The March of Dimes releases their annual report card on the United States and prematurity. Plus: Can anything be done about HPV vaccine rates? Also, a look at the place of ultrasound in breast cancer detection.
Rates of preterm birth in the United States declined from 11.5% in 2013 to 9.6% overall in 2014, according to a new March of Dimes report. The country received a grade of “C” yet again-one of the worst scores recorded among high-resource nations-however, on the organization’s 8th annual report card on prematurity.
For the first time this year, the March of Dimes Premature Birth Report Card provides data not only on all 50 states, Puerto Rico, and the District of Columbia but also on rates of prematurity in cities and counties. With a rate of 7.2% and a grade of “A,” Portland, Oregon had the best preterm birth rate of the top 100 cities with the most births nationwide. Shreveport, Louisiana had the worst ranking, with a grade of “F” and an 18.8% rate of preterm births.
The city statistics in the report are from 2013, the most recent year for which information was available from the National Center for Health Statistics (NCHS). The data at the state level and from the District of Columbia are from 2014 and also taken from the NCHS natality files.
In the report, preterm birth was defined as birth <37 weeks’ gestation based on the obstetric estimate of gestational age. A grade of “A” meant a preterm birth rate ≤8.1%, “B” was a rate of 8.2% to 9.2%, “C” was a rate of 9.3% to 10.3%, “D” was a rate of 10.4% to 11.4%, and a grade of “F” was a preterm birth rate ≥11.5%.
Idaho, Oregon, Vermont, and Washington earned “A” grades, 19 states earned a “B,” 18 states and the District of Columbia got a “C,”, 6 other states got a “D,” and an “F” was earned by Alabama, Louisiana, Mississippi, and Puerto Rico. Other cities that received “A” grades were Oxnard, California; St. Paul, Minnesota; and Seattle, Washington.
Looking at the influence of race and ethnicity on prematurity, the March of Dimes found that overall, blacks had the highest rates of preterm birth at 13.4%, followed by Native Americans (10.4%), Hispanics (9.3%), whites (9.1%), and Asians (8.7%). At a state level, racial and ethnic disparities had the greatest impact in the District of Columbia and the least impact in Maine.
Why is the HPV vaccination rate still so low?
A new report from the Centers for Disease Control and Prevention (CDC) indicates that, despite educational programs and guidance from doctors about the human papillomavirus (HPV) vaccine, rates of vaccination among US girls are still too low.
Researchers from the CDC and the National Committee for Quality Assurance looked at vaccination data from more than 626,000 13-year-old girls who were insured through either private insurance plans or Medicaid in 2013. The HEDIS HPV Vaccine for Female Adolescents performance measure was used to evaluate the proportion of female adolescent members in commercial and Medicaid health plans who received the recommended 3-dose HPV vaccination series by age 13 years.
The commercially available plans provided 3 doses of the HPV vaccine to a median of 12% of adolescent girls by age 13 years, with little between-plan variation in performance. By comparison, Medicaid plans had significantly higher rates of HPV coverage, with a median of 19% of female teenagers receiving all 3 doses, and more between-plan variation. The highest performance rate in a commercial plan was 34% versus 52% for a Medicaid plan. All of the high-performing plans were health maintenance organizations.
The CDC researchers noted 5 limitations for the report. The data covered people who were insured by a health plan; the results could not be adjusted to account for population differences such as socioeconomic status and health literacy; plans could cover multiple Department of Health and Human Services regions, which could over-represent plans covering large geographic areas; information about parental refusal or concerns about the HPV vaccine were not assessed; and reporting of the data was voluntary.
Research into why the health plans with the highest performance rates were able to achieve such high levels of coverage was recommended by the report’s authors. More study on the barriers to widespread adoption of HPV vaccination also is warranted.
A place for ultrasound in breast cancer detection?
According to a Japanese randomized trial, the addition of ultrasound to mammography may lead to more sensitive screening for a higher rate of detection of early breast cancers.
Between July 2007 and March 2011, the researchers enrolled asymptomatic women between 40 to 49 years at 42 study sites located in 23 prefectures across Japan in the Japan Strategic Anti-cancer Randomized Trial. The women had no history of cancer in the 5 years prior to enrollment and were expected to live for more than 5 years.
Participants were randomly assigned in a 1:1 ratio to either mammography and ultrasonography or mammography alone twice in 2 years. Of the 72,998 women in the study, 36,859 were assigned to the intervention group and 36,139 to the control group.
The investigators found that sensitivity was significantly higher in the intervention group (91.1%) than in the control group (77.0%), but specificity was higher in the control group (91.1%) than in the intervention group (87.3%). The intervention group also had more cancers detected than did the control group (184 vs 117, P = 0.0003) and the disease was more often stage 0 or I (144 vs 79, P = 0.0194). In addition, 18 interval cancers were found in the intervention group compared to 35 in the control group.
The researchers concluded that using ultrasound in addition to mammography could increase the sensitivity and detection of early cancers.