Perinatal Health Indicators for Ontario 2012
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 2012. Ottawa ON, 2012. Perinatal Health Indicators for Ontario 2012 1
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... 31 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, 2006 2010. 8 Table 1-A Crude rate of fetal mortality, Ontario and the rest of Canada, 2006 2010... 9 Table 1-B Rate of fetal mortality 500 grams (g), Ontario and the rest of Canada, 2006 2010 10 Table 1-C Rate of fetal mortality 1,000 grams (g) or 28 weeks gestation, Ontario and the rest of Canada, 2006 2010.. 11 Figure 2 Rate of small for gestational age (SGA), Ontario, 2006 2010. 13 Table 2 Rate of small for gestational age (SGA), Ontario and the rest of Canada, 2006 2010 14 Figure 3 Rate of large for gestational age (LGA), Ontario, 2006 2010. 15 Table 3 Rate of large for gestational age (LGA), Ontario and the rest of Canada, 2006 2010. 16 Figure 4 Rate of preterm birth, Ontario, 2006 2010.. 17 Table 4-A Rate of preterm birth <37 weeks gestation, Ontario and the rest of Canada, 2006 2010 18 Table 4-B Rate of preterm birth 32 36 weeks gestation, Ontario and the rest of Canada, 2006 2010.. 19 Table 4-C Rate of preterm birth <32 weeks gestation, Ontario and the rest of Canada, 2006 2010.. 20 Figure 5 Rate of postterm birth, Ontario, 2006 2010. 21 Table 5 Rate of postterm birth, Ontario and the rest of Canada, 2006 2010. 22 Figure 6 Age-specific live birth rates, aged 10 14, 15 17 and 18 19, Ontario, 2006 2010.... 23 Figure 7 Proportion (%) of to aged 10 14, 15 17 and 18 19, Ontario, 2006 2010.... 24 Table 6-A Age-specific live birth rates, aged 10 14, Ontario and the rest of Canada, 2006 2010.... 25 Table 6-B Age-specific live birth rates, aged 15 17, Ontario and the rest of Canada, 2006 2010. 26 Table 6-C Age-specific live birth rates, aged 18 19, Ontario and the rest of Canada, 2006 2010. 27 Table 7-A Proportion (%) of to aged 10 14, Ontario and the rest of Canada, 2006 2010.. 28 Table 7-B Proportion (%) of to aged 15 17, Ontario and the rest of Canada, 2006 2010.. 29 Perinatal Health Indicators for Ontario 2012 2
Table 7-C Proportion (%) of to aged 18 19, Ontario and the rest of Canada, 2006 2010.. 30 Figure 8 Age-specific live birth rates, aged 35 39, 40 44 and 45 49, Ontario, 2006 2010.. 31 Figure 9 Proportion (%) of to aged 35 39, 40 44 and 45 49, Ontario, 2006 2010. 32 Table 8-A Age-specific live birth rates, aged 35 39, Ontario and the rest of Canada, 2006 2010.... 33 Table 8-B Age-specific live birth rates, aged 40 44, Ontario and the rest of Canada, 2006 2010. 34 Table 8-C Age-specific live birth rates, aged 45 49, Ontario and the rest of Canada, 2006 2010. 35 Table 9-A Proportion (%) of to aged 35 39, Ontario and the rest of Canada, 2006 2010.. 36 Table 9-B Proportion (%) of to aged 40 44, Ontario and the rest of Canada, 2006 2010.. 37 Table 9-C Proportion (%) of to aged 45 49, Ontario and the rest of Canada, 2006 2010.. 38 Figure 10 Rate of multiple birth, Ontario, 2006 2010.. 39 Table 10 Rate of multiple birth, Ontario and the rest of Canada, 2006 2010 40 Perinatal Health Indicators for Ontario 2012 3
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 2012 4
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: www.bornontario.ca. Perinatal Health Indicators for Ontario 2012 5
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 2005 2006 2006 2007 2007 2008 2008 2009 2009 2010 BIS* 118,252 123,934 134,690 137,917 138,002 CIHI DAD* 136,752 138,679 141,653 140,328 140,430 % captured by BORN 86.5 89.4 95.1 98.3 98.3 *Hospital at 20 weeks gestation to Ontario residents. Live birth records with missing gestational age information were excluded. Perinatal Health Indicators for Ontario 2012 6
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 2010. 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 (2006 2010) 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 (2006 2008), 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 2012 7
FETAL MORTALITY RATE Ontario: The crude rate of fetal mortality remained stable between 2006 and 2010 (5.6 per 1,000 total, : 5.2 6.0 in 2006, and 5.5 per 1,000 total, : 5.1 5.9, 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 (: 3.5 4.2) in 2006 to 3.8 per 1,000 (: 3.4 4.1) in 2010. 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 (: 2.9 3.5) (Figure 1). FIGURE 1 Rate of fetal mortality Ontario, 2006 2010 Data source BORN Information System, 2006 2010 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 2010. This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario 2012 8
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 (: 5.2 6.0) in 2006 to 5.3 per 1,000 (: 4.9 5.7) in 2007 and to 5.5 per 1,000 (: 5.1 5.9) in 2008. In the rest of Canada, there was a small increase from 6.0 (: 5.7 6.3) in 2006 to 6.6 (: 6.3 7.0) per 1,000 total in 2008 1 (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 (: 3.3 4.0) in Ontario and 4.6 per 1,000 total (: 4.3 4.9) 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, 2006 2010 of of fetal deaths Deaths per 1,000 total of of fetal deaths Deaths per 1,000 total 2006 115,914 647 5.6 5.2 6.0 220,338 1,322 6.0 5.7 6.3 2007 125,309 664 5.3 4.9 5.7 230,920 1,493 6.5 6.1 6.8 2008 130,798 716 5.5 5.1 5.9 238,679 1,585 6.6 6.3 7.0 2009 130,992 714 5.5 5.1 5.9 Estimates not available 2010 130,221 713 5.5 5.1 5.9 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 2010. This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario 2012 9
TABLE 1-B Rate of fetal mortality 500 grams (g) Ontario and the rest of Canada, 2006 2010 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 2006 115,518 445 3.9 3.5 4.2 219,686 948 4.3 4.0 4.6 2007 124,905 460 3.7 3.4 4.0 230,238 1,073 4.7 4.4 4.9 2008 130,358 474 3.6 3.3 4.0 237,907 1,096 4.6 4.3 4.9 2009 130,573 480 3.7 3.4 4.0 Estimates not available 2010 129,760 488 3.8 3.4 4.1 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 2010. This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario 2012 10
TABLE 1-C Rate of fetal mortality 1,000 grams (g) or 28 weeks gestation Ontario and the rest of Canada, 2006 2010 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 2006 115,185 372 3.2 2.9 3.6 218,762 670 3.1 2.8 3.3 2007 124,534 394 3.2 2.9 3.5 229,177 713 3.1 2.9 3.3 2008 129,980 403 3.1 2.8 3.4 236,875 734 3.1 2.9 3.3 2009 130,197 400 3.1 2.8 3.4 Estimates not available 2010 129,444 413 3.2 2.9 3.5 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 2010. This exclusion comprises approximately 5% to 6% of the total Ontario. Perinatal Health Indicators for Ontario 2012 11
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 2012 12
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 2010. In 2010, 9.4% of singleton in Ontario (: 9.2 9.6) were below the 10 th percentile of birth weight for gestational age (Figure 2). FIGURE 2 Rate of small for gestational age (SGA) Ontario, 2006 2010 Data source BORN Information System, 2006 2010 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 2012 13
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, 2006 2010 singleton of SGA singleton live SGA live per 100 singleton singleton of SGA singleton live SGA live per 100 singleton 2006 117,428 10,751 9.2 9.0 9.3 211,923 17,394 8.2 8.1 8.3 2007 126,778 11,528 9.0 8.9 9.3 222,145 18,080 8.1 8.0 8.3 2008 132,617 11,703 8.8 8.7 9.0 229,675 17,869 7.8 7.7 7.9 2009 132,647 11,872 9.0 8.8 9.1 Estimates not available 2010 131,593 12,357 9.4 9.2 9.6 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 2012 14
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 (: 9.8 10.1) (Figure 3). FIGURE 3 Rate of large for gestational age (LGA) Ontario, 2006 2010 Data source BORN Information System, 2006 2010 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 2012 15
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, 2006 2010 singleton of LGA singleton live LGA live per 100 singleton singleton of LGA singleton live LGA live per 100 singleton 2006 117,428 12,358 10.5 10.4 10.7 211,923 23,166 10.9 10.8 11.1 2007 126,778 13,294 10.5 10.3 10.7 222,145 24,102 10.8 10.7 11.0 2008 132,617 14,625 11.0 10.9 11.2 229,675 25,557 11.1 11.0 11.3 2009 132,647 13,665 10.3 10.1 10.5 Estimates not available 2010 131,593 13,097 10.0 9.8 10.1 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 2012 16
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 (: 8.2 8.5) to 7.9 per 100 (: 7.8 8.1) (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, 2006 2010 Data source BORN Information System, 2006 2010 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) 32 36 weeks; and (iii) <32 weeks. Perinatal Health Indicators for Ontario 2012 17
Comparison to the rest of Canada: Between 2006 and 2008, rates of preterm birth <37 weeks gestation and preterm birth at 32 36 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, 2006 2010 of preterm <37 weeks Preterm birth <37 weeks per 100 live of preterm <37 weeks Preterm birth <37 weeks per 100 live 2006 121,788 10,183 8.4 8.2 8.5 218,840 17,560 8.0 7.9 8.1 2007 131,442 10,886 8.3 8.1 8.4 229,291 17,604 7.7 7.6 7.8 2008 137,470 11,393 8.3 8.1 8.4 237,005 18,752 7.9 7.8 8.0 2009 137,832 11,238 8.1 8.0 8.3 Estimates not available 2010 136,770 10,856 7.9 7.8 8.1 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 2012 18
TABLE 4-B Rate of preterm birth 32 36 weeks gestation Ontario and the rest of Canada, 2006 2010 of preterm 32 36 weeks Preterm birth 32 36 weeks per 100 of preterm 32 36 weeks Preterm birth 32 36 weeks per 100 2006 121,788 8,573 7.0 6.9 7.2 218,840 15,016 6.9 6.8 7.0 2007 131,442 9,222 7.0 6.9 7.2 229,291 15,042 6.6 6.5 6.7 2008 137,470 9,697 7.0 6.9 7.2 237,005 16,020 6.8 6.7 6.9 2009 137,832 9,611 7.0 6.8 7.1 Estimates not available 2010 136,770 9,292 6.8 6.7 6.9 Estimates not available The with a gestational age of 32 36 completed weeks, expressed as a percentage of the total (in a given place and time). Perinatal Health Indicators for Ontario 2012 19
TABLE 4-C Rate of preterm birth <32 weeks gestation Ontario and the rest of Canada, 2006 2010 preterm <32 weeks Preterm birth <32 weeks per 100 live preterm <32 weeks Preterm birth <32 weeks per 100 live 2006 121,788 1,610 1.3 1.3 1.4 218,840 2,544 1.2 1.1 1.2 2007 131,442 1,664 1.3 1.2 1.3 229,291 2,562 1.1 1.1 1.2 2008 137,470 1,696 1.2 1.2 1.3 237,005 2,732 1.2 1.0 1.2 2009 137,832 1,627 1.2 1.1 1.2 Estimates not available 2010 136,770 1,564 1.1 1.1 1.2 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 2012 20
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 2010. FIGURE 5 Rate of postterm birth Ontario, 2006 2010 Data source BORN Information System, 2006 2010 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 2012 21
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, 2006 2010 of postterm ( 42 weeks) Postterm birth per 100 live of postterm ( 42 weeks) Postterm birth per 100 live 2006 121,788 388 0.32 0.29 0.35 218,840 1,507 0.69 0.65 0.72 2007 131,442 403 0.31 0.28 0.34 229,291 1,656 0.72 0.69 0.76 2008 137,470 392 0.29 0.26 0.31 237,005 1,481 0.62 0.59 0.66 2009 137,832 463 0.34 0.31 0.37 Estimates not available 2010 136,770 394 0.29 0.26 0.32 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 2012 22
LIVE BIRTHS TO TEENAGE MOTHERS Ontario: The age-specific rate birth to aged 18 19 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 2010. The rate birth to aged 15 17 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 10 14 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% (: 3.4 3.6) of to under 20 of age at the time of delivery. Of these, the majority of were to 18 19 of age (Figure 7). FIGURE 6 Age-specific live birth rates, aged 10 14, 15 17 and 18 19 Ontario, 2006 2010 Data sources BORN Information System, 2006 2010 Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 The to aged 10 14, 15 17 and 18 19, expressed per 1,000 in the same age category (in a given place and time). Perinatal Health Indicators for Ontario 2012 23
FIGURE 7 Proportion (%) of to aged 10 14, 15 17 and 18 19 Ontario, 2006 2010 Data source BORN Information System, 2006 2010 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 2012 24
Comparison to the rest of Canada: Between 2006 and 2008, the age-specific rates birth per 1,000 aged 10 19 were consistently lower in Ontario compared with the rest of Canada. For instance, in 2008, the rate was 6.2 per 1,000 (: 6.0 6.4) aged 10 19 in Ontario and 8.7 per 1,000 (: 8.5 8.8) 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, 15 17 and 18 19, respectively. Similarly, the proportion of to aged 10 19 was consistently about one percentage point lower in Ontario compared with the rest of Canada between 2006 and 2008. In 2008, 3.7% (: 3.6 3.8) and 4.6% (: 4.5 4.7) 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, 15 17 and 18 19, respectively. TABLE 6-A Age-specific live birth rates, aged 10 14 Ontario and the rest of Canada, 2006 2010 of 10 14 10 14 per 1,000 10 14 of 10 14 10 14 per 1,000 10 14 2006 406,477 30 0.07 0.05 0.11 617,785 99 0.16 0.13 0.20 2007 399,436 35 0.09 0.06 0.12 604,130 94 0.16 0.13 0.19 2008 392,164 40 0.10 0.07 0.14 589,958 110 0.19 0.15 0.22 2009 384,807 47 0.12 0.09 0.16 Estimates not available 2010 378,041 57 0.15 0.11 0.20 Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 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 051-0001. The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada 2011 1 report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario 2012 25
TABLE 6-B of 15 17 Age-specific live birth rates, aged 15 17 Ontario and the rest of Canada, 2006 2010 15 17 per 1,000 15 17 of 15 17 15 17 per 1,000 15 17 2006 257,415 1,265 4.9 4.6 5.2 396,419 2,943 7.4 7.2 7.7 2007 259,369 1,498 5.8 5.5 6.1 399,612 3,147 7.9 7.6 8.2 2008 256,863 1,515 5.9 5.6 6.2 395,199 3,173 8.0 7.6 8.3 2009 253,684 1,413 5.6 5.3 5.9 Estimates not available 2010 251,169 1,421 5.7 5.4 6.0 Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 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 051-0001. The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada 2011 1 report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario 2012 26
TABLE 6-C of 18 19 Age-specific live birth rates, aged 18 19 Ontario and the rest of Canada, 2006 2010 18 19 per 1,000 18 19 of 18 19 18 19 per 1,000 18 19 2006 168,009 2,954 17.6 17.0 18.2 253,073 7,030 27.8 27.1 28.4 2007 170,701 3,324 19.5 18.8 20.1 259,927 7,378 28.4 27.8 29.0 2008 177,018 3,562 20.1 19.5 20.8 270,686 7,599 28.1 27.4 28.7 2009 179,766 3,528 19.6 19.0 20.3 Estimates not available 2010 179,284 3,311 18.5 17.9 19.1 Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 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 051-0001. The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada 2011 1 report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario 2012 27
TABLE 7-A to <50 Proportion (%) of to aged 10 14 Ontario and the rest of Canada, 2006 2010 10 14 to 10 14 per 100 to <50 10 14 to 10 14 per 100 2006 122,474 30 0.02 0.02 0.03 218,993 99 0.05 0.04 0.06 2007 132,119 35 0.03 0.02 0.04 229,401 94 0.04 0.03 0.05 2008 137,759 40 0.03 0.02 0.04 237,049 110 0.05 0.04 0.06 2009 137,928 47 0.03 0.03 0.05 Estimates not available 2010 137,146 57 0.04 0.03 0.05 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 2012 28
TABLE 7-B to <50 Proportion (%) of to aged 15 17 Ontario and the rest of Canada, 2006 2010 15 17 to 15 17 per 100 to <50 15 17 to 15 17 per 100 2006 122,474 1,265 1.0 1.0 1.1 218,993 2,943 1.3 1.3 1.4 2007 132,119 1,498 1.1 1.1 1.2 229,401 3,147 1.4 1.3 1.4 2008 137,759 1,515 1.1 1.1 1.2 237,049 3,173 1.3 1.3 1.4 2009 137,928 1,413 1.0 1.0 1.1 Estimates not available 2010 137,146 1,421 1.0 1.0 1.1 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 2012 29
TABLE 7-C to <50 Proportion (%) of to aged 18 19 Ontario and the rest of Canada, 2006 2010 18 19 to 18 19 per 100 to <50 18 19 to 18 19 per 100 2006 122,474 2,954 2.4 2.3 2.5 218,993 7,030 3.2 3.1 3.3 2007 132,119 3,324 2.5 2.4 2.6 229,401 7,378 3.2 3.1 3.3 2008 137,759 3,562 2.6 2.5 2.7 237,049 7,599 3.2 3.1 3.3 2009 137,928 3,528 2.6 2.5 2.6 Estimates not available 2010 137,146 3,311 2.4 2.3 2.5 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 2012 30
LIVE BIRTHS TO OLDER MOTHERS Ontario: The age-specific rate birth to aged 35 39 increased in Ontario between 2006 (45.4 per 1,000, : 44.8 46.0) and 2010 (53.5 per 1,000, : 52.9 54.2). The rate birth to aged 40 44 showed a more modest absolute increase between 2006 and 2010, from 7.8 (: 7.6 8.1) to 10.6 (: 10.3 10.9) per 1,000 aged 40 44. The age-specific rate birth to aged 45 49 was very low over the same time period, but also increased (Figure 8). The proportion of to aged 35 49 in Ontario increased modestly between 2006 and 2010 from 21.0% (: 20.8 21.2) to 22.0% (: 21.8 22.2). Of these, the majority were to 35 39 of age (Figure 9). FIGURE 8 Age-specific live birth rates, aged 35 39, 40 44 and 45 49 Ontario, 2006 2010 Data sources BORN Information System, 2006 2010 Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 The to aged 35 39, 40 44 and 45 49, expressed per 1,000 in the same age category (in a given place and time). Perinatal Health Indicators for Ontario 2012 31
FIGURE 9 Proportion (%) of to aged 35 39, 40 44 and 45 49 Ontario, 2006 2010 Data source BORN Information System, 2006 2010 Note The to aged 35 39, 40 44 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 2012 32
Comparison to the rest of Canada: Between 2006 and 2008, the age-specific rates birth per 1,000 aged 35 49 were consistently higher in Ontario compared with the rest of Canada. For instance, in 2008, the rate was 19.3 per 1,000 (: 19.0 19.5) aged 35 49 in Ontario and 17.0 per 1,000 (: 16.8 17.1) in the rest of Canada. There was also a small increase in the age-specific rate birth per 1,000 aged 35 49 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, 40 44 and 45 49, respectively. Similarly, the proportions of to aged 35 49 were consistently higher in Ontario compared with the rest of Canada between 2006 and 2008. In 2008, 21.2% (: 20.9 21.4) and 16.3% (: 16.1 16.4) of in Ontario and the rest of Canada, respectively, were to 35 49. Tables 9-A through 9-C present the proportions of to aged 35 39, 40 44 and 45 49, respectively. TABLE 8-A Age-specific live birth rates, aged 35 39 Ontario and the rest of Canada, 2006 2010 of 35 39 35 39 per 1,000 35 39 of 35 39 35 39 per 1,000 35 39 2006 469,055 21,314 45.4 44.8 46.0 680,674 29,224 42.9 42.5 43.4 2007 466,775 23,206 49.7 49.1 50.3 678,074 30,951 45.6 45.1 46.1 2008 465,284 24,157 51.9 51.3 52.6 677,871 32,373 47.8 47.3 48.3 2009 462,832 24,329 52.6 51.9 53.2 Estimates not available 2010 462,069 24,729 53.5 52.9 54.2 Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 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 051-0001. The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada 2011 1 report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario 2012 33
TABLE 8-B of 40 44 Age-specific live birth rates, aged 40 44 Ontario and the rest of Canada, 2006 2010 40 44 per 1,000 40 44 of 40 44 40 44 per 1,000 40 44 2006 539,008 4,227 7.8 7.6 8.1 806,331 5,369 6.7 6.5 6.8 2007 528,934 4,416 8.3 8.1 8.6 783,378 5,713 7.3 7.1 7.5 2008 514,300 4,717 9.2 8.9 9.4 756,470 5,852 7.7 7.5 7.9 2009 498,927 4,912 9.8 9.6 10.1 Estimates not available 2010 487,310 5,155 10.6 10.3 10.9 Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 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 051-0001. The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada 2011 1 report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario 2012 34
TABLE 8-C Age-specific live birth rates, aged 45 49 Ontario and the rest of Canada, 2006 2010 of 45 49 45 49 per 1,000 45 49 of 45 49 45 49 per 1,000 45 49 2006 509,280 175 0.34 0.29 0.40 824,109 248 0.30 0.26 0.34 2007 520,044 229 0.44 0.39 0.50 829,923 267 0.32 0.28 0.36 2008 533,286 268 0.50 0.44 0.57 836,595 298 0.36 0.32 0.40 2009 545,316 286 0.52 0.47 0.59 Estimates not available 2010 551,400 284 0.51 0.46 0.58 Estimates not available Population estimates for in each age category: Statistics Canada. CANSIM Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, 2006 2010 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 051-0001. The s for the rest of Canada may differ slightly from those reported in the Perinatal Health Indicators for Canada 2011 1 report due to updates to the CANSIM tables. Perinatal Health Indicators for Ontario 2012 35
TABLE 9-A to <50 Proportion (%) of to aged 35 39 Ontario and the rest of Canada, 2006 2010 35 39 to 35 39 per 100 to <50 35 39 to 35 39 per 100 2006 122,474 21,314 17.4 17.2 17.6 218,993 29,224 13.3 13.2 13.5 2007 132,119 23,206 17.6 17.4 17.8 229,401 30,951 13.5 13.4 13.6 2008 137,759 24,157 17.5 17.3 17.7 237,049 32,373 13.7 13.5 13.8 2009 137,928 24,329 17.6 17.4 17.8 Estimates not available 2010 137,146 24,729 18.0 17.8 18.2 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 2012 36
TABLE 9-B to <50 Proportion (%) of to aged 40 44 Ontario and the rest of Canada, 2006 2010 40 44 to 40 44 per 100 to <50 40 44 to 40 44 per 100 2006 122,474 4,227 3.5 3.4 3.6 218,993 5,369 2.5 2.4 2.5 2007 132,119 4,416 3.3 3.3 3.4 229,401 5,713 2.5 2.4 2.6 2008 137,759 4,717 3.4 3.4 3.5 237,049 5,852 2.5 2.4 2.5 2009 137,928 4,912 3.6 3.5 3.7 Estimates not available 2010 137,146 5,155 3.8 3.7 3.9 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 2012 37
TABLE 9-C to <50 Proportion (%) of to aged 45 49 Ontario and the rest of Canada, 2006 2010 45 49 to 45 49 per 100 to <50 45 49 to 45 49 per 100 2006 122,474 175 0.14 0.12 0.17 218,993 248 0.11 0.10 0.13 2007 132,119 229 0.17 0.15 0.20 229,401 267 0.12 0.10 0.13 2008 137,759 268 0.19 0.17 0.22 237,049 298 0.13 0.11 0.14 2009 137,928 286 0.21 0.18 0.23 Estimates not available 2010 137,146 284 0.21 0.18 0.23 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 2012 38
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 (: 3.5 3.7), corresponding to 5,018 infants ( and still) born following a multiple gestation pregnancy (Figure 10). FIGURE 10 Rate of multiple birth Ontario, 2006 2010 Data source BORN Information System, 2006 2010 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 2012 39
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 (: 3.3 3.5) in Ontario and 3.0 per 100 total (: 3.0 3.1) in the rest of Canada (Table 10). TABLE 10 Rate of multiple birth Ontario and the rest of Canada, 2006 2010 of of multiple Multiple birth per 100 total of multiple Multiple birth per 100 total 2006 123,210 4,270 3.5 3.4 3.6 220,338 6,742 3.1 3.0 3.1 2007 132,872 4,560 3.4 3.3 3.5 230,920 7,049 3.1 3.0 3.1 2008 138,561 4,732 3.4 3.3 3.5 238,679 7,220 3.0 3.0 3.1 2009 138,723 5,031 3.6 3.5 3.7 Estimates not available 2010 137,903 5,018 3.6 3.5 3.7 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 2012 40
REFERENCES 1. Public Health Agency of Canada. Perinatal Health Indicators for Canada 2011. Ottawa, 2012. 2. Public Health Agency of Canada. Canadian Perinatal Health Report. 2008 Edition. Ottawa: Public Health Agency of Canada; 2008. 3. Joseph KS. Overview. In: Canadian Perinatal Health Report, 2008 Edition. Ottawa: Public Health Agency of Canada; 2008. 4. Statistics Canada. Births 2009. Table 1. Catalogue no. 84F0210X. Available at: http://www.statcan.gc.ca/pub/84f0210x/84f0210x2009000-eng.pdf. Accessed: August 5, 2012. 5. BORN Ontario. Perinatal Health Reports 2009 2010. August 2011. Available at: http://www.bornontario.ca/reports/lhin-regional-reports. Accessed: January 5, 2012. 6. BORN Ontario. Perinatal Health Reports 2008. May 2010. Available at: http://www.bornontario.ca/reports/public-health-unit-reports. Accessed: January 5, 2012. 7. 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 2012 41
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