Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018

May 26, 2021

Questions for Anne Driscoll, Health Statistician and Lead Author of “Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018.”

Q: Why did you decide to focus on infant mortality rates in the Appalachia and Delta region?

AD: These two regions are interesting to me because although they are very different in terms of history, geography and population but they are similar in that both have higher poverty rates and worse health outcomes including infant mortality rates (IMRs). In addition, there are official, congressionally-mandated definitions of which counties belong to each region which made it possible to be precise in our definition of each region for the analyses.


Q: Can you summarize how the infant mortality data varied by age and race?

AD: Infants of women in the youngest and oldest age groups (under age 20 and age 40 and over) had the highest mortality rates in all three regions (Appalachia, the Delta and the rest of the US). Infants born to women in their early thirties had the lowest mortality rates. In all three regions, infants of non-Hispanic black women had the highest mortality rates.


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

AD: The main question we asked in this report was whether the gap in infant mortality rates between these two regions and the rest of the U.S. changed over the last two decades. Our results support the conclusion that there has been some narrowing in the gap between the Delta and the rest of the US; the gap decreased from 2.9 deaths per 1,000 births to 2.2. Another way to think of this is that the gap was about one quarter smaller in 2017-2018 than it was in 1995-1996. During the study period, rates did not start declining in the Delta until 2005-2006.

In contrast, the gap between Appalachia and the rest of the US hasn’t narrowed. That is, IMRs have declined in both regions over the last 20 years but since they declined at about the same rate the gap between them didn’t close. In both 1995-96 and 2017-18, IMRs in Appalachia were 0.9 deaths per 1,000 births higher than in the rest of the country. Thus, while the gap between Appalachia and the rest of the US has been smaller than that between the Delta and the rest of the country, it hasn’t narrowed.


Q: Why do you think infant mortality rates have dropped in the Appalachia, Delta, and rest of U.S.?

AD: IMRs have declined for a variety of reasons. Other research has shown that more advanced and effective medical interventions for at-risk infants, particularly for premature infants, have helped lower the mortality rate. In addition, Medicaid is more widely available for pregnant women which allows low-income women to access timely and adequate prenatal care.

Another change which we show in our report is the decline in births to teens. Infants born to teens are at higher risk of poor outcomes, including death. Our analysis shows that the percent of births to teens declined in all three regions and that this accounted for about a fifth of the decline in IMRs in each region.


Q: Do you have infant mortality data on other regions of the United States during the same time-period?

AD: We calculate and publish IMRs for each state every year. But in terms of regions, the key is to have an ‘official’ definition of the region. One of the factors that made this research project possible was that there is an official definition of each of the two regions we studied. That is, we were able to categorize each county as part of Appalachia, the Delta, or the rest of the US.


QuickStats: Age-Adjusted Death Rates for Four Selected Mechanisms of Injury — National Vital Statistics System, United States, 1979–2019

May 21, 2021

In 1979, of the four mechanisms of injury, age-adjusted mortality rates were highest for motor vehicle traffic deaths and lowest for drug poisoning deaths.

From 1979 to 2019, the age-adjusted rate of motor vehicle traffic deaths decreased from 22.1 per 100,000 to 11.1, and the rate of firearm-related deaths decreased from 14.7 to 11.9.

During the same period, the rate of drug poisoning (overdose) deaths increased from 3.0 to 21.6, and the rate of fall-related deaths increased from 6.2 to 10.1. In 2019, the rates were highest for drug poisoning deaths and lowest for fall-related deaths.

Source: National Vital Statistics System compressed mortality file, underlying cause of death. https://wonder.cdc.gov/mortsql.html

https://www.cdc.gov/mmwr/volumes/70/wr/mm7020a4.htm


Total Fertility Rates, by Maternal Educational Attainment and Race and Hispanic Origin: United States, 2019

May 12, 2021

NVSR70_5_cover1Questions for Brady Hamilton, Health Statistician and Lead Author of “Total Fertility Rates, by Maternal Educational Attainment and Race and Hispanic Origin: United States, 2019.”

Q: What is the difference between general fertility rates and total fertility rates?

BH: The general fertility rate is the number of births per 1,000 females aged 15–44 in a given year, whereas, the total fertility rate is the estimated number of births that a group of 1,000 women would have over their lifetimes, based on age-specific birth rates in a given year.


Q: Why did you decide to compare educational attainment with total fertility rates?

BH: Educational attainment is considered an important measure of socioeconomic status and can be useful in interpreting patterns and differences in fertility behavior both overall and among population groups. Maternal education has been shown to be associated with contraceptive use, the timing of childbearing, and the total number of children women have in their lifetimes. I wanted to examine the association between educational attainment and the expected number of births for women using the latest available vital statistics birth data (2019) from NCHS.


Q: How did the total fertility rates differ by educational attainment?

BH: Total fertility rates decreased as level of education increased from women with a 12th grade education or less through an associate’s and bachelor’s degree, and then increased from bachelor’s degree through a doctorate or professional degree, although the increase from master’s to doctorate or professional degree was not statistically significant.


Q: How did the total fertility rates by educational attainment differ by race?

BH: The patterns in and levels of the total fertility rates by educational attainment differed across the three race and Hispanic-origin groups shown in the report.

Total fertility rates generally declined from the lowest educational level through a bachelor’s degree for non-Hispanic white women, and through an associate’s degree for Hispanic women, and then generally rose for both groups for women with advanced degrees. Rates for non-Hispanic black women declined by educational level through a master’s degree.

Total fertility rates for non-Hispanic black and Hispanic women with some college credit or less were generally higher than the rates for non-Hispanic white women, but TFRs for non-Hispanic black and Hispanic women with a master’s degree or more were generally lower than the rates for non-Hispanic white women


Q: Was there a specific finding in the data that surprised you from this report?

BH: Yes, the span of the range in the total fertility rates was surprising, from the low of 1,284 for women with a bachelor’s degree to the high of 2,791 for women with a 12th grade education or less. To put this difference in perspective, a woman with a 12th grade education or less would be expected to have more than one additional birth compared with a woman with a bachelor’s degree.


Fact or Fiction: The pandemic had a significant impact on fertility in the United States during 2020

May 5, 2021

Source: National Vital Statistics System

https://www.cdc.gov/nchs/data/vsrr/vsrr012-508.pdf


Births: Provisional Data for 2020

May 5, 2021

lady-holding-baby-mask-01The general fertility rate in the U.S. reached another record low in 2020 and the number of births in 2020 fell for the sixth straight year, according to provisional statistics released today by NCHS.

The provisional data are featured in a new report, “Births: Provisional Data for 2020,” which is based on over 99% of birth certificates issued during the year. The report reveals that the number of births in 2020 was 3,605,201, down 4% from 2019. The general fertility rate in 2020 was 55.8 births per 1,000 women ages 15–44, also down 4% from 2019.

Other findings in the report:

  • The total fertility rate (TFR) was 1,637.5 births per 1,000 women in 2020, down 4% from 2019 and another record low for the nation. The TFR in 2020 means the U.S. continues to be at “below replacement levels.”
  • Birth rates were unchanged for adolescents ages 10-14 and women ages 45-49, but declined for all other age groups.
  • The birth rate for teenagers ages 15–19 declined by 8% in 2020 to 15.3 births per 1,000 females. The teen birth rate has declined every year except for two (2006 and 2007) going back to 1991. The rates declined in 2020 for both younger (ages 15–17) and older (ages 18–19) teenagers.
  • The cesarean delivery rate increased to 31.8% in 2020, and the low-risk cesarean delivery rate increased to 25.9%.
  • The preterm birth rate declined for the first time since 2014, to 10.09% in 2020.

NYC-medium_croppedNCHS also released a second report today that examined changes in the proportion of births to New York City residents outside the city for 2018-2019 and 2019-2020.

Other findings in the report:

  • From 2019 to 2020, the percentage of births to New York City residents that occurred outside of the City increased for all months from March through November, ranging from +15% for September to +70% for April.
  • Out-of-city births peaked in April (10.2%) and May (10.3%) at more than one and onehalf times the 2019 levels (6.0% and 6.2%, respectively).
  • Among non-Hispanic white women, the percentage of out-of-city births was nearly 2.5 times higher in 2020 than in 2019 in April (15.6% versus 6.6%) and May (15.8% versus 6.5%).
  • The percentage of out-of-city births among non-Hispanic black and Hispanic residents increased in only two months in 2020.

NCHS UPDATES”STATS OF THE STATES” PAGE WITH LATEST FINAL DATA

March 26, 2021

SOS_Nav_Page

The CDC National Center for Health Statistics web page “Stats of the States” has been updated to include the latest state-based final data on selected vital statistics topics, including:

  • General fertility rates
  • Teen birth rates
  • Selected other maternal and infant health measures
  • Marriage & divorce rates
  • Leading causes of death
  • Other high profile causes of death.

The site’s map pages allow users to rank states from highest to lowest or vice versa.  This latest version of “Stats of the States” also includes two new topics:  Life expectancy by state and COVID-19 death rates by state (provisional data on a quarterly basis, through Q3 of 2020).  All death rates are adjusted for age.  Rates are featured in the maps because they best illustrate the impact of a specific measure on a particular state.

The main “Stats of the States” page can be accessed at:  https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm


Drug Poisoning Mortality, by State and by Race and Ethnicity: United States, 2019

March 25, 2021

2019_drugs_state

NCHS released a Health E-Stat that provides information on drug overdose mortality by state (and the District of Columbia) and by race and ethnicity, and adds to findings from a recently published Data Brief on drug overdose death rates.

Findings: 

  • The age-adjusted rate for drug overdose deaths in the United States for 2019 was 21.6 per 100,000 standard population.
  • The five states with the highest rates were West Virginia (52.8), Delaware (48.0), District of Columbia (43.2), Ohio (38.3), and Maryland (38.2). 
  • The five states with the lowest rates were Nebraska (8.7), South Dakota (10.5), Texas (10.8),
    North Dakota (11.4), and Iowa (11.5).
  • The age-adjusted drug overdose death rate for the non-Hispanic white population in 2019 (26.2
    per 100,000 standard population) was 21.3% higher than the national rate.
  • The rate for the non-Hispanic black population (24.8) was 14.8% higher than the national rate.
  • The rate for the non-Hispanic American Indian or Alaska Native population (30.5) was 41.2% higher than
    the national rate.
  • The rate for the non-Hispanic Asian population (3.3) was 84.7% lower than the national rate.
  • The rate for the non-Hispanic Native Hawaiian or Other Pacific Islander population (9.5) was 56.0% lower than the national rate. The rate for the Hispanic population (12.7) was 41.2% lower than the national rate.

Motor Vehicle Traffic Death Rates, by Sex, Age Group, and Road User Type: United States, 1999–2019

March 18, 2021

A new NCHS report provides national trends in motor vehicle traffic deaths by sex, age group, and type of road user (i.e., motor vehicle occupant, motorcyclist, pedestrian, or pedal cyclist) from 1999 through 2019 using the latest mortality data from the National Vital Statistics System.

Findings:

  • Motor vehicle traffic death rates were stable from 1999 to 2006, declined on average by 8% each year from 2006 (14.5 per 100,000) to 2010 (10.7), and then increased from 2010 through 2019 (11.1).
  • Among males, differences in the rates by age group diminished over time; by 2019, the rate for males aged 15–24, the group with the highest rate in 1999, was lower than the rate for males aged 25–64 and 65 and over.
  • Among females, rates for all age groups decreased from 1999 through 2019.
  • Rates for motor vehicle occupants decreased by 37% from 12.0 in 1999 to 7.6 in 2019.

Provisional Monthly Drug Overdose Deaths from August 2019 to August 2020

March 17, 2021

Today, NCHS released the next set of monthly provisional drug overdose death counts.

Provisional data show that the reported number of drug overdose deaths occurring in the United States increased by 25.1% from the 12 months ending in August 2019 to the 12 months ending in August 2020, from 68,371 to 85,516. 

After adjustments for delayed reporting, the predicted number of drug overdose deaths showed an increase of 26.8% from the 12 months ending in August 2019 to the 12 months ending in August 2020, from 69,640 to 88,295. 

The reported number of opioid-involved drug overdose deaths in the United States for the 12-month period ending in August 2020 (62,972) increased from 47,772 in the previous year. The predicted number of opioid-involved drug overdose deaths in the United States for the 12-month period ending in August 2020 (65,030) increased from 48,747 in the previous year.

Recent trends may still be partially due to incomplete data. The reported and predicted number of drug overdose deaths involving synthetic opioids (excluding methadone; T40.4) and psychostimulants with abuse potential (T43.6) continued to increase compared to the previous year. Both reported and predicted overdose deaths involving cocaine increased compared to the previous year. The reported and predicted number of natural and semi-synthetic opioid deaths also increased compared to the previous year.


Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019

March 17, 2021

Questions for Holly Hedegaard, Health Statistician and Lead Author of “Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019.”

Q: How do drug overdose death rates in urban and rural areas compare?

HH: Over the past 20 years, rates of drug overdose deaths have increased in both urban and rural areas. Rates in rural areas were higher than in urban areas from 2007 through 2015, but in 2016 that pattern changed. From 2016 through 2019, rates have been higher in urban areas than in rural areas.

Although urban rates are higher than rural rates nationally, for 5 states (California, Connecticut, North Carolina, Vermont, and Virginia), rates are higher in rural areas than in urban areas.


Q: Is this the most recent data you have on this topic?  When do you plan on releasing 2020 data?

HH: Final 2020 data won’t be released until the end of 2021. In the interim, monthly provisional estimates of drug overdose death rates are available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


Q: Was there a specific finding in the data that surprised you from this report?

HH: In this report, we looked at trends in rates for drug overdose deaths involving certain types of opioids, including natural and semisynthetic opioids. This group includes such drugs as hydrocodone, oxycodone, and codeine – drugs that are often thought of as prescription opioids. In looking at the trends from 1999 through 2019, the rates of drug overdose deaths involving natural and semisynthetic opioids were higher in rural than in urban areas from 2004 through 2017, but in 2018 and 2019, the urban and rural rates were similar, because of a decline in the rates in rural areas. We will continue to monitor whether this decline in the rate continues.


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

HH: The key messages from this report are: 1) for the past 20 years, drug overdose death rates have increased in both urban and rural areas, and 2) there are urban-rural differences in the rates of drug overdose deaths involving specific types of drugs. For example, for the past 20 years, rates of drug overdose deaths involving cocaine or heroin have been consistently higher in urban areas than in rural areas. In contrast, in recent years, rates of drug overdose deaths involving psychostimulants (such as methamphetamine) have been higher in rural areas than in urban areas.


Q: Do you think rural counties will go back to having higher drug overdose death rates in the future?

HH: It’s impossible to predict what will happen in the future. While a lot of resources have been devoted to prevention and treatment of drug overdose in recent years, new drugs are becoming available all the time. NCHS will continue to monitor drug overdose deaths to identify patterns to help inform public health efforts.