v17.1 special report: comparative birth trends

V17.1 SPECIAL REPORT ©2017 NPIC NPIC.ORG | 1

V17.1 Special Report: Comparative Birth Trends

INTRODUCTION

The Centers for Disease Control and Prevention (CDC) recently announced preliminary birthrate

data for 2016, highlighting declining multi‐year trends and characterizing comparisons between

2015 and 2016 data as “alarming” to many demographers.1 2

While the overall 2016 birth numbers are down by 1% in comparison to 2015, the messages are

mixed. The good news is that births to teens are down, however births to women in their 20s,

which account for the largest percent of births overall, are also down. Births to women in their 30s

and 40s are up, but not enough to impact the overall numbers or achieve the “replacement level”

that demographers look to for economic stability and growth.

Below is a chart summarizing the CDC data and, where available, notes on comparisons between

2015 data or earlier periods.

CDC 2016 Metric3 Comparison Note/Data

Total births 3,941,109 1% decline from 2015

General fertility rate (births per 1,000 women ages 15‐44)

62.0 .5% decline from 2015

Total fertility rate (per 1,000 women)

1818 Lowest since 1984; replacement rate 2,100/per 1,000 women

Births per 1,000 women 15‐19 20.3 9% lower than 2015; 51% lower than 2007 and 67% lower than 1991

Births per 1,000 women 20‐24 73.7 4% lower than 2015

Births per 1,000 women 25‐29 101.9 2% lower than 2015


Births per 1,000 women 30‐34 102.6 Highest since 1964



Births to unmarried women 39.7% 40.3 % in 2015

No prenatal care in 2016 6.2%

Preterm births (< 37 weeks GA) 9.84% Up from 9.63% in 2015

Babies < 2500 grams 8.16% Up from 8.07% in 2015

I. V17.1 Special Report: Comparative Birth Trends

This V17.1 Special Report: Comparative Birth Trends is designed to look at the birth trends for

NPIC’s Trend Data Base with comparisons to the CDC rates where possible. The Trend Data

Base (55 hospitals) was used so we would have the stability of looking at the same hospitals for

the last 5 years and 1 quarter period.

Table I shows the time period 2012‐2016 and Q1, 2017. Total deliveries and total inborn (birth)

counts are for the entire Trend Data Base, and all the metrics below these counts are derived

from the total inborn counts. Where we are looking at the maternal profile, linked

mother/baby information was used. Hospitals with invalid/missing data are excluded from the

distribution displayed for most metrics (for the missing birthweight and gestational age

categories defaults of > 2500 grams and 37 weeks were used). We also provide the % change

from the CY 2012 to the CY 2016 NPIC rates.

There are four CDC comparative distributions that correspond with the NPIC metrics. The last

column shows the NPIC rates for Q1, 2017.

II. Long Acting Reversible Contraception (LARC) Trends

Some of our member hospitals that have seen a drop in their births have seen a corresponding

increase in their LARC implantation rates at the time of delivery and are speculating about

correlation. While it seems most LARC implantations occur in the outpatient setting, the

reporting of increased implantations at delivery piqued our interest in the rates that we might

find for delivery discharges in our Trend Data Base.


Table II shows the overall count of total deliveries for the Trend Data Base and the number of

LARC procedure (some diagnosis) codes picked up for the entire delivery discharge population.

The ICD 9 and ICD 10 codes used for this analysis are listed below the Table.

The increases reflected in Table II are dramatic and likely show an increase in the use of LARC

and, we suspect, much better coding of the actual procedure over the 2012‐Q1, 2017 period.

Questions and comments regarding this report can be directed to [email protected].

1 Kaplan, K. (2017, June 30) Americans keep having fewer babies as U.S. birthrates hit some record lows. LA Times. Retrieved from www.latimes.com/science/sciencenow/la‐sci‐sn‐us‐birth‐rate‐20170630‐htmlstory.html 2 Cha, A.E. (2017, June 30) The U.S. fertility rate just hit a historic low. Why some demographers are freaking out. The Washington Post. Retrieved from www.washingtonpost.com/news/to‐your‐health/wp/2017/06/30/the‐u‐s‐fertility‐rate‐just‐hit‐a‐historic‐low‐why‐some‐demographers‐are‐freaking‐out/?utm_term=.f46d7713cf55 3 Hamilton, B. E., Martin, J. A., Osterman, M.J.K., Driscoll, A.K., Rossen, L. M. (2017, June 30). Births: Provisional Data for 2016. Division of Vital Statistics, National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/vsrr/report002.pdf.

NPIC Trend Data Base 2012 2013 2014 2015 2016

Percent

Change

12 - 16

CDC

2016

Distribution

2017

(Q1)

Total Deliveries 238,950 237,433 239,946 242,438 246,238 3.1% 57,676

Total Inborns 243,271 241,539 244,652 246,198 249,264 2.5% 3,941,109 58,351

Distribution of Inborns By Hospital Annual Birth Volume 1

≥ 5,000 Inborns 29.1% 29.1% 27.3% 29.1% 29.1% 0.0% 27.3%2,500-4,999 Inborns 43.6% 43.6% 47.3% 41.8% 41.8% -4.2% 40.0%1,500-2,499 Inborns 12.7% 12.7% 9.1% 12.7% 12.7% 0.0% 16.4%< 1,500 Inborns 14.6% 14.6% 16.4% 16.4% 16.4% 12.4% 16.4%

Distribution of Inborns by Age of Mother 2

< 20 years 6.2% 5.4% 4.8% 4.4% 4.3% -31.2% 5.4% 4.2%20-29 years 46.2% 45.9% 45.6% 44.8% 43.8% -5.2% 49.6% 44.4%30-39 years 44.3% 45.4% 46.3% 47.4% 48.7% 9.8% 42.1% 48.1%≥ 40 years 3.3% 3.3% 3.3% 3.4% 3.3% -0.6% 2.8% 3.3%

Distribution of Inborns by Mother's Marital Status 2

Single/Divorced/Widowed/Unknown 42.2% 42.1% 42.7% 42.2% 42.9% 1.7% 39.7% 45.0%Married 57.8% 57.9% 57.3% 57.8% 57.1% -1.2% 60.3% 55.0%

Distribution of Inborns by Race

White 49.3% 48.5% 47.4% 47.2% 46.1% -6.4% 45.9%Black 17.9% 17.9% 17.4% 17.1% 16.9% -5.7% 18.2%American Indian/Alaska Native 0.7% 0.5% 0.4% 0.4% 0.5% -33.3% 0.5%Asian 4.7% 3.9% 3.6% 3.7% 4.3% -9.2% 4.6%Other/Unknown 27.4% 29.2% 31.1% 31.5% 32.3% 17.8% 30.8%

Distribution of Inborns by Birthweight

< 2500 grams 10.8% 10.8% 10.5% 10.9% 10.9% 1.2% 8.2% 15.0%≥ 2500 grams 89.2% 89.2% 89.5% 89.1% 89.1% -0.1% 91.8% 85.0%

Distribution of Inborns by Gestational Age

< 34 weeks 7.2% 7.5% 7.4% 7.0% 7.2% 0.3% 2.8% 8.1%34-36 weeks 16.8% 17.4% 16.5% 15.4% 14.9% -11.2% 7.1% 19.0%≥ 37 weeks 76.1% 75.1% 76.2% 77.7% 77.9% 2.4% 90.2% 72.9%


Table 1: NPIC Comparative Birth Data

2012-2017 (Q1)

1 2017 (Q1) birth volume distribution based on annualized rates. 2 Based on data from hospitals with a valid (≥ 70%) mother/baby linking rate for all time periods.

Hospitals with invalid/missing data within a particular category are excluded from the distribution.


NPIC Trend Data Base 2012 2013 2014 2015 20162017

(Q1)

Percent

Change

12 - 16

Total Deliveries 238,950 237,433 239,946 242,438 246,238 57,676 3.1%

Total Cases coded with LARC Insertion 507 546 552 1,308 2,638 718 420.3%

Rate of LARC Insertion per 1,000 deliveries 2.1 2.3 2.3 5.4 10.7 12.4 404.9%

Qualifying Diagnosis codes:

ICD-9:V25.11 - Encounter for insertion of intrauterine contraceptive device

ICD-10:Z30.430 - Encounter for insertion of intrauterine contraceptive deviceZ30.433 - Encounter for removal and reinsertion of intrauterine contraceptive device

Qualifying Procedure codes:

ICD-9:69.7 - Insertion of intrauterine contraceptive device99.23 - Injection of cortisone, subdermal implantation of progesterone

ICD-10:0UH97HZ - Insertion of Contraceptive Device into Uterus, Via Natural or Artificial Opening0UH98HZ - Insertion of Contraceptive Device into Uterus, Via Natural or Artificial Opening Endoscopic0UHC7HZ - Insertion of Contraceptive Device into Cervix, Via Natural or Artificial Opening0UHC8HZ - Insertion of Contraceptive Device into Cervix, Via Natural or Artificial Opening0JH80HZ - Insertion of Contraceptive Device into Abdomen Subcutaneous Tissue and Fascia, Open Approach0JHD0HZ - Insertion of Contraceptive Device into Right Upper Arm Subcutaneous Tissue and Fascia, Open Approach0JHD3HZ - Insertion of Contraceptive Device into Right Upper Arm Subcutaneous Tissue and Fascia, Percutaneous Approach 0JHF0HZ - Insertion of Contraceptive Device into Left Upper Arm Subcutaneous Tissue and Fascia, Open Approach 0JHF3HZ - Insertion of Contraceptive Device into Left Upper Arm Subcutaneous Tissue and Fascia, Percutaneous Approach 0JHG3HZ - Insertion of Contraceptive Device into Right Lower Arm Subcutaneous Tissue and Fascia, Percutaneous Approach 0JHH3HZ - Insertion of Contraceptive Device into Left Lower Arm Subcutaneous Tissue and Fascia, Percutaneous Approach 0JHH0HZ - Insertion of Contraceptive Device into Left Lower Arm Subcutaneous Tissue and Fascia, Open Approach 0JHL3HZ - Insertion of Contraceptive Device into Right Upper Leg Subcutaneous Tissue and Fascia, Percutaneous Approach0JHM3HZ - Insertion of Contraceptive Device into Left Upper Leg Subcutaneous Tissue and Fascia, Percutaneous Approach 0JHP3HZ - Insertion of Contraceptive Device into Left Lower Leg Subcutaneous Tissue and Fascia, Percutaneous Approach


Table 2: Long Acting Reversible Contraception (LARC) Coding Trends

2012-2017 (Q1)


v17.1 special report: comparative birth trends

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