Perinatal Health Indicators for Ontario

Transcription

1 Perinatal Health Indicators for Ontario 2012

2 Although significant effort has been made to ensure the accuracy of the information presented in this report, neither the authors nor BORN Ontario nor any other parties make any representation or warranties as to the accuracy, reliability or completeness of the information contained herein. The information in this report is not a substitute for clinical judgment or advice. Permission is granted for the reproduction of these materials solely for non-commercial and educational purposes. Suggested citation: Better Outcomes Registry & Network (BORN) Ontario. Perinatal Health Indicators for Ontario Ottawa ON, Perinatal Health Indicators for Ontario

3 Table of Contents Introduction. 4 Fetal Mortality Rate 8 Infant Mortality Rate. 12 Small-for-Gestational-Age (SGA) Rate 13 Large-for-Gestational-Age (LGA) Rate 15 Preterm Birth Rate.. 17 Postterm Birth Rate 21 Live Births to Teenage Mothers. 23 Live Births to Older Mothers Multiple Birth Rate.. 39 List of Figures and Tables Comparison of the hospital recorded in the BORN Information System (BIS) and the Canadian Institute for Health Information Discharge Abstract Database (CIHI DAD).. 6 List of perinatal indicators included in CPSS report.. 7 Figure 1 Rate of fetal mortality, Ontario, Table 1-A Crude rate of fetal mortality, Ontario and the rest of Canada, Table 1-B Rate of fetal mortality 500 grams (g), Ontario and the rest of Canada, Table 1-C Rate of fetal mortality 1,000 grams (g) or 28 weeks gestation, Ontario and the rest of Canada, Figure 2 Rate of small for gestational age (SGA), Ontario, Table 2 Rate of small for gestational age (SGA), Ontario and the rest of Canada, Figure 3 Rate of large for gestational age (LGA), Ontario, Table 3 Rate of large for gestational age (LGA), Ontario and the rest of Canada, Figure 4 Rate of preterm birth, Ontario, Table 4-A Rate of preterm birth <37 weeks gestation, Ontario and the rest of Canada, Table 4-B Rate of preterm birth weeks gestation, Ontario and the rest of Canada, Table 4-C Rate of preterm birth <32 weeks gestation, Ontario and the rest of Canada, Figure 5 Rate of postterm birth, Ontario, Table 5 Rate of postterm birth, Ontario and the rest of Canada, Figure 6 Age-specific live birth rates, aged 10 14, and 18 19, Ontario, Figure 7 Proportion (%) of to aged 10 14, and 18 19, Ontario, Table 6-A Age-specific live birth rates, aged 10 14, Ontario and the rest of Canada, Table 6-B Age-specific live birth rates, aged 15 17, Ontario and the rest of Canada, Table 6-C Age-specific live birth rates, aged 18 19, Ontario and the rest of Canada, Table 7-A Proportion (%) of to aged 10 14, Ontario and the rest of Canada, Table 7-B Proportion (%) of to aged 15 17, Ontario and the rest of Canada, Perinatal Health Indicators for Ontario

4 Table 7-C Proportion (%) of to aged 18 19, Ontario and the rest of Canada, Figure 8 Age-specific live birth rates, aged 35 39, and 45 49, Ontario, Figure 9 Proportion (%) of to aged 35 39, and 45 49, Ontario, Table 8-A Age-specific live birth rates, aged 35 39, Ontario and the rest of Canada, Table 8-B Age-specific live birth rates, aged 40 44, Ontario and the rest of Canada, Table 8-C Age-specific live birth rates, aged 45 49, Ontario and the rest of Canada, Table 9-A Proportion (%) of to aged 35 39, Ontario and the rest of Canada, Table 9-B Proportion (%) of to aged 40 44, Ontario and the rest of Canada, Table 9-C Proportion (%) of to aged 45 49, Ontario and the rest of Canada, Figure 10 Rate of multiple birth, Ontario, Table 10 Rate of multiple birth, Ontario and the rest of Canada, Perinatal Health Indicators for Ontario

5 INTRODUCTION In May 2012, the Canadian Perinatal Surveillance System (CPSS) of the Public Health Agency of Canada released a new national perinatal health report 1 to update data for 14 perinatal indicators most recently reported in the Canadian Perinatal Health Report, 2008 Edition. 2 Of these 14 indicators, nine were calculated using data from the Canadian Vital Statistics System, comprising, still and infant death registration files. These vital event files are available in both unlinked and linked formats, the latter of which is primarily used for reporting infant mortality and studying the relationship between infant death and risk factors extant at birth. Linkage of provincial birth and infant death registrations into a national linked file is conducted annually by Statistics Canada under the auspices of the CPSS, and has been successful in all provinces and territories of Canada except Ontario, the result of which has been its exclusion from all vital statisticsbased perinatal indicators in reports and publications produced by the CPSS. 2,3 The most recent CPSS report 1 is no exception all nine perinatal indicators calculated using vital statistics data excluded the province of Ontario due to a history of data quality issues with respect to live birth registrations. Among other concerns, the incomplete registration of for infants who die within the first year after birth is of particular concern for accurate computation of many perinatal health statistics. For instance, in a 2003 national live birth infant death linkage, 42.3% of infant death registrations in Ontario could not be linked to a live birth registration, compared with only 1.1% in the rest of Canada. 3 Unlike all previous national perinatal health surveillance reports produced by CPSS, the current CPSS report did not provide estimates for Ontario in a supplementary appendix; thus, Ontario was only included in five of 14 indicators in this national report, despite comprising close to 40% of all in Canada. 4 Since the Canadian Perinatal Health Report, 2008 Edition was released by CPSS, 2 the province of Ontario has made great strides in developing an alternative data source for timely and accurate maternal-newborn information. The intent of this supplementary report is thus to act as a companion to the Perinatal Health Indicators for Canada 2011 report, providing estimates for the province of Ontario that can be interpreted alongside the estimates presented in the recent CPSS report. 1 Only those perinatal indicators that were excluded from the CPSS report are presented herein, and all indicators have been computed using data from the BORN (Better Outcomes Registry & Network) Information System. About the Better Outcomes Registry & Network Ontario (BORN Ontario) BORN is Ontario s pregnancy, birth and childhood registry and network. Established in 2009 to collect, share and rigorously protect critical data about each child born in the province, BORN Ontario manages an advanced database that provides reliable, secure and comprehensive information on maternal and child health. BORN Ontario is funded by the Ontario Ministry of Health and Long-Term Care, operates under the auspices of the Children s Hospital of Eastern Ontario, and is recognized as a registry of personal health Perinatal Health Indicators for Ontario

6 information under the Ontario Personal Health Information Protection Act (PHIPA). With a vision of providing the knowledge needed for The best possible beginnings for lifelong health, the mission of BORN is to: Facilitate and improve care for, children and youth by linking information and providers to address care gaps spanning the spectrum from normal to high acuity and rare conditions Be an authoritative source of accurate, trusted and timely information to monitor, evaluate and plan for the best possible beginnings for life-long health Provide scientific and technical leadership for Ontario s maternal, child and youth health system through the support of research and innovation Mobilize information and expertise to optimize care and contribute to a high-performing healthcare system, improving the lives of individual and children For further information about BORN Ontario, including how to access BORN data or previous BORN reports, visit: Perinatal Health Indicators for Ontario

7 Methods Source of data This report was prepared using birth record data from the BORN Information System (BIS) (formerly known as the BORN Ontario Niday Perinatal Database). Information for all hospital ( and still) at 20 weeks gestational age among Ontario residents was included in this report. For the time period encompassed by this report, there was no data collection for pregnancies that ended in miscarriage before 20 weeks gestation or terminations of pregnancy for fetal anomalies at any gestational age. The BIS is a web-based system into which data on and babies are directly entered either by care providers or data entry clerks, or extracted and uploaded by a hospital s electronic patient record. This birth record database was first operational in Eastern and Southeastern Ontario in 1997 and expanded province-wide in more recent. As of November 2009, all hospitals in the province with a maternalnewborn program were contributing birth data. BORN Ontario recently compared the hospital captured in the BIS with those in the Canadian Institute for Health Information Discharge Abstract Database (CIHI DAD) for the time period reflected in this report. Table 1 below shows the hospital recorded by the BIS, expressed as a percentage of the total hospital captured in the CIHI DAD over five fiscal. Although the capture of Ontario hospital in the BIS was high in each year, it is important to consider the expansion of data collection activities in relation to the graphs that present 5-year trends in this report, since a change in a rate over time may be due to an improvement in data capture rather than a true temporal trend. COMPARISON OF THE NUMBER OF HOSPITAL LIVE BIRTHS RECORDED IN THE BORN INFORMATION SYSTEM (BIS) AND THE CANADIAN INSTITUTE FOR HEALTH INFORMATION DISCHARGE ABSTRACT DATABASE (CIHI DAD) Fiscal year Ontario hospital BIS* 118, , , , ,002 CIHI DAD* 136, , , , ,430 % captured by BORN *Hospital at 20 weeks gestation to Ontario residents. Live birth records with missing gestational age information were excluded. Perinatal Health Indicators for Ontario

8 Reported indicators Table 2 lists the 14 indicators presented in the CPSS report, 1 along with the data source used to calculate each indicator and whether or not Ontario was included in the calculation. Only the perinatal indicators that were excluded from the CPSS report are presented in this report with the exception of the infant mortality rate, for which no reliable source of data currently exists in Ontario. Where possible, perinatal indicators in this report are consistent with the definitions used in the CPSS report. 1 Definitions for each indicator, along with any applicable notes, are provided beneath each figure and table, and a brief interpretation of the data is provided. Additional contextual and clinical information about each indicator can be obtained from other reports. 1,2,5,6 LIST OF PERINATAL INDICATORS INCLUDED IN CPSS REPORT 1 Perinatal health indicator Data source used for rate calculation Ontario included Fetal Mortality Rate Canadian Vital Statistics System No Infant Mortality Rate Canadian Vital Statistics System No Small-for-Gestational-Age (SGA) Rate Canadian Vital Statistics System No Large-for-Gestational-Age (LGA) Rate Canadian Vital Statistics System No Preterm Birth Rate Canadian Vital Statistics System No Postterm Birth Rate Canadian Vital Statistics System No Maternal Mortality Rate Discharge Abstract Database Yes Rate of Live Births to Teenage Mothers Canadian Vital Statistics System No Rate of Live Births to Older Mothers Canadian Vital Statistics System No Birth Prevalence of Congenital Anomalies Canadian Congenital Anomalies Surveillance System Yes Severe Maternal Morbidity Rate Discharge Abstract Database Yes Rate of Cesarean Delivery Discharge Abstract Database Yes Rate of Breastfeeding Canadian Community Health Survey Yes Multiple Birth Rate Canadian Vital Statistics System No Data analysis A 5-year dataset was extracted from the BIS in June 2012, encompassing the calendar 2006 to Only hospital residents of Ontario were included in the dataset (records in the BIS for home and Ontario hospital for women from other Canadian provinces/territories or from other countries were excluded). Hospital attended by midwives are included in these analyses. This report presents descriptive statistics, predominantly proportions. Each indicator is first presented over the five calendar ( ) for Ontario, following which Ontario is compared to estimates for the rest of Canada (i.e., Canada, excluding Ontario) for the three calendar year period ( ), using the published data from the CPSS report. 1 In order to quantify the precision of the point estimates (i.e., proportions), exact binomial 95% confidence intervals (CI) were calculated for all estimates using SAS Enterprise Guide 4.3 (SAS Institute Inc, Cary, NC). No statistical tests were conducted on these data; therefore, differences in estimates over time or between Ontario and the rest of Canada are not necessarily statistically significant and should be interpreted cautiously. Records that were missing information for a particular indicator were excluded from analyses of that indicator. The proportion of records with missing information did not exceed 0.1% for any of the reported indicators. Perinatal Health Indicators for Ontario

9 FETAL MORTALITY RATE Ontario: The crude rate of fetal mortality remained stable between 2006 and 2010 (5.6 per 1,000 total, : in 2006, and 5.5 per 1,000 total, : , in 2010; Figure 1). Similarly, the rate of fetal mortality 500 grams was stable across the five calendar, from 3.9 per 1,000 total (: ) in 2006 to 3.8 per 1,000 (: ) in Little variability was observed for fetal mortality rates 1,000 grams or 28 weeks gestation in 2010, the rate was 3.2 per 1,000 total 1,000 grams or 28 weeks gestation (: ) (Figure 1). FIGURE 1 Rate of fetal mortality Ontario, Data source BORN Information System, The fetal deaths (still) per 1,000 total ( and still) (in a given place and time). The fetal mortality rate is presented using three different calculations: (i) crude calculation, which includes all ; (ii) 500 grams (g); and (iii) 1,000 g or 28 weeks gestation. Two individual hospital sites have been excluded from these calculations due to incomplete collection of stillbirth records in This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario

10 Comparison to the rest of Canada: Between 2006 and 2008, the crude fetal mortality rate in Ontario fluctuated slightly, going from 5.6 per 1,000 (: ) in 2006 to 5.3 per 1,000 (: ) in 2007 and to 5.5 per 1,000 (: ) in In the rest of Canada, there was a small increase from 6.0 (: ) in 2006 to 6.6 (: ) per 1,000 total in (Table 1-A). Similarly, the rate of fetal mortality 500 grams was slightly lower in Ontario than in the rest of Canada for example, in 2008, the rate of fetal mortality 500 grams was 3.6 per 1,000 total (: ) in Ontario and 4.6 per 1,000 total (: ) in the rest of Canada (Table 1-B). Rates of fetal mortality 1,000 grams or 28 weeks gestation were approximately the same in Ontario as in the rest of Canada and were stable between 2006 and 2008 (Table 1-C). TABLE 1-A Crude rate of fetal mortality Ontario and the rest of Canada, of of fetal deaths Deaths per 1,000 total of of fetal deaths Deaths per 1,000 total , ,338 1, , ,920 1, , ,679 1, , Estimates not available , Estimates not available The fetal deaths (still) per 1,000 total ( and still) (in a given place and time). Two individual hospital sites have been excluded from these calculations due to incomplete collection of stillbirth records in This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario

11 TABLE 1-B Rate of fetal mortality 500 grams (g) Ontario and the rest of Canada, of 500 g of fetal deaths 500 g Deaths per 1,000 total 500 g of 500 g of fetal deaths 500 g Deaths per 1,000 total 500 g , , , ,238 1, , ,907 1, , Estimates not available , Estimates not available The fetal deaths (still) 500 grams (g) per 1,000 total ( and still) 500 g (in a given place and time). Two individual hospital sites have been excluded from these calculations due to incomplete collection of stillbirth records in This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario

12 TABLE 1-C Rate of fetal mortality 1,000 grams (g) or 28 weeks gestation Ontario and the rest of Canada, of 1,000 g or 28 weeks of fetal deaths 1,000 g or 28 weeks Deaths per 1,000 total 1,000 g or 28 weeks of 1,000 g or 28 weeks of fetal deaths 1,000 g or 28 weeks Deaths per 1,000 total 1,000 g or 28 weeks , , , , , , , Estimates not available , Estimates not available The fetal deaths (still) 1,000 grams (g) or 28 weeks gestation per 1,000 total ( and still) 1,000 g or 28 weeks gestation (in a given place and time). Two individual hospital sites have been excluded from these calculations due to incomplete collection of stillbirth records in This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario

13 INFANT MORTALITY RATE The infant mortality rate (IMR) is a key indicator of population health and is defined as the infants who die during the first year after birth, per thousand. In Ontario, there is a recognized problem with live birth registration 3 that prevents calculation of birth weight-specific infant mortality rates. While BORN Ontario currently captures all as well as infant deaths that occur close to the time of birth, we are missing infant deaths occurring in NICUs and later in the first year. BORN Ontario is pursuing several strategies to capture these missing data including: (i) improving ascertainment of NICU data, (ii) partnering with the Provincial Council for Maternal-Child Health (PCMCH) to recommend that all are registered before the mother is discharged from hospital after giving birth, and (iii) partnering with ServiceOntario to undertake annual database linkage of in the BIS with infant death registrations from ServiceOntario. Perinatal Health Indicators for Ontario

14 SMALL-FOR-GESTATIONAL-AGE RATE Ontario: The rate of small for gestational age (SGA) based on the 10 th percentile of the sex-specific birth weight distribution for gestational age 7 was very stable between 2006 and In 2010, 9.4% of singleton in Ontario (: ) were below the 10 th percentile of birth weight for gestational age (Figure 2). FIGURE 2 Rate of small for gestational age (SGA) Ontario, Data source BORN Information System, The singleton with a birth weight below the 10 th percentile of the sex-specific birth weight distribution for gestational age 7 expressed as a percentage of the total singleton (in a given place and time). Perinatal Health Indicators for Ontario

15 Comparison to the rest of Canada: Between 2006 and 2008, the rates of SGA decreased modestly in both Ontario (from 9.2 to 8.8 per 100 singleton ) and in the rest of Canada (from 8.2 to 7.8 per 100 singleton ) 1 (Table 2). In each of the three calendar, the rate of SGA was approximately one percent higher in Ontario than the rate in the rest of Canada. TABLE 2 Rate of small for gestational age (SGA) Ontario and the rest of Canada, singleton of SGA singleton live SGA live per 100 singleton singleton of SGA singleton live SGA live per 100 singleton ,428 10, ,923 17, ,778 11, ,145 18, ,617 11, ,675 17, ,647 11, Estimates not available ,593 12, Estimates not available The singleton with a birth weight below the 10 th percentile of the sex-specific birth weight distribution for gestational age 7 expressed as a percentage of the total singleton (in a given place and time). Perinatal Health Indicators for Ontario

16 LARGE-FOR-GESTATIONAL-AGE RATE Ontario: There was little variation in the rate of large for gestational age (LGA) based on the 90 th percentile of the sex-specific birth weight distribution for gestational age 7 between 2006 and 2010 in Ontario. In 2010, the rate of LGA was 10.0 per 100 singleton (: ) (Figure 3). FIGURE 3 Rate of large for gestational age (LGA) Ontario, Data source BORN Information System, The singleton with a birth weight above the 90 th percentile of the sex-specific birth weight distribution for gestational age 7 expressed as a percentage of the total singleton (in a given place and time). Perinatal Health Indicators for Ontario

17 Comparison to the rest of Canada: Between 2006 and 2008, the rates of LGA in Ontario and in the rest of Canada were very similar (Table 3). TABLE 3 Rate of large for gestational age (LGA) Ontario and the rest of Canada, singleton of LGA singleton live LGA live per 100 singleton singleton of LGA singleton live LGA live per 100 singleton ,428 12, ,923 23, ,778 13, ,145 24, ,617 14, ,675 25, ,647 13, Estimates not available ,593 13, Estimates not available The singleton with a birth weight above the 90 th percentile of the sex-specific birth weight distribution for gestational age 7 expressed as a percentage of the total singleton (in a given place and time). Perinatal Health Indicators for Ontario

18 PRETERM BIRTH RATE Ontario: There was a small absolute decrease in the overall rate of preterm birth (<37 weeks) between 2006 and 2010 from 8.4 per 100 (: ) to 7.9 per 100 (: ) (Figure 4).The component rates of preterm birth at 32 to 36 weeks gestation and very preterm birth (<32 weeks) remained mostly stable during the same time period. FIGURE 4 Rate of preterm birth Ontario, Data source BORN Information System, The with a gestational age of <37 completed weeks, expressed as a percentage of the total (in a given place and time). The preterm birth rate is presented using three different gestational age cut-offs: (i) <37 weeks, (ii) weeks; and (iii) <32 weeks. Perinatal Health Indicators for Ontario

19 Comparison to the rest of Canada: Between 2006 and 2008, rates of preterm birth <37 weeks gestation and preterm birth at weeks gestation in Ontario were marginally higher than the rates in the rest of Canada (Tables 4-A and 4-B), while rates of very preterm birth (<32 weeks) were similar (Table 4-C). TABLE 4-A Rate of preterm birth <37 weeks gestation Ontario and the rest of Canada, of preterm <37 weeks Preterm birth <37 weeks per 100 live of preterm <37 weeks Preterm birth <37 weeks per 100 live ,788 10, ,840 17, ,442 10, ,291 17, ,470 11, ,005 18, ,832 11, Estimates not available ,770 10, Estimates not available The with a gestational age of <37 completed weeks, expressed as a percentage of the total (in a given place and time). Perinatal Health Indicators for Ontario

20 TABLE 4-B Rate of preterm birth weeks gestation Ontario and the rest of Canada, of preterm weeks Preterm birth weeks per 100 of preterm weeks Preterm birth weeks per ,788 8, ,840 15, ,442 9, ,291 15, ,470 9, ,005 16, ,832 9, Estimates not available ,770 9, Estimates not available The with a gestational age of completed weeks, expressed as a percentage of the total (in a given place and time). Perinatal Health Indicators for Ontario

21 TABLE 4-C Rate of preterm birth <32 weeks gestation Ontario and the rest of Canada, preterm <32 weeks Preterm birth <32 weeks per 100 live preterm <32 weeks Preterm birth <32 weeks per 100 live ,788 1, ,840 2, ,442 1, ,291 2, ,470 1, ,005 2, ,832 1, Estimates not available ,770 1, Estimates not available The with a gestational age of <32 completed weeks, expressed as a percentage of the total (in a given place and time). Perinatal Health Indicators for Ontario

22 POSTTERM BIRTH RATE Ontario: The rate of postterm birth ( 42 weeks) in Ontario was approximately 0.3 per 100 and did not show any meaningful trend between 2006 and FIGURE 5 Rate of postterm birth Ontario, Data source BORN Information System, The with a gestational age of 42 completed weeks, expressed as a percentage of the total (in a given place and time). Perinatal Health Indicators for Ontario

23 Comparison to the rest of Canada: Between 2006 and 2008, the rates of postterm birth in the rest of Canada (0.6 to 0.7 per 100 ) 1 were about twice as high as the rates in Ontario (approximately 0.3 per 100 ) (Table 5); however, since the rates of postterm birth are so low, the absolute differences in these rates are not likely to be clinically meaningful. TABLE 5 Rate of postterm birth Ontario and the rest of Canada, of postterm ( 42 weeks) Postterm birth per 100 live of postterm ( 42 weeks) Postterm birth per 100 live , ,840 1, , ,291 1, , ,005 1, , Estimates not available , Estimates not available The with a gestational age of 42 completed weeks, expressed as a percentage of the total (in a given place and time). Perinatal Health Indicators for Ontario

24 LIVE BIRTHS TO TEENAGE MOTHERS Ontario: The age-specific rate birth to aged increased between 2006 and 2008 (from 17.6 per 1,000 to 20.1 per 1,000, respectively), before decreasing to 18.5 per 1,000 by The rate birth to aged showed a small increase between 2006 and 2007, following which the rate remained stable (5.7 per 1,000 in 2010). The age-specific rate birth to aged was very low and remained fairly stable at approximately 0.1 per 1,000 (Figure 6). The proportion of to <20 in Ontario was fairly stable between 2006 and 2010 with 3.5% (: ) of to under 20 of age at the time of delivery. Of these, the majority of were to of age (Figure 7). FIGURE 6 Age-specific live birth rates, aged 10 14, and Ontario, Data sources BORN Information System, Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 10 14, and 18 19, expressed per 1,000 in the same age category (in a given place and time). Perinatal Health Indicators for Ontario

25 FIGURE 7 Proportion (%) of to aged 10 14, and Ontario, Data source BORN Information System, Note The to aged 10 14, 15 17and 18 19, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

26 Comparison to the rest of Canada: Between 2006 and 2008, the age-specific rates birth per 1,000 aged were consistently lower in Ontario compared with the rest of Canada. For instance, in 2008, the rate was 6.2 per 1,000 (: ) aged in Ontario and 8.7 per 1,000 (: ) in the rest of Canada. Additionally, there was a small absolute rise in the rate in both Ontario and the rest of Canada over the three-year period. Tables 6-A through 6- C present the age-specific live birth rates for aged 10 14, and 18 19, respectively. Similarly, the proportion of to aged was consistently about one percentage point lower in Ontario compared with the rest of Canada between 2006 and In 2008, 3.7% (: ) and 4.6% (: ) of in Ontario and the rest of Canada, respectively, were to under the age of 20. Tables 7-A through 7-C present the proportion of to aged 10 14, and 18 19, respectively. TABLE 6-A Age-specific live birth rates, aged Ontario and the rest of Canada, of per 1, of per 1, , , , , , , , Estimates not available , Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 10 14, expressed per 1,000 in the same age category (in a given place and time). Note The in each age category for Ontario and for the rest of Canada (i.e., Canada, excluding Ontario) were obtained from CANSIM Table The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario

27 TABLE 6-B of Age-specific live birth rates, aged Ontario and the rest of Canada, per 1, of per 1, ,415 1, ,419 2, ,369 1, ,612 3, ,863 1, ,199 3, ,684 1, Estimates not available ,169 1, Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 15 17, expressed per 1,000 in the same age category (in a given place and time). Note The in each age category for Ontario and for the rest of Canada (i.e., Canada, excluding Ontario) were obtained from CANSIM Table The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario

28 TABLE 6-C of Age-specific live birth rates, aged Ontario and the rest of Canada, per 1, of per 1, ,009 2, ,073 7, ,701 3, ,927 7, ,018 3, ,686 7, ,766 3, Estimates not available ,284 3, Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 18 19, expressed per 1,000 in the same age category (in a given place and time). Note The in each age category for Ontario and for the rest of Canada (i.e., Canada, excluding Ontario) were obtained from CANSIM Table The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario

29 TABLE 7-A to <50 Proportion (%) of to aged Ontario and the rest of Canada, to per 100 to < to per , , , , , , , Estimates not available , Estimates not available Note The to aged 10 14, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

30 TABLE 7-B to <50 Proportion (%) of to aged Ontario and the rest of Canada, to per 100 to < to per ,474 1, ,993 2, ,119 1, ,401 3, ,759 1, ,049 3, ,928 1, Estimates not available ,146 1, Estimates not available Note The to aged 15 17, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

31 TABLE 7-C to <50 Proportion (%) of to aged Ontario and the rest of Canada, to per 100 to < to per ,474 2, ,993 7, ,119 3, ,401 7, ,759 3, ,049 7, ,928 3, Estimates not available ,146 3, Estimates not available Note The to aged 18 19, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

32 LIVE BIRTHS TO OLDER MOTHERS Ontario: The age-specific rate birth to aged increased in Ontario between 2006 (45.4 per 1,000, : ) and 2010 (53.5 per 1,000, : ). The rate birth to aged showed a more modest absolute increase between 2006 and 2010, from 7.8 (: ) to 10.6 (: ) per 1,000 aged The age-specific rate birth to aged was very low over the same time period, but also increased (Figure 8). The proportion of to aged in Ontario increased modestly between 2006 and 2010 from 21.0% (: ) to 22.0% (: ). Of these, the majority were to of age (Figure 9). FIGURE 8 Age-specific live birth rates, aged 35 39, and Ontario, Data sources BORN Information System, Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 35 39, and 45 49, expressed per 1,000 in the same age category (in a given place and time). Perinatal Health Indicators for Ontario

33 FIGURE 9 Proportion (%) of to aged 35 39, and Ontario, Data source BORN Information System, Note The to aged 35 39, and 45 49, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

34 Comparison to the rest of Canada: Between 2006 and 2008, the age-specific rates birth per 1,000 aged were consistently higher in Ontario compared with the rest of Canada. For instance, in 2008, the rate was 19.3 per 1,000 (: ) aged in Ontario and 17.0 per 1,000 (: ) in the rest of Canada. There was also a small increase in the age-specific rate birth per 1,000 aged in both Ontario and the rest of Canada over the three-year period. Tables 8-A through 8-C present the age-specific live birth rates for aged 35 39, and 45 49, respectively. Similarly, the proportions of to aged were consistently higher in Ontario compared with the rest of Canada between 2006 and In 2008, 21.2% (: ) and 16.3% (: ) of in Ontario and the rest of Canada, respectively, were to Tables 9-A through 9-C present the proportions of to aged 35 39, and 45 49, respectively. TABLE 8-A Age-specific live birth rates, aged Ontario and the rest of Canada, of per 1, of per 1, ,055 21, ,674 29, ,775 23, ,074 30, ,284 24, ,871 32, ,832 24, Estimates not available ,069 24, Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 35 39, expressed per 1,000 in the same age category (in a given place and time). Note The in each age category for Ontario and for the rest of Canada (i.e., Canada, excluding Ontario) were obtained from CANSIM Table The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario

35 TABLE 8-B of Age-specific live birth rates, aged Ontario and the rest of Canada, per 1, of per 1, ,008 4, ,331 5, ,934 4, ,378 5, ,300 4, ,470 5, ,927 4, Estimates not available ,310 5, Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 40 44, expressed per 1,000 in the same age category (in a given place and time). Note The in each age category for Ontario and for the rest of Canada (i.e., Canada, excluding Ontario) were obtained from CANSIM Table The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario

36 TABLE 8-C Age-specific live birth rates, aged Ontario and the rest of Canada, of per 1, of per 1, , , , , , , , Estimates not available , Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table Estimates of population, by age group and sex for July 1, Canada, provinces and territories, The to aged 45 49, expressed per 1,000 in the same age category (in a given place and time). Note The in each age category for Ontario and for the rest of Canada (i.e., Canada, excluding Ontario) were obtained from CANSIM Table The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario

37 TABLE 9-A to <50 Proportion (%) of to aged Ontario and the rest of Canada, to per 100 to < to per ,474 21, ,993 29, ,119 23, ,401 30, ,759 24, ,049 32, ,928 24, Estimates not available ,146 24, Estimates not available Note The to aged 35 39, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

38 TABLE 9-B to <50 Proportion (%) of to aged Ontario and the rest of Canada, to per 100 to < to per ,474 4, ,993 5, ,119 4, ,401 5, ,759 4, ,049 5, ,928 4, Estimates not available ,146 5, Estimates not available Note The to aged 40 44, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

39 TABLE 9-C to <50 Proportion (%) of to aged Ontario and the rest of Canada, to per 100 to < to per , , , , , , , Estimates not available , Estimates not available Note The to aged 45 49, expressed as a percentage of the total (in a given place and time). Live 50 of age are excluded from the denominator used for the calculation. Perinatal Health Indicators for Ontario

40 MULTIPLE BIRTH RATE Ontario: The multiple birth rate was stable between 2006 and 2010 in the latter time period, the rate was 3.6 per 100 total (: ), corresponding to 5,018 infants ( and still) born following a multiple gestation pregnancy (Figure 10). FIGURE 10 Rate of multiple birth Ontario, Data source BORN Information System, The and still following a multiple gestation pregnancy, expressed as a percentage of the total and still (in a given place and time). Perinatal Health Indicators for Ontario

41 Comparison to the rest of Canada: Between 2006 and 2008, the rates of multiple birth were slightly higher in Ontario compared with the rest of Canada; however, the rates were stable over the time period for both. In 2008, the rate of multiple birth was 3.4 per 100 total (: ) in Ontario and 3.0 per 100 total (: ) in the rest of Canada (Table 10). TABLE 10 Rate of multiple birth Ontario and the rest of Canada, of of multiple Multiple birth per 100 total of multiple Multiple birth per 100 total ,210 4, ,338 6, ,872 4, ,920 7, ,561 4, ,679 7, ,723 5, Estimates not available ,903 5, Estimates not available The and still following a multiple gestation pregnancy, expressed as a percentage of the total and still (in a given place and time). Perinatal Health Indicators for Ontario

42 REFERENCES 1. Public Health Agency of Canada. Perinatal Health Indicators for Canada Ottawa, Public Health Agency of Canada. Canadian Perinatal Health Report Edition. Ottawa: Public Health Agency of Canada; Joseph KS. Overview. In: Canadian Perinatal Health Report, 2008 Edition. Ottawa: Public Health Agency of Canada; Statistics Canada. Births Table 1. Catalogue no. 84F0210X. Available at: Accessed: August 5, BORN Ontario. Perinatal Health Reports August Available at: Accessed: January 5, BORN Ontario. Perinatal Health Reports May Available at: Accessed: January 5, Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, et al. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001; 108 (2): e35. Perinatal Health Indicators for Ontario

43 BORN Ontario CHEO RI, CPCR, 401 Smyth Road O awa, ON K1H 8L1 T: x 6022 F: info@bornontario.ca