Births: Final Data for 2016

January 31, 2018

Questions for Joyce A. Martin, M.P.H., Demographer, Statistician, and Lead Author on, “Births: Final Data for 2016.”

Q: Are there any data that are new in this report compared with previous annual final birth reports?

JM: Yes!  This report includes new national data on a number of items including prenatal care utilization in the US, whether the mother received WIC food during pregnancy, cigarette smoking before and during pregnancy, maternal body mass index of overweight or obese, primary cesarean and vaginal birth after previous cesarean delivery and source of payment for the delivery.


Q: Is the U.S. birth rate going up or down in 2016?

JM: Both the number of births and the general fertility rate (births per 1,000 women aged 15-44) declined in the US from 2015 to 2016.


Q: Are teen births in the U.S. continuing to decline?

JM: Yes, the teen birth rate declined 9% from 2015 to another record low.


Q: What did the findings show for the mean age of U.S. mothers at first birth?

JM: The 2016 mean or average age of mothers having a first birth was a record high in 2016, at 26.6 years.


Q: What is the take home message in this report?

JM: Births are down overall and among women 15 to 29 years of age.  The cesarean delivery rate continued to decline but rates of preterm birth and low birthweight are on the rise.  Birth certificate data are a rich source for important information on mothers and their newborns.


QuickStats: Percentage of Emergency Department Visits for Acute Viral Upper Respiratory Tract Infection That Had an Antimicrobial Ordered or Prescribed, by Metropolitan Statistical Area — United States, 2008–2015

January 29, 2018

From 2008–2011 to 2012–2015, the percentage of visits for acute viral upper respiratory tract infection that had an antimicrobial ordered or prescribed decreased from 37.1% to 25.5% among emergency departments (EDs) located in nonmetropolitan statistical areas, but this decline was not seen among EDs in metropolitan statistical areas.

In 2008–2011, the percentage was higher among nonmetropolitan EDs than metropolitan EDs, but there was no difference in 2012–2015.

Source: National Hospital Ambulatory Medical Care Survey, 2008–2015
https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a7.htm


Main Reasons for Never Testing for HIV Among Women and Men Aged 15–44 in the United States, 2011–2015

January 25, 2018

Isaedmarie Febo-Vazquez, M.S., Epidemiologist at NCHS

Questions for Isaedmarie Febo-Vazquez, M.S., Epidemiologist and Lead Author of “Main Reasons for Never Testing for HIV Among Women and Men Aged 15–44 in the United States, 2011–2015

Q: What made you decide to focus on the reasons Americans aren’t getting HIV tests for the subject of your new report?

IFV: Our main motivation for conducting this study was our curiosity about why a large number of women and men aged 15-44 have never been tested for HIV. The 2011-2015 National Survey of Family Growth, or NSFG, provides nationally representative data on HIV testing among women and men aged 15-44. Despite the considerable evidence of the benefits of early detection of HIV and initiatives to promote routine HIV testing, there is a significant proportion of adults aged 15-44 in the United States that have never been tested for HIV. Our NSFG data on the reasons why people haven’t been tested for HIV recently became available, and we were curious to investigate these reasons.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

IFV: The survey question which asks what is the main reason for never testing for HIV is a relatively new question in the NSFG — since 2011. And this is the first time we’ve analyzed this important data. Some interesting findings include differences in the reasons Americans have never tested for HIV — by level of education. For example, a higher percentage of men and women aged 22-44 with Bachelor’s degrees or more education said that the main reason they had never been tested for HIV was because they were unlikely to have been exposed to HIV — compared with those who had less than a high school diploma. We were expecting to see some variations by level of education but were not sure which group would present a higher percentage for this reason for never being tested.


Q: What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

IFV: There are a number of interesting demographic findings in this report. Non-Hispanic Black men and women aged 15-44 were less likely to have never been tested for HIV, compared to other race and ethnic groups. A higher proportion of non-Hispanic white women and men said the main reason they had never been tested for HIV was because they were unlikely to have been exposed to HIV. In contrast, Hispanic men and women were most likely to report they were never offered an HIV test compared with other race and ethnic groups.


Q: What sort of trend data do you have on this topic so we can see how attitudes and behaviors have evolved over time?

IFV: This is the first time we have published data on the main reasons for never testing for HIV. There are prior published reports about HIV testing using NSFG data, but we did not focus on comparing data over time in this report.  Instead, we provide additional information related to HIV testing that could help guide national prevention strategies.


Q: How is the data in this report different or the same when compared to the other National Center for Health Statistics surveys that measure HIV testing, like the National Health Interview Survey and the National Health and Nutrition Examination Survey?   

IFV: The data on HIV testing that comes from different surveys at our agency offers a comprehensive picture of this important public health measure. The overall HIV-testing-question series in the NSFG is patterned after the National Health Interview Survey, or NHIS, and other surveys, where generally a distinction is made between testing done passively as part of donating blood or blood products and all other contexts for HIV testing. The NHIS currently collects data on ever having an HIV test outside of a blood donation, while the NSFG collects data on HIV testing as both part of blood donation and outside of blood donation. Also, the response categories for the question on the main reason for never having been tested for HIV are not the same for NHIS and NSFG.


Q: What is the take-home message of this report?

IFV: I think the take-home message of this report is that despite the considerable evidence of the benefits of early detection of HIV and initiatives to promote routine HIV testing, there is a significant proportion of adults aged 15-44 in the United States that have never been tested for HIV. Overall, 38.8% of women and more than half of men aged 15-44 have never tested for HIV outside of donating blood or blood products. The most common reason reported by women and men for never testing for HIV was that they were “unlikely to have been exposed to HIV,” followed by they had “never been offered an HIV test.” The NSFG continues to provide valuable nationally representative information to help evaluate and guide national HIV prevention strategies.  


QuickStats: Age-Adjusted Percentages of Current Smokers Among Adults Aged 18 Years or Older, by Sex, Race, and Hispanic Origin — National Health Interview Survey, 2016

January 16, 2018

In 2016, men aged 18 years or older were more likely to be current smokers than women (17.5% compared with 13.6%).

Non-Hispanic black men (20.1%) and non-Hispanic white men (18.4%) were more likely to be current smokers than Hispanic men (13.8%).

Non-Hispanic white women (16.2%) were more likely to be current smokers than non-Hispanic black women (13.2%) and Hispanic women (6.9%).

Source: https://www.cdc.gov/mmwr/volumes/67/wr/mm6701a10.htm


Urban and Rural Variation in Fertility-related Behavior Among U.S. Women, 2011–2015

January 9, 2018

Questions for Kimberly Daniels, Ph.D., Statistician and Lead Author of “Urban and Rural Variation in Fertility-related Behavior Among U.S. Women, 2011–2015.”

Q: Why did you decide to examine fertility-related behavior among U.S. women in urban and rural areas?

KD: We decided to examine fertility-related behavior among U.S. women based on urban and rural residence because while there are many National Survey of Family Growth (NSFG) reports on fertility, they do not usually include information about place of residence.  Two NCHS reports were recently published that use Vital Statistics data from birth certificates and focus on urban and rural differences.

One of those reports was on urban and rural differences in infant mortality rates and the other on urban and rural differences in teen birth rates.  After seeing the differences shown in those reports, we decided to work on an NSFG report focusing on fertility-related behavior and place of residence.


Q: Are there any findings among the urban-rural differences that surprised you?

KD: As far as what findings in this report surprised me, based on other publications we reviewed before starting this report I expected that the percentage of currently married women would be higher in rural areas compared with urban areas.  The results in this report showed that the percentage of women who were currently married in each area was similar, around 40%.  I also expected that there would be a difference for cohabitation; although I am not sure which group I expected would be higher.

The results for age at first sexual intercourse may be surprising to readers of the report.  This report uses data from women ages 18-44.  Place of residence is measured at the time of interview.  Among adult women who have ever had sex, the average age at first sexual intercourse was lower for women living in rural areas, 16.6 years on average, compared with 17.4 for women living in urban areas.


Q: Do you have any older trend data to this report from the National Survey of Family Growth for urban and rural fertility-related behavior?

KD: As far as trends over time, we do not show trend data in this report on urban and rural variation in fertility-related behavior.  Some older NSFG reports do include that information, such as this one on fertility, family planning, and reproductive health using 2002 data.  The variable that classifies women as living in an urban or rural area is available on our public use datasets.  It is available to download from our website so researchers could examine time trends or differences in other topical areas by place of residence.


Q: What did your report find on contraceptive use among women in urban and rural areas?

KD: The report looked at contraceptive method use at last sexual intercourse among women ages 18-44 who had sex in the last 12 months.  Contraceptive methods were grouped into four categories based on effectiveness at preventing pregnancy; no method, a less effective method, a moderately effective method, and a most effective method.  The results showed that similar percentages of women in urban and rural areas used no method of contraception, 21.0%.  A higher percentage of women in urban areas used a less effective method, such as a condom, compared with women in rural areas.  A higher percentage of women in urban areas also used a moderately effective method, such as the oral contraceptive pill, compared with women in rural areas.  A higher percentage of women in rural areas used one of the most effective methods of contraception such as a sterilizing operation or an intrauterine device compared with women in urban areas.

As we note in the report, the percentages we show for contraceptive use and the other measures do not account for other factors that could play a role.  For example, the figure that describes differences in number of births shows that women in rural areas are more likely to have had any births and have a higher average number births.  So, some of the differences in contraceptive use across the two groups could be related to differences in plans for future childbearing.


Q: What is the take home message of this report?

KD: The takeaway messages are shown in the key findings and summary in the report.  Among women aged 18-44, on average, women living in rural areas had their first sexual intercourse at younger ages than women living in urban areas. Similar percentages of women in urban and rural areas were currently married, cohabiting, or never married. A higher percentage of women living in rural areas were formerly married compared with women in urban areas. Women living in rural areas were more likely than women living in urban areas to have had any births and had a higher average number of births. Among women aged 18–44 who had sexual intercourse in the past year, a higher percentage of women living in rural areas used one of the most effective methods of contraception at their last intercourse compared with women in urban areas.  It is important to remember that place of residence was measured at the time of interview.

Some of the outcomes in the report occurred when the woman lived in another geographic location.  Also, as I mentioned above the results do not account for other factors that could play a role in the urban and rural differences presented in the


QuickStats: Percentage of Adults Aged 18 Years or Older Who Currently Use E-Cigarettes, by Sex and Age Group — National Health Interview Survey, 2016

January 8, 2018

In 2016, 3.8% of men and 2.6% of women aged 18 years older currently used e-cigarettes.

Among men, current e-cigarette use decreased with advancing age, from 7.1% among men aged 18–24 years to 4.8% among men aged 25–49 years, 2.6% among men 50–64 years, and 1.1% among men aged 65 years or older.

Among women, current e-cigarette use increased between ages 18–24 years (2.3%) and 25–49 years (3.3%) and decreased between ages 50–64 years (3.0%) and 65 years or older (0.9%).

A greater percentage of men aged 18–24 years and 25–49 years currently used e-cigarettes compared with women in the same age groups.

Source: National Health Interview Survey, 2016

https://www.cdc.gov/mmwr/volumes/66/wr/mm665152a7.htm


Stat of the Day – January 5, 2018

January 5, 2018


State Variations in Infant Mortality by Race and Hispanic Origin of Mother, 2013-2015

January 4, 2018

T.J. Mathews, NCHS Demographer

Questions for T.J. Mathews, Demographer and Author of “State Variations in Infant Mortality by Race and Hispanic Origin of Mother, 2013-2015

Q:  What made you decide to focus on maternal race and Hispanic origin in this state-by-state analysis of infant mortality in the United States?

TM:  We decided to focus on maternal race and Hispanic origin from this most recent special data set because previous research has shown a wide variation in infant mortality rates within, and between, race and Hispanic origin groups at the national level. We were particularly interested in seeing how rates vary by race and Hispanic origin by state, which groups had the largest within-group differences by state, and how much variation there was by state among non-Hispanic whites, non-Hispanic blacks, and Hispanics.


Q:  Was there a result in your study’s analysis of infant mortality that you hadn’t expected and that really surprised you?

TM:  Although we expected to see significant variations throughout race and Hispanic-origin groups, we were surprised by how much rate variation there was for specific race and Hispanic-origin demographics across states. Specifically, our finding that infants of non-Hispanic white women had the widest range in rates by state—the highest was 2.8 times as high as the lowest – was especially striking. The most interesting result from our analysis is what we found for infants of non-Hispanic black women. The lowest infant mortality rate of 8.27 in Massachusetts was higher than the highest state rates for infants of non-Hispanic white women (7.04 in Arkansas) and Hispanic women (7.28 in Michigan).


Q:  What differences, if any, did you see in infant mortality among race and ethnic groups?

TM:  There were several differences in infant mortality among race and Hispanic origin groups. Specifically, as in previous research, non-Hispanic blacks had significantly higher infant mortality rates than non-Hispanic whites and Hispanics. Although non-Hispanic whites had lower infant mortality, the range in rates was larger than for the other groups examined in this study.


Q:  What does “linked birth and infant death data” mean exactly – which is what you reference as a source for the statistics in your report?

TM: The linked birth and infant death data is a file that connects data from infant death certificates with their birth certificate data, allowing us to obtain more accurate reporting of race and Hispanic origin group identity. Further items such as birthweight, period of gestation, plurality, prenatal care, maternal education, live birth order, marital status, and maternal smoking are included from the birth certificate that allow more detailed analyses related to infant mortality in the United States. This analysis from the linked data file is the most detailed source for infant mortality data.


Q: Why did you focus your analysis on a handful of years, 2013-2015, and not a longer term trend study going back further in time?

TM: We combined the data years 2013-2015 and did not look at each year individually or across years. So, we weren’t assessing a trend at all in this report (as we have in the past), but rather focused on ensuring we had a large enough sample size to get reliable estimates by race and Hispanic origin for a majority of the states. This new analysis is really about health disparities in U.S. infant mortality by state.


Q: Do you have any cause of death data for the infants, or health insurance coverage data for the mothers and infants in this study group?

TM: For this particular project, we did not look at the causes of death for the infants or the payment source used for the birth. We do not have data that would indicate the health insurance coverage for the infant at time of death. However, the linked birth and infant death files do contain this information in the public use data sets from the information included on the birth certificates in the data files.


Q: What is the take-home message of this report?

TM: The main take home message of this report is found in the evidence of health disparities in U.S. infant mortality. The differences – the rate variation across geographic and race and ethnic demographics – is staggering. Although the overall U.S. infant mortality rate has decreased over time, these gains have not been equally distributed across race and Hispanic origin groups or across the United States. The significant differences among some states indicates that states might be able to decrease infant mortality rates by focusing on specific demographic groups.


Stat of the Day – January 3, 2018

January 3, 2018