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Adverse health behaviors up among women; no progress made addressing low birthweight; and child mortality, teen suicide and drug deaths among women up

Chlamydia up among women with disparities across states and by race/ethnicity

Chlamydia incidence, a proxy for risky sexual activity, increased 2 percent since 2018 among females ages 15-44 from 1,609.0 to 1,639.8 new cases per 100,000 females and increased 5 percent since 2016 (from 1,559.0) (Figure 25). There were 61,822 more cases in 2019 than in 2016. Chlamydia has increased in 40 states and D.C. since 2016. Figure 26 shows the five states with the largest increases and the seven states with the largest decreases in chlamydia incidence since 2016. Delaware had the largest increase (306.0 more new cases per 100,000 females ages 15-44) and Alabama saw the largest drop (406.4 fewer new cases per 100.000 females ages 15-44).
Chlamydia is the most commonly reported sexually transmitted infection, with more than 1.7 million cases of chlamydia reported to the CDC in 2017. While wsomen usually have no symptoms, chlamydial infections can cause permanent damage to reproductive organs. Chlamydia in pregnant women can result in negative health outcomes for the baby, including premature delivery, low birthweight, eye infection and pneumonia.

Disparities and geographic variation
There are large disparities by race/ethnicity and across states. Chlamydia incidence among females ages 15-44 is 10.2 times higher among black (3,320.3) than Asian (325.8) females (Figure 27).

Excessive drinking up among women, with widespread disparities

Excessive drinking increased 11 percent since 2016 from 17.7 percent to 19.6 percent of women ages 18-44, an increase of nearly 1.2 million women (Figure 28). Six states had significant increases in excessive drinking (Figure 29). The largest increase occurred in Tennessee, increasing 50 percent.
According to the National Institute on Alcohol Abuse and Alcoholism, excessive drinking is the third leading cause of preventable death in the nation; an estimated 26,000 women die annually from alcohol-related causes. Excessive alcohol consumption among women is associated with increased risk of liver and heart disease, breast cancer and high blood pressure, and it is detrimental to mother and infant health. CDC notes, however, that most people who drink in excess do not have an alcohol use disorder.

Disparities and geographic variation
There are significant differences in excessive drinking among women ages 18-44 by age group, race/ethnicity, education, income (Figure 30) and across states. Since 2016, excessive drinking increased significantly among women ages 35-44 (13.6 percent to 15.7 percent). Significant increases also occurred during the same time frame among black (13.5 percent to 16.4 percent) and white (20.8 percent to 23.4 percent) women, those with some college (16.6 percent to 20.3 percent) and college graduates (19.8 percent to 21.2 percent), those with incomes of $50,000-$74,999 (18.2 percent to 22.1 percent) and those with incomes $75,000 or more (20.1 percent to 22.7 percent).

Obesity up among women of reproductive age, with widespread disparities

Obesity increased 6 percent since 2016 from 25.9 percent to 27.4 percent (Figure 31). The only state with a significant change since 2016 was Nebraska, where obesity increased 16 percent (from 25.8 percent to 29.8 percent).
According to CDC, adults with obesity are more likely to have decreased quality of life and an increased risk of serious health conditions. Obesity impacts reproductive health; it is associated with reduced fertility and contraception effectiveness. Obesity can have a negative effect on mother and infant health by contributing to gestational hypertension and diabetes; birth complications (preeclampsia, C-section and postpartum hemorrhage); miscarriage; stillbirth; and neonatal mortality.
Disparities and geographic variation
There are significant differences in obesity prevalence among women ages 18-44 by age group, race/ethnicity, education, income (Figure 32) and across states. Since 2016, the prevalence of obesity increased significantly among women ages 18-24 (16.0 percent to 18.0 percent), American/Alaska Native (32.5 percent to 42.9 percent) and white (23.3 percent to 25.0 percent) women, and high school (36.2 percent to 39.2 percent) and college (18.2 percent to 20.0 percent) graduates . Obesity increased significantly across all annual household income-levels except among women making less than $25,000, who have the highest prevalence of all income groups at 40.3 percent.

No progress addressing low birthweight, with widespread disparities

Low birthweight increased 2 percent since 2018 from 8.1 percent to 8.3 percent of live births (Figure 33). Since 2016, the largest increase occurred in Nebraska (+0.9 percentage points), and the greatest decrease, though not substantial, occurred in Maine and Wyoming (both -0.5 percentage points).
According to CDC’s Division of Vital Statistics, low birthweight infants are at increased risk of infant mortality. Low birthweight is associated with multiple health conditions in infants and additional health problems during childhood and adulthood. The average hospital cost for a low birthweight infant is estimated to be $27,200, compared with $3,200 on average for all babies, according to the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project.
Disparities and geographic variation
The percentage of mothers with a low birthweight infant differs by maternal age group, race/ethnicity, education (Figure 34) and across states. The percentage of mothers with low birthweight babies is 1.4 times higher among mothers ages 40-44 (10.9 percent) than younger mothers (mothers ages 25-29 and 30-34, both 7.7 percent).

Child mortality, teen suicide and drug deaths among women of reproductive age up

Child mortality up with disparities across states and by age group, gender and race/ethnicity

Child mortality increased 6 percent since 2016 from 24.3 to 25.7 deaths per 100,000 children (Figure 35). Eight states experienced significant increases since 2016 (Figure 36), notably Alaska with a 37 percent increase (33.1 to 45.4 deaths).
According to Child Trends, child mortality had been declining since 1980, with rates among children ages 1-4 and 5-14 declining until 2017. Death rates for teens ages 15-19 declined from 1980 to 2013. CDC’s Division of Vital Statistics reported there were 20,337 deaths among children ages 1-19 in 2017. Among children and adolescents, motor vehicle crashes are the leading cause of death, followed by firearm-related injuries and cancer, according to a recent study.

Disparities and geographic variation
Child mortality rates differ significantly by age group, gender and race/ethnicity (Figure 37) as well as across states. Child mortality rates are 3.8 times higher among children ages 15-19 (50.3) than children ages 5-14 (13.4). Figure 38 shows this disparity has grown. Since 2016, there was no significant change in the rate among children ages 1-4, a 5 percent increase among children ages 5-14 (12.8 to 13.4 deaths per 100,000) and a 10 percent increase among children ages 15-19 (45.8 to 50.3 deaths per 100,000). The child mortality rate is 1.8 times higher among males than females. Both experienced significant increases since 2016, males from 30.7 to 32.6 deaths per 100,000 and females from 17.5 to 18.5 deaths per 100,000. Since 2016, child mortality increased 5 percent among white (23.5 to 24.6 deaths per 100,000) and Hispanic children (19.7 to 20.6 deaths per 100,000), and 11 percent among black children (36.1 to 40.0 deaths per 100,000) (Figure 39). Increases among Asian and American Indian/Alaska Native children were not significant due to large confidence intervals.

Teen suicide up with large disparities across states and by gender and race/ethnicity

Teen suicide increased 25 percent since 2016 from 8.4 to 10.5 deaths per 100,000 teens (Figure 40). Since 2016, significant increases occurred in seven states (Figure 41). The largest increase occurred in Colorado, increasing 58 percent.
According to CDC’s Division of Violence Prevention, suicide was the second leading cause of death among teens ages 15-19 in 2016. Far more adolescents have suicidal thoughts or attempt suicide and survive than those who die by suicide. Results from the 2017 Youth Behavioral Risk Factor Surveillance System show that in the past year 17.2 percent of high school students seriously considered attempting suicide and 7.4 percent attempted suicide.

Disparities and geographic variation
Teen suicide varies by gender, race/ethnicity (Figure 42) and across states. Teen suicide is 3.1 times higher among males (15.7 deaths per 100,000 teens) than females (5.1 deaths per 100,000). Both significantly increased since 2016, with females increasing 28 percent (4.0 to 5.1 deaths per 100,000) and males increasing 24 percent (12.7 to 15.7 deaths per 100,000) (Figure 43). Teen suicide also increased significantly since 2016 among Hispanic (30 percent increase from 5.6 to 7.3 deaths per 100,000), black (46 percent increase from 4.6 to 6.7 deaths per 100,000), and white (37 percent increase from 9.3 to 12.7 deaths per 100,000) teens.

Drug deaths up among females, with disparities across states and by age group and race/ethnicity

Drug deaths increased 36 percent since 2016 from 12.0 to 16.3 deaths per 100,000 females ages 15-44 (Figure 44). During this time, drug deaths increased significantly in 27 states, shown in blue in Figure 45.
According to U.S. Drug Enforcement Administration’s 2018 National Drug Threat Assessment report, drug overdose deaths have risen steadily in the United States over the past two decades and have become a leading cause of injury death. The alarming rise is fueled largely by an epidemic of opioid overdoses, accounting for nearly seven in 10 drug overdose deaths in 2017, reports CDC. According to the American College of Obstetricians and Gynecologists, drug use during pregnancy can result in the child developing neonatal abstinence syndrome as well as placental growth issues, preterm labor, miscarriage and stillbirths.

Disparities and geographic variation
The drug death rate among women of reproductive age varies by age group, race/ethnicity (Figure 46) and across states. The rate is 3.3 times higher among females ages 35-44 (23.0 deaths per 100,000) than women ages 15-24 (6.9). The differences in drug death rates by race/ethnicity have increased since 2016 (Figure 47). Since 2016, drug deaths increased 69 percent among black females (6.1 to 10.3 deaths per 100,000), 64 percent among white (14.1 to 23.1) and 31 percent among Hispanic (4.5 to 5.9) females.

Maternal mortality a national concern

Maternal mortality is defined as the number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within one year of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 births (5-year estimate).
The U.S. has the highest maternal mortality rate of all developed countries and is the only industrialized nation with a rising rate. According to CDC’s Pregnancy Mortality Surveillance System, maternal mortality has increased dramatically since 1987 — when surveillance was first implemented. Nationally, the maternal mortality rate is 29.6 deaths per 100,000 live births. The estimates provided in this report are calculated using death certificate data. Estimates of maternal mortality released by states my differ.
Disparities and geographic variation
Large differences in maternal mortality rates exist by race/ethnicity, maternal age group (Figure 48) and across states. Maternal mortality is 3.2 times higher among mothers ages 35-44 (51.5 deaths per 100,000 live births) than mothers ages 15-24 (15.9), 3.8 times higher among black (63.8) than Asian/Pacific Islander (17.0) women and 5.8 times higher in Louisiana (72.0) than Alaska (12.4).

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