Health Status and Demographics

Connecticut (CT) is a small state of about 5,000 square miles and 169 towns, and in 2019 had an estimated statewide population of 3,565,2871. Five towns had a population greater than 100,000 and included: Bridgeport (144,399), New Haven (130,250), Stamford (129,638), Hartford (122,105), and Waterbury (108,627)2. 17.78% of the state’s residents lived in these five towns. The remaining 164 towns had a population of just under one-tenth the size of these large towns (median population size =12,096).

The State of CT is characterized by high social and economic contrasts. From 2014-2019, the state median household income (in 2018 dollars) was $ 76,106. The median household income of the five large towns in CT varied widely from a low of $ 34,338in Hartford, to moderate levels in Waterbury ($41,617), New Haven ($41,142), and Bridgeport ($45,441), and to a high of $89,309 in Stamford2. Among the five largest towns in CT from 2010 to 2019, the population of Stamford grew the fastest, with a 5.7% increase, followed by the town of New Haven (.3%) and the town of Bridgeport (.1%). These growth rates were higher than the overall statewide growth rate of -0.2%. The town of Hartford showed a -2.1% change in population, followed by Waterbury (-2.5%), which both showed an overall decrease in population2.

In December 2020, the seasonally adjusted unemployment rate in Connecticut was estimated to be 8.2% (seasonally adjusted). The US jobless rate in December 2020 was 6.7%. Connecticut has lost 102,700 jobs (6.4% of the workforce) overall for 20203.Connecticut has fared better that other New England State and most of the country, but thousands of small businesses had to shut down4.

In CT during 2019, 65.9% of the population was non-Hispanic White. Among racial and ethnic minorities, the percentages were: 16.9% Hispanic/Latino, 12.2% non-Hispanic Black/African American, 5.0% non-Hispanic Asian, and 2.5% of another race or multi-racial background. CT’s largest towns had greater racial and ethnic diversity than CT overall. For example, 37.7% of Hartford’s population was non-Hispanic Black/African American, and 35.1% of Bridgeport’s population was non-Hispanic Black/African American. The Hispanic population accounted for approximately 44.3% of the population in Hartford, and 40.8% in Bridgeport 5.

In 2019, about one in six residents (16.8%) was 65 years of age or older. About one in five CT residents (20.8%) in 2019 was under 18 years of age. CT’s largest towns had a greater proportion of young persons than the state overall, with more than half of the population younger than 35 years of age in New Haven, Hartford, Waterbury, and Bridgeport, compared to 43.8% statewide. These statistics have policy implications for women of childbearing age and young mothers2.

Between 2015-2019, 90.6% of CT adults had completed high school or had a GED, and 39.3% had a bachelor’s degree or higher. Relative to the state overall, three of the largest towns, Hartford, Bridgeport, and Waterbury, had a greater proportion of adults with the lowest levels of educational attainment2.

Relative to the general population, a different pattern of demographics exists among children living in CT. In 2019, 14.1% of children under 18 years were living below poverty level in the past 12 months and 19.9% of children under 18 years were living in households with Supplemental Security Income (SSI), cash public assistance income, or Food Stamp/SNAP benefits5. As expected, given the economics of all ages living in CT, the magnitude and highest percent of childhood poverty exists in four of the five large towns of CT. It is estimated that the percent of children living below the poverty level in 2019 was 11.5% in Stamford, 31.4% in Bridgeport, 34.9% in Waterbury, and 36.2% New Haven, and 37.4% in Hartford. Other towns, however, also exhibited a high percent of childhood poverty. These towns included: New London (40.0%), Willimantic (39.2%), New Britain (33.4%), Ansonia (20.8%), and Derby (19.8%) these towns are in rural and suburban areas of the state. These data indicate that, although public health interventions for the general high-risk population, including women of reproductive age, should be focused in large urban areas, interventions for families and their children need to be expanded into other areas of the state.

Strengths and Challenges Impacting Health Status

While overall health in Connecticut is very good, sociodemographic disparities persist, shaped by pervasive structural and institutional social determinants of health.  For many health indicators, persons of color (anyone other than non-Hispanic White) experience a greater share of adverse health events.

Many of the issues raised from the MCH Block Grant Needs Assessment are therefore driven by the goal of advancing the health of priority populations to the high standards of health obtained by more privileged residents of Connecticut.  Based on this assessment, emergent themes in maternal and child health in Connecticut are highlighted by life course stage.

The data contained in the MCHBG NA report indicate major improvements in the health of mothers, infants, and children in Connecticut.  However, much remains to be done to achieve optimal outcomes for these populations. The lifetime effects of race, racism, social class, poverty, stress, environmental influences, health policy, and other social determinants of health are reflected in the elevated rates of adverse outcomes and persistent disparities. While we continue to strive to reduce health inequities, these challenges also are apparent at the national level and are not unique to Connecticut. The continuation of evidenced-based programs, coupled with efforts to increase health equity and address social determinants of health (SDOH), are essential to achieving improved birth outcomes and reducing/eliminating disparities for mothers, infants and children in Connecticut.

As we move from assessment to planning, we will look at the common upstream factors of SDOH as cross-cutting themes to identify systemic inequities that impact prioritized health issues. By focusing on these determinants of health, engaging cross-sector partners, identifying alignment of efforts and collaboratively exploring strategic opportunities, we will create a roadmap for collaborative health improvement activities over the next five years and will prioritize health equity for all Connecticut’s MCH population.

Maternal and Child Demographics

Overall in 2019, the State of Connecticut was 65.9% non-Hispanic White, 12.2% non-Hispanic Black, 16.9% Hispanic (8% Puerto Rican), 5.0% non-Hispanic Asian, and 2.5% non-Hispanic Other race2. At the end of 2020, the unemployment rate was 8.2%3.

Just over half (53.3%) of women who gave birth in Connecticut in 2019 were non-Hispanic White, one quarter were Hispanic, 13.3% were non-Hispanic Black, and 7.8% were non-Hispanic Other race. 

Overall, the State of Connecticut is 65.9% non-Hispanic White.  However, non-Hispanic White women make up a smaller percentage of those giving birth, at 53.3.  Most women giving birth (90.7%) had over 12 years of education and were married or had an acknowledgment of paternity.  A little over a quarter these mothers received Women, Infant, and Children (WIC) benefits (27.6%).

Because of the racial history of the U.S., race/ethnicity is correlated with poverty, which affects access to health insurance.  Prior to becoming pregnant, health insurance coverage varied greatly by race/ethnicity for women in Connecticut.  In 2019, about 72-82% of women who were non-Hispanic White or non-Hispanic Other races were covered by private health insurance, while only 49.1% of Black and 34.9% of Hispanic women were. About one quarter of Hispanic women were uninsured.

Other socioeconomic characteristics of women delivering live births in Connecticut between 2016-2019 are also not distributed equally by race/ethnicity.  Based on data from the CT DPH Office of Vital Records, in which data have been grouped as non-Hispanic Asian, non-Hispanic White, Puerto Rican, non-Hispanic Black, and Other Hispanic, these patterns are apparent.  Non-Hispanic Asian women were most likely to have obtained a bachelor’s degree or higher (71.8%), followed by non-Hispanic Whites (61.7%), non-Hispanic Blacks (23.1%), other Hispanics (20.4%), and Puerto Rican Hispanics (9.6%).  This inequity in educational attainment stems from a history of racism, colonialism (the policy of a country seeking to extend or retain its authority over other people,) and immigration patterns1. Unfortunately, lower educational attainment is associated with lower income across the life-course, neighborhood poverty, poorer health status, and poorer health status for infants and children.

Infant Mortality

Connecticut’s infant mortality rate was 4.8 deaths per 1,000 live births during the period 2015-2019 down from 5.9 deaths per 1,000 live births in 2005 – a decrease of about 2.5% each year. Connecticut’s IMR has consistently remained well below both the US rate and the Healthy People 2020 target of 6 deaths per 1,000 live births since 20101.

Reductions in the state IMR are driven by declines across many subgroups. Annual IMRs in both non-Hispanic Black/African American and Hispanic populations also declined for the period 2015-2019, at rates of 2.9% and 2.3% per year, respectively, as they had since 2005. By contrast, there was no evidence of decline in mortality rates among Non-Hispanic White infants between 2015 and 2019.  

Progress is being made in reducing Connecticut’s IMR and in reducing the disparity between black and white infants. Connecticut was recently cited as ranking eighth among all states for reducing the black-white infant mortality gap over the period 1999-2013.[i] Nonetheless, there is still work to be done. Most recently, and specifically for the period 2015-2019, annual IMRs in Connecticut’s non-Hispanic White population averaged 3.2 deaths per 1,000 live births and were significantly lower than those observed for the non-Hispanic Black/African American and Hispanic populations. Annual IMRs for non-Hispanic Black/African American populations averaged 9.8 deaths per 1,000 live births, and those for Hispanic populations averaged 5.6 deaths per 1,000 live births. The averages were 3.1 and 1.7 times higher, respectively, than that for Connecticut’s non-Hispanic White population.

Births to Teens

The 2015-2019 annual overall teen birth rates in Connecticut averaged 8.9 (range = 7.7 - 10.1, reported as live births per 1,000 women aged 15-19) and continued an 11-year decline observed to have begun in 2008. The lower limit for the range of teen birth rates during this five-year period of 7.7 births per 1,000 women aged 15-19 represents the lowest teen birth rate observed this century in Connecticut. Declines across all three major race-ethnicity groups are also evident for the period 2015-2019, with annual rates of declines in teen birth rates in the non-Hispanic White, non-Hispanic Black/African American, and Hispanic populations during this period averaging 12.9%, 11.2%, and 6.6% per year, respectively. In the presence of these significant declines across all three major race-ethnicity groups in Connecticut, however, disparities by race and ethnicity nonetheless exist. For the period 2015-2019, the average annual teen birth rate of Hispanic women of 25.4 births per 1,000 women aged 15-19 was 8.9 times higher than the average rate for non-Hispanic White women of 2.8. The average annual teen birth rate among non-Hispanic Black/African American women of 14.5 births per 1,000 women aged 15- 19 for 2015-2019 was 5.1 times that of non-Hispanic White women.2

Prenatal Care

To assure optimal health outcomes for a pregnant woman and her child, preventive care is critical. Early and continuous prenatal care, including oral health care, throughout a woman’s pregnancy helps medical providers identify and treat health problems early. Doing so can support the health of the mother and provide unborn babies with as healthy of a start to life as possible.

Beginning prenatal care in the first trimester of pregnancy and following the prescribed visit schedule improves the likelihood of positive health outcomes for mother and baby.2 Infants whose mothers do not receive prenatal care are three times more likely to be born low birthweight and five times more likely to die compared to infants born to mothers who receive prenatal care.2 Early and regular prenatal care is protective against maternal and infant adverse outcomes, including infant mortality, low birthweight, and maternal complications. By receiving early and continuous care, early diagnosis, treatment, and prevention of health problems is more likely, and doctors can also discuss topics such as breastfeeding, infant safe sleep environment, and depression to help promote health and well-being in the postpartum period.

Healthy People 2030 aims for 80.5% of women to have early prenatal care. Connecticut has exceeded that goal (84.1% for 2019) and fares better than the U.S. as well (77.6% in 2019).2, 6 However, caution in comparing rates before and after 2016 is warranted due to changes in collection methods.  Due to shifts in rates between 2015 and 2016, reporting of long-term trends for timing of prenatal care initiation is limited to the years prior to 2016.2  In 2016, Connecticut adopted the 2003 Revision of the US Birth Certificate which included changes to how timing of prenatal care initiation was collected. Specifically, the 2003 Revision collects the date of the first prenatal care visit rather than the month of pregnancy during which prenatal care began. Due to these changes, rates based on prenatal care timing are not directly comparable between Revisions. Internal review by DPH suggests that reporting of date of prenatal care initiation, rather than month, yields more accurate estimates of timing of prenatal care initiation and thus rates for 2016 and later are considered to have slightly higher validity than those released prior to 2016. 

Rates of early prenatal care utilization for the entire population of Connecticut have been stable but differ by subgroups of women with 76.5% of Black non-Hispanic women, 88.4% of White non-Hispanic women, 65.4% of women under 20 and 87.0% of women age 30-34 receiving prenatal care in the first trimester in 20195.  

Singleton Low Birth Weight and Very Low Birth Weight

There was no change in the overall rate of singleton low birth weight (LBW) around an average value of 5.9% (range = 5.8 - 6.1%) for Connecticut, nor for non-Hispanic White and Hispanic populations, for the period 2015-2019. This result is consistent with an observed stable rate of singleton LBW, both overall and in these two race-ethnicities, since the mid-2000s, when rates stopped increasing. Singleton LBW rates for the non-Hispanic Black/African American population, on the other hand, declined during the 2015-2019 period, at a modest rate of 0.08 percentage points per year, as they had since 2003. Disparities among minority race-ethnicity groups have persisted. From 2015 to 2019, the average rate of singleton LBW infants among non-Hispanic Black/African American populations (9.9%) was 2.2 times higher than that among non-Hispanic White women (4.5%). The average rate of singleton LBW among Hispanic women (6.8%) was 1.5 times that of non-Hispanic White women.

Between 2015 and 2019, there was also no change for Connecticut overall in the rate of singleton very low birth weight (VLBW). There were some minor fluctuations across all three major race-ethnicity groups, but the rates remained largely unchanged and averaged 1.1% for the total population (range=1.0-1.1%). Disparities in rates of VLBW by race-ethnicity in Connecticut were more marked than those for LBW for the period 2015-2019. Average rates of VLBW for the non-Hispanic Black/African American population (2.4%) and Hispanic population (1.3%) were 3.8 and 2.1 times that of the non-Hispanic White population rate of 0.6%, respectively.7

State’s Systems of Care

The Connecticut Department of Social Services (DSS) is the single state agency for the administration of Connecticut Medicaid and the Children’s Health Insurance Program (CHIP).  Medicaid and CHIP are collectively described as the HUSKY Health Program. The DSS Division of Health Services as well as Eligibility Policy and field staff support access to and utilization of HUSKY Health.  These programs provide person-centered health care coverage to over 800,000 individuals. The vision of Medicaid and CHIP is to represent an effective health care delivery system for eligible people in Connecticut that promotes 1) well-being with minimal illness and effectively managed health conditions; 2) maximal independence, and 3) full integration and participation in their communities. HUSKY Health serves eligible children, their caregivers, older adults, individuals with disabilities and single, childless adults. HUSKY also provides limited coverage to a number of additional small groups (e.g. for family planning and tuberculosis coverage) and helps keep older adults and people with disabilities independent at home through Medicaid “waivers”.

Note:

Specific state statutes related to the MCH Block Grant authority (and impact to the state’s MCH and CSHCN programs) can be found as an attachment.

The State Health Assessment which serves as a 5-year roadmap for promoting and advancing population health in the State (highlighting the challenges faced around achieving health equity) can be found as an attachment.

The Connecticut Department of Public Health Agency and Section Organizational Chart can be found as an attachment.

1. United States Census Bureau, 2019 Data
2. United States Census Bureau, 2019 Data https://www.census.gov/quickfacts
3. U.S. Bureau of Labor and Statistics
4. The Connecticut Business & Industry Association: https://www.cbia.com/news/media-releases/cbia-response-december-2020-employment-report/
5. American Psychological Association: https://www.apa.org/pi/ses/resources/publications/minorities
6. National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health and Development. (2017). Pregnancy: About, from https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care
7. US Department of Health and Human Services; Office on Women’s Health. (2019). Prenatal Care, from https://www.womenshealth.gov/a-z-topics/prenatal-care