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 3,595,287[i]. 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)[ii]. 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 Stamford 2. 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 population 2.
In June 2020, the seasonally adjusted unemployment rate in Connecticut was estimated to be 9.8% (seasonally adjusted. The US jobless rate in June 2020 was 11.1%. Connecticut has lost 259,500 jobs (-15.3%) through the first five months of the year, with employment falling to 1,434,000—the lowest in more than two decades. Most of the year's declines were in the private sector[iii]. It is important to note that these figures may be underestimated due to problems in accurate reporting during the current COVID-19 pandemic.
In CT during 2018, 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, 36.9% of Hartford’s population was non-Hispanic Black/African American, and 35.3% of Bridgeport’s population was non-Hispanic Black/African American. The Hispanic population accounted for approximately 44.5% of the population in Hartford, and 40.0% in Bridgeport 2.
In 2018, about one in six residents (17.7%) was 65 years of age or older. About one in five CT residents (20.4%) in 2018 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 43.2% statewide. These statistics have policy implications for women of childbearing age and young mothers 2.
Between 2014-2018, 90.5% of CT adults had completed high school or had a GED, and 38.9% 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 attainment.[iv]
Relative to the general population, a different pattern of demographics exists among children living in CT. Between 2013-2017, 14.1% of children under 18 years were living below poverty level in the past 12 months and 20.8% of children under 18 years were living in households with Supplemental Security Income (SSI), cash public assistance income, or Food Stamp/SNAP benefits 4. 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. The percent of childhood poverty between 2013-2017 was 10.2% in Stamford. One in three children in Bridgeport, Waterbury, and New Haven lived in poverty, and 40.7% of all children in Hartford lived in poverty. Other towns, however, also exhibited a high percent of childhood poverty. These towns included: New London (43.9%), Willimantic (38.2%), New Britain (34.6%), Ansonia (27.2%), and Derby (18.0%) 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 2018, the State of Connecticut was 66% non-Hispanic White, 10% non-Hispanic Black, 16% Hispanic (8% Puerto Rican), 5% non-Hispanic Asian, and 3% non-Hispanic Other race (Data.census.gov). In 2019, the unemployment rate was under 4% (U.S. Bureau of Labor Statistics).
Just over half (52.4%) of women who gave birth in Connecticut in 2016-2018 were non-Hispanic White, one quarter were Hispanic, 12.2% were non-Hispanic Black, and 10.2% were non-Hispanic Other race. Hispanic and non-Hispanic Black women were disproportionately likely to reside in a female-headed household.
Overall, the State of Connecticut is 66% non-Hispanic White. However, non-Hispanic White women make up a smaller percentage of those giving birth, at 52.4. Most women giving birth (72.2%) had over 12 years of education and were married (63.4%). Just over half of these mothers were considered ‘not poor,’ living at over 200% of the federal poverty line (FPL).
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. About 75-80% of women who were non-Hispanic White or non-Hispanic Other races were covered by private health insurance, while only 50.4% of Black and 33.6% of Hispanic women were. Over 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 patterns.[v] 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 4.6 deaths per 1,000 live births in 2017 down from 5.9 deaths per 1,000 live births in 2005 – a decrease of about 2.4% 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 2010.[vi]
Reductions in the state IMR are driven by declines across many subgroups. Declines were observed among all race and ethnicity subgroups (except non-Hispanic Asian infants for which counts were too small for analysis) and were strongest among Connecticut’s highest risk group, non-Hispanic Black residents, who showed an average decrease of 2.8% annually. Since 2005, IMRs among infants to mothers with private insurance have declined at about 3.5% each year. IMRs for babies with mothers on Medicaid declined quite markedly from 2005-2011 at about 6.8% annually but then plateaued from 2011 to 2017. Among infants born to mothers aged 25-39 years, IMRs declined from 2005-2017 while infants born to women under 25 years and over 40 years did not have any long-term trend changes during those years.
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.[vii] Nonetheless, there is still work to be done. Non-Hispanic Black infants, at 9.9 deaths per 1,000 live births, were more than three times as likely to die and Hispanic infants, at 4.9 deaths per 1,000 live births, were 1.5 times more likely to die than non-Hispanic White infants, at 3.0 deaths per 1,000 live births, in Connecticut in 2017. Infants born to mothers under 25 years of age were almost twice as likely to die as babies born to mothers 35-39 years old (2013-2017 births).
Births to Teens
Connecticut ranks 3rd lowest for Teen Birth Rate in the United States.[viii] Over the past two decades, teen births in Connecticut declined three-fold overall and declined among teens of all races/ethnicities. These declines mirror national trends. Despite the decrease in rates, disparities between racial/ethnic groups remain stable, with Hispanic teens 10 times more likely and Black teens 5.6 times more likely than White teens to have a teen birth in 2018.
In 2018, the birth rate among teens ages 15-19 by race/ethnicity were 8.2 births per 1,000 female teens overall, with 24 births per 1,000 for Hispanic female teens, 13.6 births per 1,000 for non-Hispanic Black female teens, 2.4 births per 1,000 for non-Hispanic white female teens, and 1.3 births per 1,000 for non-Hispanic Asian female teens.[ix]
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.[x] 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.[xi] 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 aims for 77.9% of women to have early prenatal care. Connecticut has exceeded that goal for the past three years (84.0% for 2016-2018) and fares better than the U.S. as well (77.0% in 2016 and 2017).[xii],9 Percentages of women receiving early prenatal care also appear to have been higher than the Healthy People 2020 goal of 77.9% for years before 2016, with the minimum percentage of 85.4% occurring in 2001. 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.[xiii] 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 were stable from 2000 to 2015. Many subgroups of women have shown no appreciable change in rates of early prenatal care. For the period 2000-2015, percentages of early prenatal care initiation were stable for non-Hispanic Asian (88.2%) women, mothers aged 25 years and older, and mothers with private insurance (92.6%). Among women with Medicaid as payer, rates declined between 2000 and 2006, but held stable (72.5%) between 2006 and 2015. Improvement did occur among women under 25 years of age and among Hispanic women (76.5% to 83.1%). Improvement also occurred in non-Hispanic Black populations beginning in 2006 and through 2015 (74.7% to 81.8%). Non-Hispanic White women showed a modest decline from 93.5% to 91.0% between 2000 and 2013.
Singleton Low Birth Weight and Very Low Birth Weight
Among singleton births in Connecticut between 2013-2017, non-Hispanic Black women had the highest rate of LBW infants (10.1%), followed by Hispanics (6.9%), and non-Hispanic Whites (4.2%), with no change in rank over time. For infants with Very Low Birth Weight, 88.2% were delivered in facilities for high risk deliveries and neonates in Connecticut in 2018 (Vital Records).
Non-Hispanic White and Hispanic women on Medicaid (6.2% and 7.2%) were more likely to have a low birthweight singleton baby when compared to women with private insurance coverage (3.8%), but there was no evidence to suggest such a difference for non-Hispanic Black (10.1%) and non-Hispanic Asian (7.0%) women, a pattern similar to those for rates of preterm birth. Trends in singleton low birthweight for women on Medicaid have improved from 10.0% to 7.9% between 2001 and 2014 but have since stabilized at an average of 7.7% in recent years. Rates of singleton low birthweight for women with private insurance remained stable around an average of 4.6% for the period 2001-2018.
Much like preterm birth, the likelihood of low birthweight increases toward both the younger (7.5% of live births) and older ends (6.1% of live births) of the maternal age spectrum. Similar to preterm birth rates, women ages 25-34 are the least likely (5.4% of live births) to have a low birthweight baby in Connecticut.
While preterm and low birthweight rates have similar patterns overall and among subgroups of women, differences between the two outcomes exist when comparing maternal age groups over time. Singleton preterm birth rates across maternal age groups (teenagers, 20-34 year-olds, and 35-54 year-olds) have shown steady declines over the period 2000-2018. In contrast, overall rates of singleton low birthweight have remained steady over that same period and have increased among both the lowest risk age group (20-34 year-olds) and the intermediate risk age group (35 years and older). Reasons behind an apparent rise in the rate of singleton low birthweight in mothers outside of the teenage age group warrants further investigation and monitoring in Connecticut.
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”.
Current Initiatives
DPH supports/coordinates a number of projects to reduce adverse maternal and child health outcomes and to address racial and ethnic disparities in these outcomes. The majority of the current initiatives are organized by domain, however, it should be noted that many of the initiatives have impact across multiple domains. These activities include the following:
- The CT Maternal and Child Health (MCH) Coalition supports the Maternal and Child Health Block Grant (MCHBG) in monitoring state MCH population needs as well as identifying appropriate state priorities. The CT MCH Coalition is made up of over 130 stakeholders that meet quarterly and are dedicated to improving the health of mothers, infants and children statewide. The Maternal, Infant and Child Health (MICH) focus area of the State Health Improvement Plan is supported by a subset of members from the MCH Coalition. The MICH focus area directly impacts and supports the MCHBG activities in several areas including perinatal/infant health, child health, children with special health care needs, and oral health.
- DPH completed the 2020 update of the State Health Needs Assessment. The report will be released this summer as the State Health Improvement Plan (SHIP) Coalition launches a series of planning workshops to advance the health improvement plan update. A DPH team is working with partners across the state to design the framework of the Healthy CT 2025 State Health Improvement Plan for its release in 2021. The development of the plan involves multiple virtual meetings and webinars to discuss priority areas and cross-cutting themes. The plan’s strategies will focus on policy, systems, and environmental changes to address upstream causes of poor health. The priorities under consideration include: a) access to health services and primary healthcare, b) economic stability, particularly around issues of poverty and employment, c) access to healthy eating and issues of food security, d) housing quality and stability, and e) community resilience as it relates to crime/violence and emergency preparedness. In addition to launching Healthy Connecticut 2025, DPH is undergoing preparations for its reaccreditation application due by the first quarter of 2022.
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
[i] United States Census Bureau, 2019 Data
[ii] United States Census Bureau, 2019 Data https://www.census.gov/quickfacts
[iii] U.S. Bureau of Labor and Statistics
[iv] U.S. Census Bureau, 2013-2018 American Community Survey 5-Year Estimates
[vi] U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. (2018). Maternal, infant, and child health. Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives.
[vii] Brown Speights, J. S., Goldfarb, S. S., Wells, B. A., Beitsch, L., Levine, R. S., & Rust, G. (2017). State-level progress in reducing the Black–White infant mortality gap, United States, 1999–2013. American Journal of Public Health, 107(5), 775-782.
[viii] Power to Decide. Connecticut Data. https://powertodecide.org/what-we-do/information/national-state-data/connecticut
[ix] CT DPH Office of Vital Records and Surveillance Analysis and Reporting Unit, Birth Registry. 2000-2017 and provisional 2018 data
[x] 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
[xi] 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
[xii] Martin, J. A., Hamilton, B. E., Osterman, M. J., Driscoll, A. K., & Drake, P. (2018). Births: final data for 2016. Hyattsville, MD: National Center for Health Statistics.
[xiii] Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., & Munson, M. L. (2005). Births: final data for 2003. Hyattsville, MD: National Center for Health Statistics.
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