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of public health epidemiology in Ontario

6B Crude Birth Rate

Description

  • General Fertility Rate (GFR) - the ratio of the number of live births during a given period to the female population aged 15-49.
  • Age-Specific Fertility Rate - the ratio of the number of live births to females in a given age group during a given period relative to the female population in that age group.
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Related Core Indicators

Crude birth rateTotal Fertility RatePopulation by age and sexPopulation growthProjected population growth
 

Method of Calculation


General Fertility Rate
total number of live births to females 15-49 years of age
1,000
total number of females 15-49 years of age
1,000


 
Age-specific Fertility Rate
total number of live births to females in age group
1,000
total number of women in age group
1,000
  


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
Age groups for age-specific rates  
  • GFR: 15-49
  • Adolescent: 15-19
  • Age-specific: 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-55 (or 45+). 

Data Sources

Numerator: Alternative 1 Numerator: Alternative 2 
Vital Statistics Live Birth Data 

Original Source:

Vital Statistics, Office of Registrar General (ORG), Service Ontario

Distributed by:

1. Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)

Suggested Citation (see Data Citation Notes)

1. Ontario Vital Statistics Live Birth Data [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
Hospitalization Data 

Original Source:

Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI)

Distributed by:

1. Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)

Suggested Citation (see Data Citation Notes)

1. Inpatient Discharges [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].
Numerator: Alternative 3 Denominator
BORN Information System 

Original Source:

 Better Outcomes Registry Network (BORN) Ontario

Distributed by:

1. Better Outcomes Registry Network (BORN) Ontario

Suggested Citation (see Data Citation Notes)

1. BORN Information System [years], Date Extracted: [date].
Additional Header Goes Here

Original Source:

Statistics Canada

Distributed by:

1. Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)

Suggested Citation (see Data Citation Notes)

1. Population Estimates [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

Analysis Checklist  

Checklist
  • 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 live birth summary table includes births to age groups less than 15 and older than 49 years of age. Include only births to females 15-49 years of age.
  • 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 information and should be consulted.
Hospitalization
  • Since this indicator requires the number of births by age of mother, and maternal age is not available in the newborn record, the number of deliveries rather than number of newborns is used.
  • In IntelliHEALTH under Standard Reports, folder "05 Inpatient Discharges", open "Hospital Births - obstetric deliveries". Refer to the Notes tab for information. Open "PHU - Deliveries x Birth Type x Mother's Age" to obtain public health unit data and "ON - Deliveries x birth type x mother's 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 data for the calendar years from 2003 to the most recent available. The query is updated when the hospital inpatient table is refreshed.
  • Select the appropriate calendar years and PHU as prompted from the pre-defined filters.
  • Group the birth types (Z37 codes).
  • Age is grouped by 5-year categories from 10-14 to 55-59 years of age.
  • The report can be edited to obtain more specific geographic information including municipality and postal code.
  • The calendar year for date of admission is used (Admit CYear) rather than date of discharge. This may or may not correspond to when the baby was born since date of admission is taken from the maternal record. If the mother was admitted a significant time before the birth, then the admission year may be different from the discharge year. Even though counts are grouped by calendar year of admission, it is the actual numbers of discharges that are counted.
  • The notes section of the report provides important data caveats and information and should be consulted.
  • Refer to the Hospitalization Data Source for more information about the data, including births and deliveries.
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.

Indicator Comments

Comments
  • The GFR is more refined than the crude birth rate; however, it is not good for comparisons between areas or periods because it ignores differences in the age structures of populations. GFRs may not be comparable across time or place if, for example, one population has a high proportion of women in the most fertile age group (25 to 34 years of age).
  • Age-specific fertility rates are better for comparisons than general fertility rates; however, the number of comparisons needed make it an unwieldy measure for that purpose.
  • High fertility rates in some age groups (e.g., adolescents and females 35 years of age and older) are associated with low birth weight, preterm birth, and increased infant morbidity and mortality.
  • The aging of the population in developed countries is attributable partially to increased life expectancy but mainly to decreased fertility.
  • GFRs are often calculated using the reproductive age range of 15 to 44 years of age (1).
  • Adjustments could be made to the denominator to account for levels of sterilization (hysterectomy and/or tubal ligation and/or vasectomy).
  • There have been sharp fertility declines in the Canadian population over the last five decades and females over 30 years of age is the only subgroup showing any recovery in fertility patterns (2).

Ontario Public Health Standards

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: 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. [Reproductive Health] 

Board of Health Outcome: 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.  [Sexual Health sexually transmitted infections and blood-borne infections (including HIV)] 

Board of Health Outcome: 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. [Foundational Standard]

Requirements Related to this Indicator

Assessment and Surveillance Requirement: 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.  [Reproductive Health; Sexual Health Sexually Transmitted Infections and Blood-borne Infections (including HIV)]

www.ontario.ca/publichealthstandards

Corresponding Indicators in Public Health Practice
Corresponding Health Indicator(s) from Statistics Canada and CIHI

Health Indicators, an online publication produced jointly by Statistics Canada and the Canadian Institute for Health Information, provides over 80 indicators measuring the health of the Canadian population and the effectiveness of the health care system.  Designed to provide comparable information at the health region and provincial/territorial levels, these data are produced from a wide range of the most recently available sources.  

None

Corresponding Indicator(s) from Other Sources

None



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.

References

Cited References
  1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary Data for 2010. National Vital Statistics Reports. 2011: 60(2); 1-26. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf
  1. Public Health Agency of Canada. Canadian Perinatal Health Report. Ottawa: Minister of Health, 2008. Available from: http://www.phac-aspc.gc.ca/publicat/2008/cphr-rspc/pdf/cphr-rspc08-eng.pdf.
Other References
  • Health Canada. Perinatal Health Indicators for Canada: A Resource Manual. Ottawa: Minister of Public Works and Government Services Canada, 2000. Available from: http://www.phac-aspc.gc.ca/rhs-ssg/phic-ispc/index.htmlhttp://publications.gc.ca/collections/Collection/H49-135-2000E.pdf


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

Core Indicator 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)

Contributing Authors

Reproductive Health Sub-group

External Reviewers

Name, Organization (at time of contribution)

Revision History

Date Review Type Author Changes PDF
March 2010 Formal Review Reproductive Health Sub-Group
  • Replaced Mandatory Health Programs section with updated Ontario Public Health Standards outcomes.
March 29, 2012 - January 16, 2013 Formal Review Built Environment Subgroup
  • Three data sources cited with analysis check-list for each
  • Include all live births, including those with birth weight less than 500g.

 

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