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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
V17.1 SPECIAL REPORT ©2017 NPIC NPIC.ORG | 2
Births per 1,000 women 30‐34 102.6 Highest since 1964
Births per 1,000 women 35‐39 52.6 Highest since 1962
Births per 1,000 women 40‐44 11.4 Highest since 1966
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.
V17.1 SPECIAL REPORT ©2017 NPIC NPIC.ORG | 3
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%
V17.1 Special Report: Comparative Birth Trends
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.
V17.1 SPECIAL REPORT ©2017 NPIC NPIC.ORG | 4
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
V17.1 Special Report: Comparative Birth Trends
Table 2: Long Acting Reversible Contraception (LARC) Coding Trends
2012-2017 (Q1)
V17.1 SPECIAL REPORT ©2017 NPIC NPIC.ORG | 5