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Better Times for Vital Statistics


Better Times for Vital Statistics

The top-cited paper in the journal Pediatrics every year is usually the “Annual Summary of Vital Statistics,” a compendium of data of interest to pediatricians, obstetricians and other health care trend watchers. However, the Summary’s popularity tends to obscure a significant problem, says Bernard Guyer, MD, MPH, an emeritus professor in Population, Family and Reproductive Health (PFRH), and a senior author of the Summary since 1994. “The data we’re publishing now in 2011 are from 2008—and they’re preliminary data at that, showing that our vital statistics reporting system is hopelessly untimely.”

Currently, the CDC obtains the data from state governments, which take them from birth and death certificates and similar documents, primarily collected for legal record-keeping reasons.

“When you’re thinking in a legal mode, a case doesn’t get closed until every ‘i’ is dotted and ‘t’ is crossed. So the data end up being delayed until every case is accounted for,” he says.

“We now have the tools to create a data system that could tell us how many births and deaths occurred in the nation as recently as yesterday!” —Bernard Guyer

Guyer has been urging policymakers to change the system into a surveillance-oriented public health data system based on the electronic records that states increasingly use. “We now have the tools to create a data system that could tell us how many births and deaths occurred in the nation as recently as yesterday!” he says.

Even delayed data, however, have value, and the article makes the best use of the vital statistics data that are available at the time. On the radar screen this year is a continuing increase in the proportion of births to older women. 

“The increase has been the largest for women over 40, who showed a 3 percent jump in fertility between 2007 and 2008,” says Donna Strobino, PhD, Guyer’s co-senior author on the Annual Summary and a fellow PFRH professor. “Women 35 and over now account for a larger proportion of births than do teenagers.”

Women who delay motherhood into their 30s and 40s may be satisfying other life goals, but Strobino notes that this delay seems to be coming at a cost. “Although rates of low birthweight and preterm births have been stagnant or slightly declining for all mothers, they generally have been rising for non-Hispanic white mothers, whose over-40 birth rate is higher than that for most other groups,” Strobino says. “Older women in general are more likely to have low birthweight babies, preterm births and multiple births.”

At the same time, the birth rate for America’s teens—“the highest teen birth rate in the developed world,” says Strobino—has resumed its long-term decline after an alarming uptick in the 2007 statistics. “I suspect that the move from 2006 to 2007 was just a hiccup, rather than a real reversal of the downward trend we’ve been seeing since 1990,” she adds.

The downward trend has not, however, brought the U.S. close to the relatively low average teen birth rate for other developed countries.

The Annual Summary this year was produced with the help of co-authors T. J. Mathews, MS; Arialdi M. Miniño, MPH; and Michelle J. K. Osterman, MHS, of the CDC’s National Center for Health Statistics.

Reproductive shifts in the u.s.

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

68.7

2008

106.2

1950

125.0

1915

Infant mortality rate (per 1,000 live births)

6.6

2008

29.2

1950

99.9

1915

Teen birth rate (births per 1,000 females ages 15–19)

41.5

2008

40.5

2005

61.8

1991

Low birthweight babies rate (percent)

8.2

2008

7.0

1990

Cesarean delivery rate (percent)

32.3

2008

31.8

2007

22.7

1990

SOURCE: “Annual Summary of Vital Statistics: 2008,” Pediatrics; published online December 2010

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