Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 1-Year Outcomes.

Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA) access in the anatomical snuffbox preserves the RA but safety and potential detrimental effects on hand function are unknown. We aimed to assess hand function and complications after DRA and PRA. In this single-center trial, 300 patients were randomly allocated 1:1 to cardiac catheterization through DRA or PRA. The primary end point of change in hand function from baseline to 1 year was a composite of the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, hand grip test, and thumb-forefinger pinch test. The secondary end points included access feasibility and complications. Of 216 patients with 1-year completed follow-up, 112 were randomly allocated to DRA and 104 to PRA, with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%, p = 0.25). Radial artery occlusion occurred in 1 PRA patient versus 2 in DRA. There was no significant difference in change of hand function, median (interquartile range) hand grip (DRA 0.7 [-3 to 4.5] vs PRA 1.3 [-2 to 4.3] kg, p = 0.57), pinch grip (DRA -0.1 [-1.1 to 1] vs PRA -0.3 [-1 to 0.7] kg, p = 0.66), and Quick DASH (DRA 0 [-6.6 to 2.3] vs PRA 0 [-4.6 to 2.9] points, p = 0.58). The composite of hand function was comparable between PRA and DRA. In conclusion, DRA is a safe strategy for cardiac catheterization, with a low complication rate. Compared with PRA, there is no increased risk of hand dysfunction or radial artery occlusion at 1 year.

The U.S. National Vital Statistics System: Transitioning Into the 21st Century, 1990-2017.

This report describes the history of the National Vital Statistics System, with a focus on the period 1990-2017. The vital statistics system is the country's most enduring program of data collection on the health of the population. It is based on information reported on the certificates of births and deaths and reports of fetal deaths, collected in each of the states and independent registration areas. Over the last two decades, the vital statistics system has experienced far-reaching changes, and has shifted in important ways to emphasize data quality, timeliness, and analysis. The changes underlying these areas are described.

Adolescent births in the border region: a descriptive analysis based on US Hispanic and Mexican birth certificates.

Adolescent childbearing adversely affects both mothers and infants. The birth rate for US adolescent women of Hispanic origin is higher than that for US adolescents overall. Birth rates among US Hispanic adolescents in the border region are higher than rates among other US Hispanic adolescents, and rates among Mexican border adolescents are higher than rates among other Mexican adolescents. We used binational birth certificate data for US Hispanic and Mexican adolescent women living inside the border region, elsewhere within the border states, and in the US and Mexico overall to compare birth rates and other health indicators among these groups. From 2000 to 2009, birth rates for 15-19 year-olds declined 19-28 % among US Hispanic geographic subgroups and 8-13 % among Mexican geographic subgroups; rates in the border region in 2009 were 73.8/1,000 women ages 15-19 for US Hispanics and 87.2/1,000 for Mexicans and were higher than rates in other US and Mexican subgroups, respectively. Less than one in five US Hispanic and Mexican adolescent mothers in the border region was married. About one in three delivered by cesarean. Late or no prenatal care was more prevalent among US Hispanic (17.6 %) than Mexican (14.3 %) border adolescents. Birth weight and gestational age outcomes were generally poorest in Texas border counties compared with border counties in other US states and in municipios of Mexican states bordering Texas. High birth rates and low prenatal care utilization among adolescents are problems along the US-Mexico border.

Cesarean birth in the border region: a descriptive analysis based on US Hispanic and Mexican birth certificates.

Cesarean birth (CB) is more prevalent in the US-Mexico border region than among all US Hispanics. Comparable data from US and Mexican birth certificates can be used to compare prevalence and identify risk factors on either side of the border. Using 2009 US and Mexican birth certificates, we compared the characteristics of US Hispanic and Mexican CBs in six geographic subgroups: US and Mexican border counties/municipios, US and Mexican non-border counties/municipios and the US and Mexico overall. We also explored cesarean prevalence over time. During 2000-2009, CB rates increased from 22.1 to 31.6 % among US Hispanics and from 25.9 to 37.9 % among Hispanics in the US border region. 2009 rates were 44.5 % in Mexico and 43.1 % in the Mexican border region. In both countries, CB rates were similar for primiparas and multiparas. Higher education, being married and parity >4 were associated with CB in Mexico; being married was associated in the US. Hispanic rates were higher in the US border than non-border region for all age groups. Along the border, cesarean rates for Hispanics were highest in Texas (43.5 %) and neighboring Tamaulipas (49.8 %). Higher cesarean prevalence in Mexico than in US Hispanics, while unexplained, is consistent with high prevalence in some Latin American countries. Higher cesarean prevalence among Hispanics in the US border region than among Hispanics nationwide cannot be explained by maternal age or parity. Medical indications are also unlikely to explain such high rates, which are undesirable for mothers and infants.

Recent declines in nonmarital childbearing in the United States.

There were sharp increases in nonmarital childbearing from 2002 to 2007, following the steady increases beginning in the 1980s. The upward trends have mainly reversed since 2007-2008. In addition, the nature of nonmarital childbearing may be changing as cohabiting unions have increased over the last few decades in the United States along with pregnancies within those unions. Births to unmarried women are at greater risk for adverse outcomes, including low birth weight, preterm birth, and infant mortality. Social and financial supports for unmarried mothers may be limited. This report describes recent trends in nonmarital births from the National Vital Statistics System (NVSS) and in cohabitation for unmarried mothers using data from the National Survey of Family Growth (NSFG).

National and state patterns of teen births in the United States, 1940-2013.

OBJECTIVES: This report presents trends from 1940 through 2013 in national birth rates for teenagers, with particular focus on the period since 1991. The percent changes in rates for 1991-2012 and for 2007-2012 are presented for the United States and for states. Preliminary data for 2013 are shown where available. METHODS: Tabular and graphical descriptions of the trends in teen birth rates for the United States and each state, by age group, race, and Hispanic origin, are presented and discussed. Data are shown for the U.S. territories. RESULTS: Birth rates for U.S. teenagers have generally fallen in the United States since peaking in 1957. The rate fell 57% between 1991 and 2013. The 2013 preliminary rate (26.6 per 1,000 aged 15-19) is less than one-third of the historically highest rate (96.3 in 1957). During 1991-2012, rates fell for all race and Hispanic ethnicity groups, with the largest declines measured for non-Hispanic black teenagers. In the more recent period, 2007-2012, the declines have been steepest for Hispanic teenagers. Birth rates declined significantly for teenagers in all states during 1991-2012; during 2007-2012, rates fell for all but two states. The drop in teen birth rates translates into an estimated 4 million fewer births to teenagers from 1992 through 2012. The declines in teen birth rates reflect a number of behavioral changes, including decreased sexual activity, increases in the use of contraception at first sex and at most recent sex, and the adoption and increased use of hormonal contraception, injectables, and intrauterine devices.

Births: preliminary data for 2012.

Objectives-This report presents preliminary data for 2012 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight are also presented. Methods-Data in this report are based on 99.96% of 2012 births.Records for the few states with less than 100% of records received are weighted to independent control counts of all births received in state vital statistics offices in 2012. Comparisons are made with final 2011 data. Results-The preliminary number of births for the United States in 2012 was 3,952,937, essentially unchanged (not statistically significant) from 2011; the general fertility rate was 63.0 births per 1,000 women aged 15-44, down only slightly from 2011, after declining nearly 3% a year from 2007 through 2010. The number of births and fertility rate either declined or were unchanged for most race and Hispanic origin groups from 2011 to 2012; however, both the number of births and the fertility rate for Asian or Pacific Islander women rose in 2012 (7% and 4%, respectively). The birth rate for teenagers aged 15-19 was down 6% in 2012 (29.4 births per 1,000 teenagers aged 15-19), yet another historic low for the United States, with rates declining for younger and older teenagers and for nearly all race and Hispanic origin groups. The birth rate for women in their early 20s also declined in 2012, to a new record low of 83.1 births per 1,000 women. Birth rates for women in their 30s rose in 2012, as did the birth rate for women in their early 40s. The birth rate for women in their late 40s was unchanged. The nonmarital birth rate declined in 2012 (to 45.3 birth per 1,000 unmarried women aged 15-44), whereas the number of births to unmarried women rose 1% and the percentage of births to unmarried women was unchanged (at 40.7%). The cesarean delivery rate for the United States was unchanged in 2012 at 32.8%. The preterm birth rate fell for the sixth straight year in 2012 to 11.54%. The low birthweight rate also declined in 2012, to 7.99%.

Pregnancy rates for U.S. women continue to drop.

The pregnancy rate for U.S. women in 2009 was 102.1 per 1,000 women aged 15-44, the lowest level in 12 years; only the 1997 rate of 101.6 has been lower in the last 30 years. Rates for women under age 30 fell during 1990-2009, while rates for women aged 30 and over increased. Rates for teenagers reached historic lows in 2009, including rates for the three major race and Hispanic origin groups. Pregnancy rates have declined about 10% each for married and unmarried women since 1990. The birth rate for married women was 72% higher than the rate for unmarried women; the abortion rate for unmarried women was almost five times higher than the rate for married women. Pregnancy rates for women in the United States continued to decline in 2009, reaching the lowest level in 12 years (102.1 per 1,000 women aged 15-44). This level is 12% below the 1990 peak (115.8). The estimated number of pregnancies dropped to 6,369,000 (4,131,000 live births, 1,152,000 induced abortions, and 1,087,000 fetal losses). The drop in birth rates since 2007 has been well documented. However, it is important to examine the other outcomes of pregnancy to understand the full scope of current reproductive trends. The data in this report provide a comprehensive picture of pregnancies and pregnancy outcomes. Data on pregnancy outcomes by age, race and Hispanic origin, and marital status are presented using data from the National Vital Statistics System, the Abortion Surveillance System and Guttmacher Institute, and the National Survey of Family Growth (NSFG).

Pregnancy and childbirth among females aged 10-19 years - United States, 2007-2010.

Pregnancy and childbirth among females aged <20 years have been the subject of long-standing concern among the public, the public health community, and policy makers. Teenagers who give birth are much more likely than older women to deliver a low birthweight or preterm infant, and their babies are at higher risk for dying in infancy. The annual public costs associated with births among teenage girls are an estimated $10.9 billion. According to the 2006-2010 National Survey of Family Growth (NSFG), an estimated 77% of births to teenagers aged 15-19 years were unintended.

A binational overview of reproductive health outcomes among US Hispanic and Mexican women in the border region.

INTRODUCTION: The US-Mexico border region has 15 million residents and 300,000 births annually. Reproductive health concerns have been identified on both sides of the border, but comparable information about reproductive health is not available. The objective of this study was to compare reproductive health indicators among populations in this region. METHODS: We used 2009 US Hispanic and Mexican birth certificate data to compare births inside the border region, elsewhere within the border states, and in the United States and Mexico overall. We examined trends in total fertility and birth rates using birth data from 2000 through 2009 and intercensal population estimates. RESULTS: Among women in the border region, US women had more lifetime births than Mexican women in 2009 (2.69 births vs 2.15 births) and throughout the decade. Birth rates in the group aged 15 to 19 years were high in both the US (73.8/1,000) and Mexican (86.7/1,000) border regions. Late or no prenatal care was nearly twice as prevalent in the border regions as in the nonborder regions of border states. Low birth weight and preterm and early-term birth were more prevalent in the US border than in the Mexican border region; US border rates were higher and Mexican rates were lower than their corresponding nonborder and national rates. We found some variations within border states. CONCLUSION: These findings constitute the first population-based information on the reproductive health of the entire Hispanic US-Mexico border population. Evidence of disparities warrants exploration at state and local levels. Teen pregnancy and inadequate prenatal care are shared problems in US-Mexico border communities and suggest an area for binational cooperation.

Births: final data for 2011.

OBJECTIVES: This report presents 2011 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics, including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (e.g., period of gestation, birthweight, and plurality). Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2011 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2010 census. Birth and fertility rates for 2001-2009 are based on revised intercensal population estimates. Denominators for 2011 and 2010 rates for the specific Hispanic groups are derived from the American Community Survey; denominators for earlier years are derived from the Current Population Survey. RESULTS: The number of births declined 1% in 2011 to 3,953,590. The general fertility rate also declined 1%, to 63.2 per 1,000 women aged 15-44. The teen birth rate fell 8%, to 31.3 per 1,000 women. Birth rates declined for women in their 20s, were unchanged for women aged 30-34, and rose for women aged 35-44. The total fertility rate (estimated number of births over a woman's lifetime) declined 2% to 1,894 per 1,000 women. The number and rate of births to unmarried women declined; the percentage of births to unmarried women was essentially stable at 40.7%. The cesarean delivery rate was unchanged from 2010 at 32.8%. The preterm birth rate declined for the fifth straight year to 11.73%; the low birthweight rate declined slightly to 8.10%. The twin birth rate was not significantly changed at 33.2 per 1,000 births; the rate of triplet and higher-order multiple births also was essentially stable at 137.0 per 100,000.

Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-2008, updating a national series of rates extending since 1976. METHODS: Tabular and graphical data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. RESULTS: In 2008, an estimated 6,578,000 pregnancies resulted in 4,248,000 live births, 1,212,000 induced abortions, and 1,118,000 fetal losses. The 2008 pregnancy rate of 105.5 pregnancies per 1000 women aged 15-44 is 9 percent below the 1990 peak of 115.8. The teen pregnancy rate dropped 40 percent from 1990 to 2008, reaching a historic low of 69.8 per 1000 women aged 15-19. Pregnancy rates have declined significantly for non-Hispanic white, non-Hispanic black, and Hispanic teenagers. Rates in 2008 for non-Hispanic black and Hispanic teenagers were two to three times higher than the rates for non-Hispanic white teenagers. Pregnancy rates for women in their early 20s declined to the lowest level in more than three decades, although the declines have been more modest than for teenagers. Pregnancy rates for women aged 25-29 have changed relatively little since 1990, while rates for women in their 30s and early 40s increased.

Birth rates for U.S. teenagers reach historic lows for all age and ethnic groups.

The widespread significant declines in teen childbearing that began after 1991 have strengthened in recent years. The teen birth rate dropped 17 percent from 2007 through 2010, a record low, and 44 percent from 1991. Rates fell across all teen age groups, racial and ethnic groups, and nearly all states. The drop in the U.S. rate has importantly affected the number of births to teenagers. If the 1991 rates had prevailed through the years 1992­2010, there would have been an estimated 3.4 million additional births to teenagers during that period. The impact of strong pregnancy prevention messages directed to teenagers has been credited with the birth rate declines (9­11). Recently released data from the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), have shown increased use of contraception at first initiation of sex and use of dual methods of contraception (that is, condoms and hormonal methods) among sexually active female and male teenagers. These trends may have contributed to the recent birth rate declines (12).

Births: final data for 2010.

OBJECTIVES: This report presents 2010 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and plurality). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as birth rates by age and race of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.0 million births that occurred in 2010 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2010 census. RESULTS: The number of births declined to 3,999,386 in 2010, 3 percent less than in 2009. The general fertility rate also declined 3 percent, to 64.1 per 1,000 women aged 15-44. The teen birth rate fell 10 percent to 34.2 per 1,000. Birth rates for women in each 5-year age group from 20 through 39 years declined, but the rate for women aged 40-44 continued to rise. The total fertility rate (estimated number of births over a woman's lifetime) was down 4 percent to 1,931 per 1,000 women. The number, rate, and percentage of births to unmarried women declined. The cesarean deliver rate was down for the first year since 1996 to 32.8 percent. The preterm birth rate declines for the fourth year in a row to 11.99 percent; the low birthweight rate was stable at 8.15 percent. The twin birth rate declined slightly to 33.1 per 1,000 births; the triplet and higer-order multipe birth rate dropped 10 percent to 137.6 per 100,000.

Births: preliminary data for 2011.

OBJECTIVES: This report presents preliminary data for 2011 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight are also presented. METHODS: Data in this report are based on approximately 100% of 2011 births. Records for the few states with less than 100% of records received are weighted to independent control counts of all births received in state vital statistics offices in 2011. Comparisons are made with final 2010 data. RESULTS: The 2011 preliminary number of U.S. births was 3,953,593, 1% less (or 45,793 fewer) births than in 2010; the general fertility rate (63.2 per 1,000 women aged 15-44) declined to the lowest rate ever reported for the United States. The number of births declined for most race and Hispanic origin groups in 2011, whereas the rate declined only for Hispanic, non-Hispanic black, and American Indian or Alaska Native women. The birth rate for teenagers aged 15-19 fell 8% in 2011 (to 31.3 births per 1,000 teenagers aged 15-19), another record low, with rates declining for younger and older teenagers and for all race and Hispanic origin groups. The birth rates for women in their 20s declined as well, to a historic low for women aged 20-24 (85.3 births per 1,000). The birth rate for women in their early 30s was unchanged in 2011 but rose for women aged 35-39 and 40-44. The birth rate for women in their late 40s was unchanged in 2011. The first birth rate in 2011 (25.4 births per 1,000) was the lowest ever recorded for the United States. The birth rate, the number of births, and the percentage of births to unmarried women declined each for the third consecutive year. The birth rate was 46.1 births per 1,000 unmarried women aged 15-44 and the percentage of births to unmarried women was 40.7. The cesarean delivery rate was 32.8%, unchanged from 2010. The preterm birth rate fell for the fifth straight year in 2011 to 11.72; declines were reported for each of the largest race and Hispanic origin groups. The 2011 low birthweight rate was 8.10%, down slightly from 8.15% in 2010.

U.S. teenage birth rate resumes decline.

Teenage childbearing has been the subject of long-standing concern among the public and policy makers. Teenagers who give birth are much more likely to deliver a low birthweight or preterm infant than older women, and their babies are at elevated risk of dying in infancy. The annual public costs associated with teen childbearing have been estimated at $9.1 billion. The U.S. teen birth rate fell by more than one-third from 1991 through 2005, but then increased by 5 percent over two consecutive years. Data for 2008 and 2009, however, indicate that the long-term downward trend has resumed. Although the recent declines have been widespread by age, race and ethnicity, and state, large disparities nevertheless persist in these characteristics. The most current data available from the National Vital Statistics System are used to illustrate trends and variations through 2009.

Births: final data for 2009.

OBJECTIVES: This report presents 2009 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics including age, live-birth order, race and Hispanic origin, marital status, hypertension during pregnancy, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and plurality). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as birth rates by age and race of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.13 million births that occurred in 2009 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census. RESULTS: The number of births declined to 4,130,665 in 2009, 3 percent less than in 2008. The general fertility rate declined 3 percent to 66.7 per 1,000 women aged 15-44 years. The teenage birth rate fell 6 percent to 39.1 per 1,000. Birth rates for women in each 5-year age group from 20 through 39 years declined, but the rate for women 40-44 years continued to rise. The total fertility rate (estimated number of births over a woman's lifetime) was down 4 percent to 2,007.0 per 1,000 women. The number and rate of births to unmarried women declined, whereas the percentage of nonmarital births increased slightly to 41.0. The cesarean delivery rate rose again, to 32.9 percent. The preterm birth rate declined to 12.18 percent; the low birthweight rate was stable at 8.16 percent. The twin birth rate increased to 33.2 per 1,000; the triplet and higher-order multiple birth rate rose 4 percent to 153.5 per 100,000.

State disparities in teenage birth rates in the United States.

KEY FINDINGS: In 2008, state-specific teenage birth rates varied widely, from less than 25.0 per 1,000 15-19 year olds to more than 60.0. Rates for non-Hispanic white and Hispanic teenagers were uniformly higher in the Southeast and lower in the Northeast and California. The highest rates for non-Hispanic black teenagers were reported in the upper Midwest and in the Southeast. The race and Hispanic origin-specific birth rates by state as well as the population composition of states by race and Hispanic origin contribute to state variations in overall teenage birth rates.

Births: final data for 2007.

OBJECTIVES: This report presents 2007 data on U.S. births according to a wide variety of characteristics; preliminary 2008 data are also referenced on key measures where available. Final 2007 data are presented for maternal demographic characteristics including age, live-birth order, race and Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations are presented of data reported on the birth certificates of the 4.3 million births that occurred in 2007. Preliminary 2008 data are based on 99.9 percent of births occurring in 2008. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census. RESULTS: A total of 4,316,233 births were registered in the United States in 2007, the largest number of births ever reported. The general fertility rate increased 1 percent to 69.5 per 1,000. Birth rates increased for women in nearly all age groups. The rate for teenagers rose 1 percent for the year and is up 5 percent from 2005. The total fertility rate increased 1 percent to 2,122.0 births per 1,000 women. Preliminary data for 2008, however, suggest a decline in the number and rate of births overall, and for most age groups under age 40 years. All measures of unmarried childbearing reached record levels in 2007. The cesarean delivery rate rose to another all-time high--31.8 percent. Preterm and low birthweight rates declined slightly, and twin and triplet and higher-order multiple birth rates were essentially unchanged. Preliminary findings for 2008 suggest that these trends continued for cesarean delivery, unmarried childbearing, and preterm births.