County, 1990, 2000, 2012.

14

Data source: California Department of Public Health, Birth Statistical Master File, 1990, 2000, and 2012.

24.727.6

22.7 23.1

28.527.4

31.1

24.6 25.4

31.2

0

5

10

15

20

25

30

35

All White Hispanic Black Asian/PI

Mean age

199020002012

Page 16: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Economic Factors

Effects of the Great Recession?

– Increase in unemployment = decrease in births

– Birth rate for mothers with the lowest education attainment has declined

15

Page 17: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Change in unemployment rate and births, Los Angeles County, 2005‐2012.

0

2

4

6

8

10

12

14

115

120

125

130

135

140

145

150

155

2005 2006 2007 2008 2009 2010 2011 2012

Percent unemployedBi

rths in

 thou

sand

s

year

birthsrate

16

Data source: Census Bureau’s American Community Survey 1‐year samples, Table S2301.California Department of Public Health’s Birth Statistical Master Files, Los Angeles County Residents

Page 18: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Birth rates by mother’s educational attainment, Los Angeles County, 2006 and 2011.

17

Data sources: California Department of Public Health, Birth Statistical Master File, 2006 and 2011. Census Bureau’s Public Use Microdata (PUMS) 2007 3‐year and 2011 3‐year.

130.6

44.6 39.848.6

62.6 64.3

42 48.1

0

20

40

60

80

100

120

140

less than HSdiploma

HS Diploma/GED some college Bachelor'sDegree+

Birth rate per 1,000

 20‐49

 year o

ld fe

males

2006 2011

Page 19: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Public Health Impacts• Lower teen births

= Fewer adverse birth outcomes = less public cost ($1,682 per teen birth) 

• Delays in reproduction:–More difficulty in reproducing–More adverse health outcomes for babies and moms

18

Page 20: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Birth outcomes by mother’s age, Los Angeles County, 2007‐2012.

19Data source: Automated Vital Statistics System (AVSS) data for Los Angeles County Residents, 2007 – 2013.

0

2

4

6

8

10

12

14

16

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

Percen

t of b

irths

Mother’s age

% Prematureearly preterm late preterm

0

2

4

6

8

10

12

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

Percen

t of b

irths

Mother’s age

% Low birth weightvery low birthwt low birth weight

Page 21: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Primary Cesareans by mother’s age, Los Angeles County, 2007‐2013.

22.5 22.119.8 18.5

20.122.2

27.8

0.0

5.0

10.0

15.0

20.0

25.0

30.010

‐14

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

Percen

t of b

irths

mother’s age

20

Data source: Automated Vital Statistics System (AVSS) data for Los Angeles County Residents, 2007 – 2013.

Page 22: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Percent of mothers who had twins or triplets by mother’s age, Los Angeles County, 2007‐2013.

0.6%0.9%

1.2%

1.7%

2.2%

2.9%

0%

1%

1%

2%

2%

3%

3%

4%

15‐19 20‐24 25‐29 30‐34 35‐39 40‐44

Percen

t of m

othe

rs

twins

triplets

21

Data source: Automated Vital Statistics System (AVSS) data for Los Angeles County Residents, 2007 – 2013..

Page 23: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Maternal Outcomes by mother’s age, Los Angeles County, 2007‐2013.

% with gestational diabetes

0.61.2

2.2

3.5

4.8

6.1

0

1

2

3

4

5

6

7

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

Percen

t of a

ll births

mother’s age

% with preclampsia

2.1 2.0 2.02.2

2.6

3.6

011223344

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

Percen

t of a

ll births

mother’s age

22Data source: Automated Vital Statistics System (AVSS) data for Los Angeles County Residents, 2007 – 2013.

Page 24: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Public Health Impacts continued…• Fewer births  fewer children 

fewer working age adults.• Declining in‐migration• Baby boomers retiring AND higher life expectancy              increasing ratio of seniors to working age adults.

= High Fiscal impacts 

23

Page 25: Trends in Los Angeles County and Public Health ImpactsBirth Trends in Los Angeles County and Potential Public Health Impacts Louise Rollin‐Alamillo, MS Alex Ho, MD, MPH Margaret

Policy Interventions• Consider intergenerational equity issues to enable young people to become parents

– secure good paying jobs, easier transition to home ownership, reduce college debt. 

• Consider pro‐natalist policies that seek to reverse the decline in total fertility rate– Provide allowance for newborn children – Promote policies that embrace working mothers  – Paid maternity and paternity leaves

• Later retirement and more savings