birth by the numbers 2014 part i: is there a problem? gene declercq, phd with support from: the...
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Birth By the Numbers 2014
Part I: Is there a problem?
Gene Declercq, PhDwww.birthbythenumbers.org
With support from: The Transforming Birth Fund
BirthByTheNumbers.org
Total U.S. Births, 1990-2013
19901992
19941996
19982000
20022004
20062008
20102012
3,800,000
3,900,000
4,000,000
4,100,000
4,200,000
4,300,000
4,400,000
3,957,577
4,316,233
Net Decrease 2007-2013358,656 or 8.3%
Source: Adapted from CDC VitalSTATS. http://www.cdc.gov/nchs/VitalStats.htmBirthByTheNumbers.org
U.S. Fertility Rates (per 1,000) by Race/Ethnicity, 1989-2012
50
60
70
80
90
100
110
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
AllWNHBNHHisp
Fertility rates computed by relating total births, regardless of age of mother, to women 15-44 years. SOURCE: adapted from NCHS Annual Birth Reports.
Prematurity and Low Birthweight, U.S., 1981-2012
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
6
7
8
9
10
11
12
13
Prematurity
Low Birthweight
9.8%Decrease 2006-12
%
Year
BirthByTheNumbers.org
Percent of all births at home, or in a birthing center, United States, 1990-2012
19901995
20002005
20102012
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Total home & birth center
Home
Birthing center
46,956(1.13%) 35,587
(0.87%)
50,761(1.28%)
43% Increase 2004-2012
35,184
15,577
BirthByTheNumbers.orgSource: NCHS Annual Birth Reports
BirthByTheNumbers.org
Is the U.S. really doing that badly?
How Do we Compare Outcomes?Neonatal Mortality Rate
Infant Deaths in First 28 days
X 1,000________________
Live Births
Outcomes: Comparative Neonatal Mortality RatesRank Country Rank Country Rank Country
1 Andorra (1/1,000) 14 Germany 27 Belarus
Iceland Ireland Netherlands
Japan Israel Greece
Luxembourg Italy Cuba
San Marino Lithuania Lithuania
Singapore Monaco New Zealand7 Austria (2/1,000) Norway United Kingdom
Belgium Portugal Switzerland
Cyprus Rep. of Korea Croatia
Czech Republic Slovenia 37 United States (4/1,000)
Estonia 24 Sweden Bahrain,Bosnia,Brunei
Finland Australia (3/1,000) Canada, Hungary, Qatar,
13France
26Belarus
Montenegro, Serbia, Slovenia, Uruguay
Source: State of the World’s Children2014. BirthByTheNumbers.org
Outcomes
Total Births in the five countries in red background in 2012 were 11,429 or fewer than the 12,104 in South Dakota in 2012
Country 2012Births
Andorra 757
Iceland 4,146
Luxembourg 6,034
San Marino 285
Monaco 207
TOTAL 11,429
BirthByTheNumbers.org
BirthByTheNumbers.org
What’s a Fair Comparison with the US?
In the most recent year available (2011):
• Countries with at least 100,000 births
• Countries with a total per capita annual expenditure on health of at least $1,500 annually in US dollars.
Defining a Set of Countries to Compare with the U.S.17 Comparison Countries (SOURCE: OECD, Health Data 2012 & State of World’s Children)
2011 Total Births
(000)
2011Total exp. health –
PC, US$ PPP
2011% Births by
Cesarean
Australia 302 *3,800 *31.2
Belgium *129 4,061 *19.7
Canada 377 4,521 *26.1
Czech Republic 109 1,966 23.3
France 792 4,118 20.2
Germany *678 4,495 31.4
Greece 106 2,361 NA
Israel 166 2,239 19.9
Italy *557 3,012 37.7
Japan 1,051 *3,213 18.0
Korea 471 2,198 34.6
Netherlands *184 5,099 *15.6
Portugal 97 2,619 33.3
Spain 471 3,072 24.9
Sweden 112 3,925 16.2
United Kingdom 808 3,406 24.1
United States 3,954 8,508 32.8
BirthByTheNumbers.org* 2010
BirthByTheNumbers.org
IOM chose 16 peer countries. 13 are same as the one’s we’ve used. They use 3 countries (Denmark, Finland, Switzerland) that have <100,000 births. We include Belgium, Czech Republic, Greece and Israel
How is the U.S. doing relative to comparison countries?
Neonatal Mortality Rate
Infant Deaths in First 27 days
X 1,000_____________
Live Births
Perinatal Mortality Rate
Fetal deaths + deaths in the first week
X 1,000 _______________Live births + fetal
deaths
BirthByTheNumbers.org
Neonatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries with 100,000+ Births
1.11.4
1.7
1.7
2.12.2
2.2
2.22.2
2.3
2.42.4
2.7
2.7
33.7
4.04
0 1 2 3 4 5
Japan
SwedenCzech Republic
Korea
Spain
Greece
Israel
Italy*
Belgium*
France
Germany
PortugalNetherlands
AustraliaUnited Kingdom
Canada*United States
Source: OECD Health Data 2014 and NCHS, Deaths Preliminary Data for 2011. BirthByTheNumbers.org
*2010 rate
Neonatal Mortality Rate
Neonatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries with 100,000+ Births
1.11.4
1.7
1.7
2.12.2
2.2
2.22.2
2.3
2.42.4
2.7
2.7
33.45
3.7
0 1 2 3 4
Japan
SwedenCzech Republic
Korea
Spain
Greece
Israel
Italy*
Belgium*
France
Germany
PortugalNetherlands
AustraliaUnited Kingdom
U.S. WNH
Canada*
Source: OECD Health Data 2014 and NCHS, Deaths Preliminary Data for 2011. BirthByTheNumbers.org
*2010 rate
Neonatal Mortality Rate
BirthByTheNumbers.org
Perinatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries 100,000+ Births
JapanKoreaSpain
PortugalCzech Republic
Italy#Israel
GreeceSweden
GermanyNetherlands
Canada#Belgium#
United States*United Kingdom
AustraliaFrance
0 2 4 6 8 10 12 14
2.83.1
3.73.83.9
4.34.54.64.7
5.55.5
6.16.56.5
7.58.4
12.1
*2006; #2010
Source: OECD Health Data 2014
Perinatal Mortality Rate
BirthByTheNumbers.org
Perinatal Mortality Rates (per 1,000 births), 2011, Industrialized Countries 100,000+ Births
JapanKoreaSpain
PortugalCzech Republic
Italy#Israel
GreeceSweden
United States* WNHGermany
NetherlandsCanada#Belgium#
United KingdomAustralia
France
0 2 4 6 8 10 12 14
2.83.1
3.73.83.9
4.34.54.64.7
5.35.55.5
6.16.5
7.58.4
12.1
*2006; #2010
Source: OECD Health Data 2014
Maternal Mortality Ratios
Maternal Mortality Ratio
Maternal Deaths* all causes X 100,000
_______________Live births
* Deaths in pregnancy and up to 42 days postpartum
BirthByTheNumbers.org
Maternal Mortality Rates, (per 100,000 births), 2011, Industrialized Countries with 300,000+ births
2.9
3.0
3.4
4.1
4.7
6.6
7.6
8.9
16.8
17.2
2.0 18.0
Italy*
Spain
Australia*
Japan
Germany
United Kingdom
Canada#
France*
United States^
Korea
Sources: OECD Health Data 2014; ^California Maternal Quality CareCollaborative (CMQCC) 2014; NCHS. 2009. Deaths, Final Data, 2007.
U.S. 2007:Black non-Hispanic 28.4White non-Hispanic 10.5Hispanic 8.9
Maternal Mortality Ratio
*2010; #2009; ^CMQCC Estimate
BirthByTheNumbers.org
Maternal Mortality Rates, (per 100,000 births), 2011, Industrialized Countries with 300,000+ births
2.9
3.0
3.4
4.1
4.7
6.6
7.6
8.9
10.5
17.2
2.0 18.0
Italy*
Spain
Australia*
Japan
Germany
United Kingdom
Canada#
France*
United States^
Korea
Sources: OECD Health Data 2014; NCHS. 2009. Deaths, Final Data, 2007.
U.S. 2007:Black non-Hispanic 28.4White non-Hispanic 10.5Hispanic 8.9
Maternal Mortality Ratio
*2010; #2009; ^2007
Are things Getting Better or Worse?
YesThings are getting better in
the U.S., but at a slower pace than comparable
countries
Neonatal Mortality Rate (per 1,000 births), 2000-2011, U.S., & Ave. for Industrialized Countries*
2.0
3.0
4.0
5.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Rate
per
1,0
00 l
ive b
irth
s
Source: OECD Health Data, 2014 & MacDorman MF, et al. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.
U.S.
* Countries with 100,000+ births (2009): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Israel, Italy, Japan, Netherlands, Portugal, Spain, S. Korea, Sweden, U.K.
2.3
4.0
4.6
3.1
Industrialized Countries
23% decrease
13% decrease
Neonatal Mortality Rate (per 1,000 births), 2000-2011, U.S., & Ave. for Industrialized Countries*
2.0
3.0
4.0
5.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Rate
per
1,0
00 l
ive b
irth
s
Source: OECD Health Data, 2014 & MacDorman MF, et al. Recent declines in infant mortality in the United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.
U.S.
* Countries with 100,000+ births (2009): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Israel, Italy, Japan, Netherlands, Portugal, Spain, S. Korea, Sweden, U.K.
2.3
4.0
4.6
3.1
If the U.S. neonatal mortality rate equaled the current average rate of the other countries in 2011, that would mean about 6,972 fewer deaths to babies 28 days or younger annually.
BirthByTheNumbers.org
Perinatal Mortality Rates, 2000-2011 , U.S., & Ave. for Industrialized Countries*
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20115
5.5
6
6.5
7 U.S. 6 %
decrease
Industrialized Countries
14% decrease
* Countries with 100,000+ births (2011): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Israel, Italy, Japan, Netherlands, Portugal, S. Korea, Spain, Sweden, United Kingdom
Sources: OECD Health Data 2014; NCHS. 2012. Fetal & Perinatal Mortality,
2006.
Maternal Mortality Ratios (per 100K births), 2000-2011, U.S. & Comparable Countries *
4
8
12
16
20
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Dea
ths
per
100
,000
live
bir
ths
Industrialized Countries
5 % Decrease
U.S.71%
Increase
* Countries with 300,000+ births (2011): Australia, Canada, France, Germany, Italy, Japan, S. Korea, Spain, United Kingdom
NOTE: 2008-2010 US rates unofficial^
Sources: OECD Health Data 2014; ^California Maternal Quality Care Collaborative (CMQCC) 2014; NCHS. 2009. Deaths, Final Data, 2007.
Case Ascertainment?
US Cesarean Rates, 1989-2013
20
22
24
26
28
30
32
34
% Tot US 23 22. 22. 22. 21. 21. 20. 20. 20. 21. 22. 23 24 26 28 29 30 31 32 32 33 33 33 33 33
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13
%
Source: National Center for Health Statistics Annual Birth Reports
%
1,294,128
If the 2013 cesarean rate was the same as in 1996, there would have been 475,000 fewer cesareans in the U.S. in ’13.
Primary Cesarean and VBAC Rates, U.S., 1989-2011
5%
10%
15%
20%
25%
30%
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
Prim Ces Rate
VBAC
r = -.95
Source: NCHS. Annual Birth Reports & Vital Stats
Note: 2005-2011 unofficial
9.2%
15.6%16.2%
18.0%19.8%19.90%20.2%
23.3%24.1%
24.9%26.1%
34.6%37.7%
32.8%31.4%
33.4%
30.8%
10% 45%
*NetherlandsSweden
JapanIsrael
*BelgiumFrance
Czech RepublicUnited Kingdom
Spain*Canada
*AustraliaGermany
United States*Portugal
KoreaItaly
Sources: OECD Health Data 2014; U.S. Natality Data; Japan – sample; Lancet 6736(09)61870-5.
Cesarean Rates in Industrialized Countries* with 100,000+ Births, 2011
*2010
* No data on cesarean rates in Greece
VBAC Rates, Selected Countries, 2004
0 10 20 30 40 50 60
NetherlandsNorwayFinland
SwedenGermany
Czech RepDenmark
FranceBelg-Flanders
ScotlandSpain-Valencia
SloveniaMalta
EstoniaCanada
LithuaniaLatvia
U.S. VBACs
51
41
45
5155
25
2732
3539
41
919
24
25
25
20
8
Source: Adapted from EuroPeristats, US & Canadian Data
Gestational Age, U.S. All Births, 1990
2% 1%
7%
20%
14%
11%
22% 23%
0%
5%
10%
15%
20%
25%
30%
<32 32-33 34-36 37-38 39 40 41 42+
* Only births occurring at home. Source: Martin JA, Hamilton BE, Osterman MJK, Curtin S and Mathews TJ. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health Statistics. 2014.
Gestational Age, U.S. All Births, 2012
2% 1%
8%
25%
30%
20%
9%
6%
0%
5%
10%
15%
20%
25%
30%
<32 32-33 34-36 37-38 39 40 41 42+
* Only births occurring at home. Source: Martin JA, Hamilton BE, Osterman MJK, Curtin S and Mathews TJ. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health Statistics. 2014.
Gestational Age, U.S. All Births, 1990 & 2012
2% 1%
20%22%
14%
11%
25%
30%
7%
23%
9%6%
2% 1%
8%
20%
0%
5%
10%
15%
20%
25%
30%
<32 32-33 34-36 37-38 39 40 41 42+
19902012
* Only births occurring at home. Source: Martin JA, Hamilton BE, Osterman MJK, Curtin S and Mathews TJ. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health Statistics. 2014.
Gestational Age, U.S. All Births & Planned Home Births*, 2012
2% 1%
8%
25%
30%
20%
9%6%
0% 0%2%
31%
19%
10%
15%
24%
0%
5%
10%
15%
20%
25%
30%
35%
<32 32-33 34-36 37-38 39 40 41 42+
All
Home
* Only births occurring at home. Source: Martin JA, Hamilton BE, Osterman MJK, Curtin S and Mathews TJ. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health Statistics. 2014.
LEADING MAJOR DIAGNOSTIC CATEGORIES by
NUMBER OF HOSPITAL DISCHARGES, U.S., 2012
1,428,045
1,428,060
1,671,380
2,192,941
3,242,725
3,251,134
3,549,166
4,796,1754,160,286
3,933,511
0
1,00
0,00
0
2,00
0,00
0
3,00
0,00
0
4,00
0,00
0
5,00
0,00
0
6,00
0,00
0
7,00
0,00
0
Infectious & Parasitic Diseases
Mental Diseases & Disorders
Kidney & Urinary Tract
Nervous System
Digestive System
Musculoskeletal System & Conn Tissue
Respiratory System
Newborns & Other Neonates
Pregnancy, Childbirth & The Puerperium
Circulatory System
AHRQ. 2014. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 3/1/2014.
MEDIAN FACILITY LABOR & BIRTH CHARGES BY MODE OF BIRTH, U.S., 2012
$9,705
$16,465
$11,539
$19,358
$0
$20,000
Vaginal noComplications
Cesarean NoComplications
VaginalComplications
CesareanComplications
Sources: AHRQ. 2011. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 3/1/14;
NOTE: Hospital charges; no physician costs
70%
Estimated Total Charges, Hospital Birth, U.S., 1993-2012 (000,000)
0
10,000
20,000
30,000
40,000
50,000
60,000
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
Vag no Compl.
Vag w Compl.
Ces no Compl.
Ces w/ Compl.
Sources: AHRQ. 2009. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov. Accessed 3/1614.
$ 55,771
$ 14,039
BirthByTheNumbers.org
•Evidence – keep an open mind and ask different questions.
• Advocacy – work for change.
BirthByTheNumbers.org
www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery
Safe Prevention of Primary Cesarean Delivery
Rethinking the Evidence
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