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6B Crude Birth Rate

Description | Specific Indicators | Ontario Public Health Standards | Corresponding Health Indicators from Statistics Canada and CIHI | Corresponding Indicators from Other Sources | Data Sources |  Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Definitions | Cross-References to Other Indicators | Cited References | Other References | Changes Made | Acknowledgements

Description
  • Total number of live births per 1,000 population
Specific Indicators
  • Crude birth rate
Ontario Public Health Standards (OPHS)
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
Outcomes Related to this Indicator 
  • Board of Health Outcome (Reproductive Health): The board of health is aware of and uses epidemiology to influence the  development of healthy public policy and its programs and services for the promotion of reproductive health.
  • Board of Health Outcome (Sexual Health sexually transmitted infections and blood-borne infections (including HIV)): The board of health is aware of and uses epidemiology to influence the development of healthy public policy and its programs and services to promote healthy sexuality and to prevent or reduce the burden of sexually transmitted infections and blood-borne infections.
  • Board of Health Outcome (Foundational Standard): The public, community partners, and health care providers are aware of relevant and current population health information Assessment and/or Surveillance Requirements Related to this Indicator.
Assessment and Surveillance Requirements Related to this Indicator (Reproductive Health; Sexual Health Sexually Transmitted Infections and Blood-borne Infections (including HIV)):
  • The board of health shall conduct epidemiological analysis of surveillance data, including monitoring of trends over time, emerging trends, and priority populations....in the area of reproductive health outcomes.

http://www.ontario.ca/publichealthstandards

 

Corresponding Health Indicator(s) from Statistics Canada and CIHI
  • None
 Corresponding Indicators from Other Sources
  •  None
Data Sources (see Resources: Data Sources)

Note that 3 data sources are listed for use: 1) Vital statistics, 2) Hospitalization, 3) BORN. The choice of data source will depend upon data quality within a health unit as well as data access and the specific analysis questions. For information related to the data sources, refer to the Data Source resources and the Reproductive Health Core Indicators Documentation Report

 

Numerator:

Alternative 1
Vital Statistics Live Birth Data
Original source: Vital Statistics, Office of Registrar General (ORG), ServiceOntario
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Ontario Vital Statistics Live Birth Data [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Alternative 2

Hospitalization Data
Original source: Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI)
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Inpatient Discharges [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Alternative 3
BORN Information System
Original source: Better Outcomes Registry Network (BORN) Ontario
Distributed by: Better Outcomes Registry Network (BORN) Ontario
Suggested citation (see Data Citation Notes): BORN Information System [years], Date Extracted: [date].

 

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by: Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested citation (see Data Citation Notes): Population Estimates [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
 

Analysis Check List

  • Exclude stillbirths.
  • The IntelliHEALTH licensing agreement does not require suppression of small cells, but caution should be used when reporting at a level that could identify individuals, (e.g. reporting at the postal code level by age and sex). Please note that privacy policies may vary by organization. Prior to releasing data, ensure adherence to the privacy policy of your organization.
  • Aggregation (e.g. combining years, age groups, categories) should also be considered when small numbers result in unstable rates.
  • Exclude births to mothers that reside out-of-province. Births to Ontario mothers that occur out-of-province are not included in the data.
  • Include all births, not just those for mothers aged 15-49 years.
  • Include live births with birth weight <500 g. For more information, refer to the Reproductive Health Core Indicators Documentation Report. 
  • HELPS Data: Historically, PHUs obtained data for live births, stillbirths, therapeutic abortions, congenital anomalies, and deaths from the Ministry of Health through HELPS (the HEalthPlanning System). Although these data are no longer commonly used, some PHUs may still be accessing these data files. Information about the data can be found in the HELPS Data Source resource.
Vital Statistics
  • In IntelliHEALTH under Standard Reports, folder "01 Vital Stats", open "Birth Summary V2". This report summarizes information on births by age group and mother's residence (Ontario, PHU and LHIN). IntelliHEALTH also provides population data (total population, female population aged 15-49 years) for the calculation of rates. Refer to the Notes tab for information. Open tab "1.2 Births x PHU x Type x Age" to obtain public health unit data and tab "1.1 ON Births x Type x Age" to obtain Ontario data. The report can be modified, renamed and saved under your own folder or can be exported into Excel.
  • The predefined report provides live birth and population data for the calendar years from 2000 to the most recent available. Table options can be edited to change the number of years of data presented.  For years that are not displayed modify the calendar year filter to include the required years.
  • The data contained in the Birth Summary V2 report includes births to Ontario mothers in Ontario only.
  • The notes section of the report provides important data caveats and background information on data sources and should be consulted. 

Hospitalization

  • In IntelliHEALTH under Standard Reports, folder ‘05 Inpatient Discharges' folder, use the "Hospital Births - newborns, stillbirths" predefined report. This report can be modified, renamed and saved under your own folder. The report provides hospital birth counts (Admit Entry Type = N for Newborn or S for Stillbirth) for Ontario and by PHU, including only Ontario residents (Patient Province equal to ON).
  • The calendar year for date of admission is used (Admit CYear) rather than date of discharge since the date of admission will be the same as the birthdate for newborns.
  • Select the appropriate calendar years, PHU, and "Newborn - Born Alive in Reporting Institution" (i.e., exclude stillborn infants) as prompted from the pre-defined filters.
  • Even though counts are grouped by calendar year of admission, it is the actual number of discharges that are counted.
  • The notes section of the report provides important data caveats and background information on data sources and should be consulted. 

BORN

  • Public Health Units access the BORN data through public health reports or data cubes.
  • Refer to the BORN Information System resource for more information about the data.
Method of Calculation

Crude Birth Rate:

total number of live births

    x 1,000

total  population 

 

Basic Categories
  • Geographic areas of patient residence:
    • Vital Statistics, Hospitalization, Population Estimates data: Ontario, public health unit, municipality, and smaller areas of geography based on aggregated postal code.
    • BORN data: Ontario, public health unit

Indicator Comments

  • Crude birth rate is influenced by the age structure of the population - it will be higher in populations with more women of childbearing age (1).
  • Crude birth rate may be affected by foreign immigrant settling patterns within Ontario, the pattern of migration into and out of Ontario from other provinces as well as migration between jurisdictions within Ontario (2).
  • Total number of births, migration information as well as age structure of the population may be helpful when interpreting crude birth rates. 

 Definitions

  • Live birth – the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as heartbeat, umbilical cord pulsation, or definite movement of voluntary muscles, whether the umbilical cord has been cut or the placenta is attached. A live birth is not necessarily a viable birth.
Cross-References to Other Indicators
Cited References  
  1. Adams MM, Alexander GR, Kirby RS. Perinatal Epidemiology for Public Health Practice. New York: Springer, 2009.
  2. Statistics Canada 2006. The Daily: Births 2004. Statistics Canada Catalogue no. 11-001-XIE. Version updated July 2006. Ottawa. Available from: http://www.statcan.gc.ca/daily-quotidien/060731/dq060731b-eng.htm. (accessed October 6, 2011).
Other References
  1. Central East Health Information Partnership. Underreporting of live births in Ontario: 1991-1997. Toronto: CEHIP, 2001.
  2. Joseph KS, Kramer MS. Recent trends in Canadian infant mortality rates: the effect of changes in registration of live newborns weighing less than 500g. Can Med Assoc J 1996; 155:1047-52.

Changes Made

Date

Type of Review - Formal or Ad Hoc

Changes Made By

Changes Made

March 2010

Formal

Reproductive Health Sub-Group

  • Replaced Mandatory Health Programs section with updated Ontario Public Health Standards outcomes.

March 29, 2012 - January 16, 2013

Formal

Reproductive Health Sub-Group

  • Three data sources cited with analysis check-list for each.
  • Include all live births, including those with birth weight less than 500g.

 

Acknowledgements

Lead Authors

  • Amira Ali, Ottawa Public Health
  • Deshayne Fell, BORN Ontario
  • Carol Paul, Ministry of Health and Long Term Care
  • Mary-Anne Pietrusiak, Durham Region Health Department

Contributing Authors

  • Reproductive Health Sub-group

Reviewers

  • Deborah Carr, Oxford County Health Unit
  • Sherri Deamond, Durham Region Health Department (Core Indicators Work Group member)
  • Suzanne Fegan, Kingston Frontenac Lennox and Addington Public Health (Core Indicators Work Group member)
  • Carmen Yue, Toronto Public Health
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