Health Status and Demographics

Connecticut (CT) is a small state of about 5,000 square miles and 169 towns, and in 2021 had an estimated statewide population of 3,623,3551. Five towns had a population greater than 100,000 and included: Bridgeport (148,333), Stamford (136,309) New Haven (135,081), Hartford (120,576), and Waterbury (113,811)2. About 15% 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 is approximately =12,500)2.

The State of CT is characterized by high social and economic contrasts. The state median household income (in 2021 dollars) was $ 83,771 and the poverty rate is 10.1%. The median household income of the five large towns in CT varied widely from a low of $42,468 in Hartford, to moderate levels in Waterbury ($48,793), Bridgeport ($46,445) and New Haven ($50,569), and to a high of $100,543 in Stamford3. Among the five largest towns in CT from 2010 to 2020, the population of Stamford grew the fastest, with a population increase of almost 13,000 people, followed by the towns of New Haven, Waterbury, and Bridgeport with an increase of a little over 4,000. The town of Hartford showed a decrease in population. The overall State population increased by almost 32,000 people1.

In December 2022, the seasonally adjusted unemployment rate in Connecticut was estimated to be 4.2%, which was much lower than the 2020 unemployment rate of 8.2% but still higher than the US seasonally adjusted unemployment rate in December 2022 at 3.5%4. In November of 2022, there was a positive job gain of 2,900 (0.2%) and private sector employment was up 2.2% from December 20215.

In CT during 2021, 64.6% of the population was non-Hispanic White. Among racial and ethnic minorities, the percentages were: 17.7% Hispanic/Latino, 12.7% non-Hispanic Black/African American, 5.1% non-Hispanic Asian, and 2.6% were two or more races. CT’s largest towns had greater racial and ethnic diversity than CT overall. For example, 36.4% of Hartford’s population was non-Hispanic Black/African American, and 34.7% of Bridgeport’s population was non-Hispanic Black/African American. The Hispanic population accounted for approximately 45.5% of the population in Hartford, and 41.7% in Bridgeport 1.

In 2021, about one in six residents (18.0%) was 65 years of age or older. About one in five CT residents (20.2%) 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 42.2% statewide. These statistics have policy implications for women of childbearing age and young mothers6.

Between 2017-2021, 91.1% of CT adults had completed high school or had a GED, and 40.6% 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 attainment1.

Relative to the general population, a different pattern of demographics exists among children living in CT. In 2021, 12.7% of children under 18 years were living below poverty level in the past 12 months. Among CT residence, 4.6% receive Supplemental Security Income (SSI), and 11.7% receive Food Stamp/SNAP benefits. 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 2021 was 31.9% in Bridgeport, 35.0% in Waterbury, 24.9% in New Haven, and 32.4% in Hartford. Other towns, however, also exhibited a high percent of childhood poverty. These towns included: New London (46.4%), Willimantic (36.3%), New Britain (30.6%), Ansonia (23.5%), and Derby (23.6%) 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 state6.

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.

Maternal and Child Demographics

Overall, in 2021, the State of Connecticut was 64.6% non-Hispanic White,17.7% Hispanic/Latino, 12.7% non-Hispanic Black/African American, 5.1% non-Hispanic Asian, and 2.6% were two or more races1. At the end of 2022, the unemployment rate was 4.2%4.

Just over half (54.4%) of women who gave birth in Connecticut in 2021 (provisional) were non-Hispanic White, 26.6% were Hispanic, 12.9% were non-Hispanic Black, and 5.6% were non-Hispanic Asian.5 

Overall, the State of Connecticut is 64.6% non-Hispanic White.  However, non-Hispanic White women make up a smaller percentage of those giving birth, at 54.4%.  Most women giving birth (91.4%) 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 (29.4%).7

Disparities are also prevalent prior to pregnancy. Non-Hispanic Black and Hispanic women were more likely than non-Hispanic White mothers to report having a checkup with their family doctor 12 months prior to pregnancy (66.7% among non-Hispanic Black, 61.1% among Hispanic, 51.9% among non-Hispanic White women). The proportion of mothers who had a checkup with an OB-GYN prior to pregnancy was 76.0%, which varied by race and ethnicity. Proportions were lower among Hispanic (71.0%), non-Hispanic Asian (62.3%), and non-Hispanic mothers of other or unknown race (64.7%), compared to non-Hispanic White mothers (79.3%). Additionally, the proportion was lower for non-Hispanic Asian mothers compared to non-Hispanic Black mothers (76.3% among non-Hispanic Black mothers). Only 20.5% of women reported having a visit for family planning or birth control 12 months prior to pregnancy, which did vary by race and ethnicity. A visit for family planning or birth control was lower among those who were non-Hispanic Black and non-Hispanic other or unknown race (14.8% and 15.3%) compared to those who were non-Hispanic White (22.4%). Only 1 out 3 women (33.7%) had a preconception health visit in the 12 months before pregnancy where they discussed with a doctor, nurse, or other health care worker how to improve their health before a pregnancy. There was no statistical difference between race and ethnicity groups.8

Infant Mortality

The Connecticut annual infant mortality rate (IMR, reported as deaths per 1,000 live births) averaged 4.5 (range: 4.3 - 4.7) during the period 2017-2021. The annual overall (i.e., total population) IMRs for this five-year period declined by 2.3% annually, consistent with long-term decline since 2005. 2021-updated trend analysis of IMRs also showed declines for all of the largest races and ethnicities in the state 2017-2021, at rates of 2.5% (non-Hispanic Black/African American), 2.0% (Hispanic), and 2.8% (non-Hispanic White) per year.  Annual IMRs in Connecticut’s non-Hispanic White population averaged 3.1 deaths per 1,000 live births 2017-2021 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 9.4 deaths per 1,000 live births, and those for Hispanic populations averaged 5.4 deaths per 1,000 live births. The averages were 3.1 and 1.8 times higher, respectively, than that for Connecticut’s non-Hispanic White population.7

Births to Teens

The 2017-2021 annual overall teen birth rates in Connecticut averaged 8.0 (range = 7.3 – 8.9, reported as live births per 1,000 women aged 15-19) and continued long-term declines over the previous two decades that ranged between 1.3 and 10.8% annual decline.  2021-updated trend analysis shows an annual rate of decline for 2017-2021 of 5.2%. The lower limit for the range of teen birth rates during this five-year period of 7.3 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 2017-2021, 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 11.8%, 4.9%, and 6.1% 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 2017-2021, the average annual teen birth rate of Hispanic women of 22.8 births per 1,000 women aged 15-19 was 9.6 times higher than the average rate for non-Hispanic White women of 2.4. The average annual teen birth rate among non-Hispanic Black/African American women of 12.2 births per 1,000 women aged 15- 19 for 2017-2021 was 5.1 times that of non-Hispanic White women.7

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. 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.10 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 (84.7% for 2021 [provisional]) and fares better than the U.S. as well (77.6% in 2021).7, 9 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 2016.5  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 79.6% of Black non-Hispanic women, 88.8% of White non-Hispanic women, and 78.4% for Hispanic women.7

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 6.1% (range = 5.9 - 6.3%) for Connecticut, nor for non-Hispanic White and Hispanic populations, for the period 2017-2021. 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 were also stable 2017-2021, but this recent period of rate stability is a previous period of decline 2003-2014. Disparities among minority race-ethnicity groups have persisted. From 2017 to 2021, the average rate of singleton LBW infants among non-Hispanic Black/African American populations (10.3%) was 2.3 times higher than that among non-Hispanic White women (4.5%). The average rate of singleton LBW among Hispanic women (6.9%) was 1.5 times that of non-Hispanic White women.

Between 2017 and 2021, the rate of singleton very low birth weight (VLBW) averaged 1.0% for the total population (range=1.0-1.1%), while decreasing as part of a long-term declining trend (since 2003) of 0.01% annually.  Recent declines in rates of VLBW 2017-2021 consistent with long-term declines at 0.03% and 0.01% annually were specifically evident for non-Hispanic Black and non-Hispanic White populations, respectively. However, VLBW rates 2017-2021 remain largely unchanged for the Hispanic population of the state. Disparities in rates of VLBW by race-ethnicity in Connecticut were more marked than those for LBW for the period 2017-2021. Average rates of VLBW for the non-Hispanic Black/African American population (2.4%) and Hispanic population (1.3%) were 4.1 and 2.2 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:

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.

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1. United States Census Bureau: QuickFacts, 2020 2021 Data
2. United States Census Bureau, City and Town Population Totals: 2020-2021. Accessed from https://www.census.gov/data/datasets/time-series/demo/popest/2020s-total-cities-and-towns.html on 1/31/2023.
3. United States Census Bureau, State Profiles. Accessed from https://data.census.gov/profile?g=0400000US09  on 1/31/2023.
4. U.S. Bureau of Labor and Statistics https://www.bls.gov/regions/news-release-finder.htm?states=CT
5. The Connecticut Business & Industry Association: https://www1.ctdol.state.ct.us/lmi/laborsit.pdf
6. U.S. Census Bureau, 2021 American Community Survey 1-Year Estimates. Accessed from https://data.census.gov/table?q=children+under+18+years+were+living+below+poverty+level+&g=0400000US09,09$1600000&tid=ACSST1Y2021.S1701 on 2/7/2023.
7. CT DPH Health Statistics and Surveillance Section, Births Dataset
8. Connecticut Department of Public Health. Connecticut Pregnancy Risk Assessment Monitoring System (PRAMS) 2020 Data Report.
9. Healthy People 2030 https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-proportion-pregnant-women-who-receive-early-and-adequate-prenatal-care-mich-08 .
10. U.S. Department of Health and Human Services Office on Women’s Health, (2021) Prenatal care, available at https://www.womenshealth.gov/a-z-topics/prenatal-care