Dataset Information

County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017.

ABSTRACT: PURPOSE:Approximately 16% of U.S. births to women aged 15-19 years are repeat (second or higher order) births. Repeat teen mothers are at elevated risk for poor perinatal outcomes. Geographic clustering and correlates of repeat teen birth are unknown. METHODS:Data from birth certificates on N = 629,939 teen births in N = 3,108 U.S. counties in 2015-2017 were merged with data on county-level demographic, socioeconomic, and health provider characteristics. We identified contiguous clusters of counties with significantly elevated rates of first teen births only, repeat teen births, both, or neither between 2015 and 2017 and compared demographic, socioeconomic, and medical provider characteristics of counties between 2010 and 2016 in each cluster type. RESULTS:A total of 193 counties (6.21%) had high rates of repeat births only; 504 (16.22%) had high rates of first teen birth only; 991 (31.89%) had high rates of both repeat and first teen births; and 1,420 (45.69%) had neither. Counties with high repeat (vs. first only) birth rates had higher rates of poverty and unemployment, higher levels of income inequality, lower high school graduation rates, a higher share of racial and ethnic minority residents, fewer publicly funded family planning clinics per capita, and more women receiving contraceptive services at publicly funded clinics. CONCLUSIONS:First and repeat teen births cluster in differentially resourced geographic areas. Counties with high repeat teen birth rates have lower socioeconomic conditions than counties with high rates of first teen births only. These counties are more reliant on publicly funded family planning clinics but have fewer of them per capita.

SUBMITTER: Maslowsky J

PROVIDER: S-EPMC6814573 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017.

Maslowsky Julie J Powers Daniel D Hendrick C Emily CE Al-Hamoodah Leila L

The Journal of adolescent health : official publication of the Society for Adolescent Medicine 20190830 5

<h4>Purpose</h4>Approximately 16% of U.S. births to women aged 15-19 years are repeat (second or higher order) births. Repeat teen mothers are at elevated risk for poor perinatal outcomes. Geographic clustering and correlates of repeat teen birth are unknown.<h4>Methods</h4>Data from birth certificates on N = 629,939 teen births in N = 3,108 U.S. counties in 2015-2017 were merged with data on county-level demographic, socioeconomic, and health provider characteristics. We identified contiguous c ...[more]

PMID: 31474434

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Project description:Importance:Progress against premature death due to noncommunicable chronic disease (NCD) has stagnated. In the United States, county-level variation in NCD premature mortality has widened, which has impeded progress toward mortality reduction for the World Health Organization (WHO) 25?×?25 target. Objectives:To estimate variations in county-level NCD premature mortality, to investigate factors associated with mortality, and to present the progress toward achieving the WHO 25?×?25 target by analyzing the trends in mortality. Design, Setting, and Participants:This cross-sectional study focused on NCD premature mortality and its factors from 3109 counties using US mortality data for cause of death from the Centers for Disease Control and Prevention WONDER databases and county-level characteristics data from multiple databases. Data were collected from January 1, 1999, through December 31, 2017, and analyzed from April 1 through October 28, 2019. Exposures:County-level factors, including demographic composition, socioeconomic features, health care environment, and population health status. Main Outcomes and Measures:Variations in county-level, age-adjusted NCD mortality in the US residents aged 25 to 64 years and associations between mortality and the 4 sets of county-level factors. Results:A total of 6?794?434 deaths due to NCD were recorded during the study period (50.58% women; 16.49% aged 65 years or older). Mortality decreased by 4.30 (95% CI, -4.54 to -4.08) deaths per 100?000 person-years annually from 1999 to 2010 (P?<?.001) and decreased annually at a rate of 0.90 (95% CI, -1.13 to -0.73) deaths per 100?000 person-years annually from 2010 to 2017 (P?<?.001). Mortality in the county with the highest mortality was 10.40 times as high as that in the county with the lowest mortality (615.40 vs 59.20 per 100?000 population) in 2017. Geographic inequality was decomposed by between-state and within-state differences, and within-state differences accounted for most inequality (57.10% in 2017). County-level factors were associated with 71.83% variation in NCD mortality. Association with intercounty mortality was 19.51% for demographic features, 23.34% for socioeconomic composition, 16.40% for health care environment, and 40.75% for health-status characteristics. Conclusions and Relevance:Given the stagnated trend of decline and increasing variations in NCD premature mortality, these findings suggest that the WHO 25?×?25 target appears to be unattainable, which may be related to broad failure by United Nations members to follow through on commitments of reducing socioeconomic inequalities. The increasing inequalities in mortality are alarming and warrant expanded multisectoral efforts to ameliorate socioeconomic disparities.

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Dataset Information

County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017.

Publications

County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017.

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