Estimating the under 18 Estimating the under 18 conception rate in Brighton & conception rate in Brighton &

Hove Hove

Anna-Marie JonesAnna-Marie Jones

Brighton & Hove City CouncilBrighton & Hove City Council

1010thth March March

OverviewOverview

• What we want to knowWhat we want to know

• Data & MethodologyData & Methodology

• Data sharingData sharing

• Results: comparisons of local estimates vs Results: comparisons of local estimates vs official statistics official statistics 

• Using the estimates to help develop services Using the estimates to help develop services to support the teenage pregnancy agenda to support the teenage pregnancy agenda

• SummarySummary

• Questions/DiscussionQuestions/Discussion

What we want to knowWhat we want to know

Number of young women who usually Number of young women who usually live in Brighton and Hove who live in Brighton and Hove who conceived when aged under 18 yearsconceived when aged under 18 years

Data & MethodologyData & Methodology

DefinitionsDefinitions

ConceptionsConceptions MaternitiesMaternities

Live and still Live and still births are births are includedincluded

TerminationsTerminations

Miscarriages & Miscarriages & illegal abortions are illegal abortions are

excludedexcluded

+=

Usually Usually live in BHlive in BH

= Address postcode falls in BH boundary

Data Source & Fields: BirthsData Source & Fields: Births

PostcodePostcode Date of BirthDate of BirthDelivery Delivery

AgeAgeDelivery Delivery

DateDate

BN3 0XXBN3 0XX 07-Apr-9107-Apr-91 1818 2-Dec-092-Dec-09

BN1 0XXBN1 0XX 03-May-9203-May-92 1717 19-Nov-0919-Nov-09

BN1 0XXBN1 0XX 2-Oct-912-Oct-91 1818 5-Dec-095-Dec-09

BN2 0XXBN2 0XX 2-Jul-932-Jul-93 1616 2-Nov-092-Nov-09

BN42 0XXBN42 0XX 3-May-913-May-91 1818 1-Nov-091-Nov-09

TN22 0XXTN22 0XX 18-Sep-9118-Sep-91 1717 14-Aug-0914-Aug-09

RH15 0XXRH15 0XX 5-Feb-935-Feb-93 1616 18-Dec-0918-Dec-09

Brighton and Sussex University Hospitals data

Investigated where else Brighton & Hove residents may deliver•if no room at the main hospital •If they are on the LA boundary

Discovered a handful of planned deliveries take place at Princess Royal Hospital Haywards Heath (12 miles north of Brighton)

Extra fields

•Birth weight

•Smoking

•Parity

•Delivery method

Data Source & Fields: Data Source & Fields: TerminationsTerminations

British Pregnancy Advisory Service data

PostcodePostcodeDate of Date of

BirthBirthProcedure Procedure

AgeAge

Date of Date of procedurproceduree

Gestation Gestation periodperiod

/foetal size*/foetal size*

BN3 0XXBN3 0XX 07-Apr-9107-Apr-91 1818 2-Dec-092-Dec-09 88

BN1 0XXBN1 0XX 03-May-9203-May-92 1717 19-Nov-0919-Nov-09 1111

BN1 0XXBN1 0XX 2-Oct-912-Oct-91 1818 5-Dec-095-Dec-09 1212

BN2 0XXBN2 0XX 2-Jul-932-Jul-93 1616 2-Nov-092-Nov-09 1010

BN42 0XXBN42 0XX 3-May-913-May-91 1818 1-Nov-091-Nov-09 1919

TN22 0XXTN22 0XX 18-Sep-9118-Sep-91 1717 14-Aug-0914-Aug-09 88

RH15 0XXRH15 0XX 5-Feb-935-Feb-93 1616 18-Dec-0918-Dec-09 66

*Pre April 2009 enhanced dataset included foetal size instead of gestation

Extra fields

•Ethnicity

•Marital status

•Chlamydia testing

•Number of previous TOPs

•Contraception

•TOP method

Age at conception: BirthsAge at conception: Births

• Estimate the conception date• Average length of pregnancy is 38 weeks• Length of pregnancy in days is 38x7=266 days• Conception date = delivery date – 266 days

• Use dob to get age on conception date• (conception date – dob)/365.25• Use integer part of age estimate; don’t round up

Taken from the factsheet for teenage pregnancy co-ordinators (ONS)

Age at conception: Age at conception: TerminationsTerminations• Estimate the conception date

• Estimate the gestation period= foetal size x 7OR = gestation X

7

• Date of conception = (date of procedure – gestation period) +14 days

• Use dob to get age on conception date• Conception age = (conception date – dob)/365.25• Use integer part of age estimate; don’t round up

Taken from the factsheet for teenage pregnancy co-ordinators (ONS)

• Brighton and Hove look-up table in ExcelBrighton and Hove look-up table in Excel• Bought from Royal MailBought from Royal Mail• 9718 postcodes9718 postcodes

– WardWard– LSOALSOA– OS Eastings OS Eastings & Northings& Northings

Usual Residence IUsual Residence I

• Brighton & Hove council analyst Brighton & Hove council analyst mapped all the postcodes to different areasmapped all the postcodes to different areas

– Brighton & Hove CC boundary – added an in/out area indicatorBrighton & Hove CC boundary – added an in/out area indicator– CYPT Area (East/West/Central)CYPT Area (East/West/Central)– CYPT Children CentresCYPT Children Centres– Also other information merged on such as IMDAlso other information merged on such as IMD

• Manually check postcodes are entered correctly Manually check postcodes are entered correctly – BN2 1XX vs bn21xxBN2 1XX vs bn21xx

• Manually check addressesManually check addresses– Is PC embedded in the address fieldIs PC embedded in the address field

• Use Royal mail to find out missing Use Royal mail to find out missing postcodes from addresspostcodes from address

• If address & PC missing look to other recordsIf address & PC missing look to other records– ConnexionsConnexions– Social Care (Carefirst)Social Care (Carefirst)– Education (IMPULSE)Education (IMPULSE)

• Some addresses are simply falsifiedSome addresses are simply falsified– ““New Grove Car Park; Brighton” so can only assume they are ‘in New Grove Car Park; Brighton” so can only assume they are ‘in

area’area’

Usual Residence IIUsual Residence IIIn the births and termination data sets…

Estimating the ratesEstimating the rates

• Problem: Obtaining the population bases for creating BH rates; ONS Problem: Obtaining the population bases for creating BH rates; ONS data either data either – 15-19yrs age groups15-19yrs age groups– 15-17yrs age group but included males15-17yrs age group but included males– Was from 2001 Census and so was out of dateWas from 2001 Census and so was out of date

• Solution: Use the population sources from the Official statistics Solution: Use the population sources from the Official statistics – Annual LA rate = under 18 count in year/populationAnnual LA rate = under 18 count in year/population– Quarterly LA rate = under 18 count in last 4 quarters/ population estimates Quarterly LA rate = under 18 count in last 4 quarters/ population estimates

for last 4 quartersfor last 4 quarters– Ward rate = under 18 count in last 3 years/population estimate for last 3 Ward rate = under 18 count in last 3 years/population estimate for last 3

yearsyears

Data sharing IData sharing I

• Developed a good relationship with BSUH (Births data)Developed a good relationship with BSUH (Births data)– Partnership agreement between BSUH and Connexions - part of integrated Partnership agreement between BSUH and Connexions - part of integrated

working working – Data comes in monthly after remindersData comes in monthly after reminders– Improved consistency in which data fields are sent Improved consistency in which data fields are sent – Data is at a named level so that it can be linked up to other datasets Data is at a named level so that it can be linked up to other datasets

• CarefirstCarefirst• Connexions databaseConnexions database• Education dataEducation data

– Ideally wanted to get the births straight from the child births register but this Ideally wanted to get the births straight from the child births register but this hasn’t happened yethasn’t happened yet

• Good relationship with BPAS (Terminations data)Good relationship with BPAS (Terminations data)– Partnership agreement between BPAS and SH & HIV commissioner at PCT; we Partnership agreement between BPAS and SH & HIV commissioner at PCT; we

have agreement with PCT to have access to same informationhave agreement with PCT to have access to same information– Data sent regularly without remindersData sent regularly without reminders– Data fields are consistentData fields are consistent– Data is anonymous so that it can’t be linked up to other dataData is anonymous so that it can’t be linked up to other data

Data sharing IIData sharing II

• Who to approach for dataWho to approach for data– Sexual Health & HIV commissioner within your PCTSexual Health & HIV commissioner within your PCT– Maternity services commissioner within your PCTMaternity services commissioner within your PCT– Public Health lead with-in the local main hospitalPublic Health lead with-in the local main hospital

• What if they are reluctant to share dataWhat if they are reluctant to share data– All young people services should meet the ‘You’re Welcome’ quality All young people services should meet the ‘You’re Welcome’ quality

criteria – you can help them criteria – you can help them – The CYPT strives to be a joined up service – as part of the 5ECM The CYPT strives to be a joined up service – as part of the 5ECM

outcomes data sharing is part of the processoutcomes data sharing is part of the process

Process made easy by Brighton & Hove’s commitment to integrated working across the city…Where can you start?

ResultsResults

Total under 18 conceptionsTotal under 18 conceptions

Year

2004 2005 2006 2007 2008

Out of area 13 24 18 22 24

In area 155 186 165 179 142

Counts of under 18 conceptions, by year

Source: BPAS & BSUH

8-15% Out of area

LondonTonbridge

Redhill

LA level annual

155

186

165179

142

194180 181

150

184

0

20

40

60

80

100

120

140

160

180

200

2004 2005 2006 2007 2008

Conception Year

Co

un

t o

f co

nce

pti

on

s

Local Estimate

Official Statistics

Official Statistics Vs Local Official Statistics Vs Local Estimates IEstimates I

Count of under 18 conceptions, by year

Source: BPAS & BSUH & ONS

•Counts consistently under estimated but close

•2007 best estimate

•Currently out by 8 for 2008. Investigating the difference

LA level annual

Worthing and Southlands (PCT search of Hospital data)

?

Official Statistics Vs Local Official Statistics Vs Local Estimates IIEstimates II

Proportion of under 18 conceptions leading to a termination, by year

Source: BPAS & BSUH & ONS

•% estimate generally close but over estimated

•Suggests we may not be capturing all the births

LA level annual

63%60% 61%

65% 65%

56% 58%63%

60%57%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2004 2005 2006 2007 2008

Conception Year

Pro

po

rtio

n o

f co

nce

pti

on

s le

adin

g t

o

term

inat

ion

Local Estimate

Official Statistics

Official Statistics Vs Local Official Statistics Vs Local Estimates IIIEstimates IIIUnder 18 conception rates, by year

Rates per 1000 15-17 year old womenSource: BPAS & BSUH & ONS

•Rates consistently under estimated but close 2007 & 2008

•2007 best estimate

LA level annual

37.6

43.8

39.543.0

34.1

45.743.1 43.5

36.0

44.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

2004 2005 2006 2007 2008

Conception Year

Rat

e o

f co

nce

pti

on

s

Local Estimate

Official Statistics

0

10

20

30

40

50

60

30 35 40 45 50 55 60

Local qrtly estimated rates

Off

icia

l q

rtly

rat

es

Official Statistics Vs Local Official Statistics Vs Local Estimates IVEstimates IV

Under 18 conception quarterly rates Q4 2004- Q4 2008

Rates per 1000 15-17 year old women

LA level quarterly

•Outlier based on early data

•Rates consistently under estimated; not enough conceptions/births?

Y=X2004 data

0

20

40

60

80

100

120

0 20 40 60 80 100 120

Local ward rate estimate

Off

icia

l w

ard

rat

e es

tim

ate

14 Official 9 Estimatedsmall pop of 148

Under 18 conception rates by ward 2005-2007

Rates per 1000 15-17 year old women

•Need to consider size of ward population and number of conceptions.

•Small changes in number of conceptions can create relatively large differences in the rates

Official Statistics Vs Local Official Statistics Vs Local Estimates VEstimates VWard level annual

Y=X

Using the estimatesUsing the estimates

Predicting the 2006-2008 ward Predicting the 2006-2008 ward rates: U18 conceptionsrates: U18 conceptions

Under 18 conception rates: changes over time

Rates per 1000 15-17 year old women

•Used population counts from 2005-2007 official rates to estimate 2006-2008

•Official 2006-2008 conception rates not available until Feb 2011

•Prediction falls inline with the 25% fall reported for 2008

Small number of conceptions

0

20

40

60

80

100

120

140

Brighton & Hove Wards

Ra

te p

er

10

00

Hotspot cutoff

2005-07 Rate

Local 2006-08 Rate

Hotspot cutoff

Rate decrease 2002-04 vs 2005-07

Rate Increase2002-04 vs 2005-07

l

Predicting the 2006-2008 ward Predicting the 2006-2008 ward rates: U18 terminationsrates: U18 terminations

•Used the TPU definition of a hotspot of 53.3 per 1000

•Official stats show 60% conceptions lead to termination

•Therefore use 0.6 X 53.3 = 32.0 per 1000

Predicting the 2006-2008 ward Predicting the 2006-2008 ward rates: U18 birthsrates: U18 births

Official stats show 60% conceptions lead to termination

Therefore use (1-0.6) X 53.3 = 213 per 1000 for

births

The estimates can be used The estimates can be used to…to…• Predict if performance is off target

– What needs to be done– Funding implications

• Identify risky groups– Early conception; unplanned pregnancy; repeat pregnancy; STIs

• Identify specific areas where there are high rates of birth– Increase level of targeted interventions work; changing behaviour; changing life

cycle; raising aspirations; challenging poor sexual health

• Use the maps to identify gaps in service provision– High areas of terminations imply poor access to EHC and CASH services– Need to increase LARC

• Use the maps to identify where we have high numbers of young parents– As part of a needs assessment we’d want to establish if there is sufficient support

for young parents

• Identifying where SH campaigns should be targeted– Want to target young people at high risk of teenage pregnancy or poor sexual

health

The estimates can also be used The estimates can also be used to…to…• Feed back to front line workers and anyone committed to the TP agenda

(and those who aren’t)– Shows them the impact their work has had– Motivates them to continue – Maintains momentum– Highlights needs for training + workforce development needs– identify champions (existing & potential)

• Inform commissioning and Value for Money exercises

• Steer service provider contracts– All contacts young women, aged 15 – 17– Direct access to services campaigns at wards with high TOPS rates– Repeat TOPS and uptake of contraception data has informed specialist post and training consultants to issue

contraception

• Aid service providers to move towards accountability for own performance

• Help to develop outcomes profiling reports

• Along side caseload audits to inform practice and to assess where / what prevention work was put in place and what impact it had

Data toolsData tools

• ExcelExcel

• STATA SoftwareSTATA Software– Database management and statisticsDatabase management and statistics

• GISGIS

• Postcode look-up tablePostcode look-up table

In SummaryIn Summary• Obtain data from local maternity and termination centres for help; look toObtain data from local maternity and termination centres for help; look to

– HIV & SH commissioner at your PCTHIV & SH commissioner at your PCT– Maternity services commissioner at your PCTMaternity services commissioner at your PCT– Public Health lead at the local main hospitalPublic Health lead at the local main hospital

• Use look-up tables to determine whether postcode in/out of areaUse look-up tables to determine whether postcode in/out of area– Find out if other analysts in the service have a look-up facilityFind out if other analysts in the service have a look-up facility

• Use populations from the Official statsUse populations from the Official stats

• Create rates using definitions from the Create rates using definitions from the factsheet for teenage pregnancy co-ordinators (ONS)(ONS)

• Compare rates to published figures to determine accuracyCompare rates to published figures to determine accuracy

• Make predictions ahead of Official releaseMake predictions ahead of Official release– Maybe use weighting systemMaybe use weighting system

• Use of the data Use of the data – Predict if off targetPredict if off target– Identify the ‘at risk group’ and locateIdentify the ‘at risk group’ and locate– Needs analysis: access to CASH services; support to young parentsNeeds analysis: access to CASH services; support to young parents– Profiling Teenage Parents; identifying areas with high ratesProfiling Teenage Parents; identifying areas with high rates– Targeted campaignsTargeted campaigns– Inform service provider contractsInform service provider contracts

Estimating the under 18 Estimating the under 18 conception rate in Brighton & conception rate in Brighton &

Hove Hove

Questions?Questions?

Anna-marie.jones@brighton-hove.gov.uk01273 296546