North Carolina VITAL STATISTICS 2001

North Carolina VITAL STATISTICS 2001 VOLUME 1: Births Deaths Population Marriages Divorces N.C. Department of Health and Human Services Division of Public Health State Center for Health Statistics 1908 Mail Service Center Raleigh, NC 27699-1908 (919) 733-4728 www.schs.state.nc.us/schs/ i

STATE OF NORTH CAROLINA Michael F. Easley, Governor DEPARTMENT OF HEALTH AND HUMAN SERVICES Carmen Hooker-Odom, Secretary DIVISION OF PUBLIC HEALTH Leah Devlin, D.D.S., M.P.H., Acting Health Director STATE CENTER FOR HEALTH STATISTICS Gustavo Fernandez, Ph.D., Director Edited by: Manjoo Mittal Other Contributors: Paul Buescher Dianne Enright Ziya Gizlice Michelle Lown Jean Stafford December 2002 550 copies of this public document were printed at a cost of $2,838.10 or $5.16 per copy. ii

TABLE OF CONTENTS I. INTRODUCTION... 1-1 II. GEOGRAPHICAL PATTERNS IN VITAL STATISTICS... 1-5 Page III. REGISTRATION OF VITAL EVENTS... 1-15 Birth and Death... 1-15 Fetal Death... 1-15 Marriage and Divorce... 1-15 IV. TECHNICAL NOTES... 1-17 Residence Allocation... 1-17 Occurrence Allocation... 1-17 Race or Color Allocation... 1-17 Completeness of Registration of Vital Events... 1-17 Accuracy of Items on Certificate... 1-18 Treatment of Missing Values... 1-18 V. POPULATION BASES AND BIASES IN VITAL STATISTICS RATES... 1-19 VI. DEFINITIONS AND FORMULAS... 1-21 SYMBOLS... 1-26 REFERENCES... 1-27 TABLES State... 2-1 Perinatal Care Regions... 3-1 Counties... 4-1 COVER: The pen and ink drawing of the lighthouse at Baldhead Island is used by permission of the artist, Jerry Miller of Cary. iii

I. INTRODUCTION This volume is the 86th annual vital statistics report of the State of North Carolina. It is intended to serve as a basic resource to those individuals, institutions, and agencies delivering and/or planning health services for the citizens of North Carolina. The tables of this report show annual frequencies, annual rates, and 5-year rates for the state, six Perinatal Care Regions, and the 100 counties of North Carolina. Due to incompleteness of the data and potential problems with accuracy, information for cities is not shown. The reader may obtain vital statistics for cities in North Carolina by special request to the Center. Section II contains maps depicting county data. Sections III-VI contain description and discussion of the terms and procedures underlying the tabular and graphical data presented. Other publications available through this office are described on the back of the front cover. If you want copies of these publications, contact us at (919) 733-4728 or address correspondence to: State Center for Health Statistics Department of Health and Human Services 1908 Mail Service Center Raleigh, North Carolina 27699-1908 Caution: Any percentage or rate with a small number of events in the numerator will have substantial random variation over time. A rule of thumb is that any percentage or rate with fewer than 20 events in the numerator may be subject to serious random error. Therefore, many of the percentages and rates in this volume should be interpreted with caution. 1-1

Trends depicted in the graphs are for North Carolina and the United States. Data for the U.S. are from the National Center for Health Statistics. Rate per 1,000 Population 20 LIVE BIRTHS 1981-2001 10 LOW-WEIGHT BIRTHS 1981-2001 Percent of Live Births 18 16 8 14 12 6 10 8 4 6 4 2 0 United States North Carolina 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year 2 United States North Carolina 0 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year Percent of Live Births 35 OUT-OF-WEDLOCK LIVE BIRTHS 1981-2001 30 25 20 15 10 5 United States North Carolina 0 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year 1-2

10 TOTAL MORTALITY 1981-2001 Rate per 1,000 Population 20 INFANT MORTALITY 1981-2001 Rate per 1,000 Live Births 18 8 16 14 6 12 10 4 8 6 2 United States North Carolina 0 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year 4 2 United States North Carolina 0 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year WHITE PERINATAL AND POSTNEONATAL MORTALITY NORTH CAROLINA Rate 1981-2001 12 10 8 6 4 2 0 Fetal Neonatal Postneonatal 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year MINORITY PERINATAL AND POSTNEONATAL MORTALITY NORTH CAROLINA Rate 1981-2001 20 18 16 14 12 10 8 6 4 2 0 Fetal Neonatal Postneonatal 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year 1-3

MARRIAGE RATES 1981-2001 DIVORCE RATES 1981-2001 Rate per 1,000 Population 14 Rate per 1,000 Population 6 12 5 10 8 4 3 6 4 2 United States North Carolina 0 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year 2 1 United States North Carolina 0 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 Year 1-4

II. GEOGRAPHICAL PATTERNS IN VITAL STATISTICS This section contains nine maps depicting population and selected vital statistics for the state s 100 counties. Data and population bases for the vital statistics rates are for the 5-year period 1997-2001. The range of data values indicated by the map legend was formed by a clustering routine from the Statistical Analysis System. 1 This routine groups into five clusters counties that were most like each other with respect to the statistic being examined. This procedure may result in very large or very small groups, depending upon how counties differ from one another. The nine maps display the county statistics listed below. Definitions and formulas are found in Section VI and maps displaying county names are printed on the reverse sides of region and county divider sheets. It should be noted that marriage and divorce rates are not mapped because these data are tabulated only by county of occurrence, not county of residence. FIGURE 1. Estimated Population, July 2001 2. Live Births per 1,000 Population 3. Low Birthweight Live Births per 100 Live Births 4. Out-of-Wedlock Live Births per 100 Live Births 5. Fetal Deaths per 1,000 Deliveries 6. Neonatal Deaths per 1,000 Live Births 7. Postneonatal Deaths per 1,000 Neonatal Survivors 8. Infant Deaths per 1,000 Live Births 9. Deaths per 1,000 Population Although the vital statistics rates shown on the maps are 5-year rates, be careful when interpreting relatively high rates in sparsely populated counties. These counties usually have a small number of births and deaths, which may create a very unstable rate. Consult your respective county tables for the 2001 numbers involved before becoming concerned about relatively high county-level rates. 1-5

Population 1-6 Population July 1, 2001 Estimate 113,170-228,086 301,098-310,331 424,032 658,490-713,780 4,149-96,808 North Carolina Resident Data 2001 Figure 1

Birth Rates 1-7 Total Births Per 1,000 Population North Carolina Resident Data 21.5 1997-2001 16.7-19.4 12.3-16.4 9.4-12.1 8.1-8.9 Figure 2

Low Birthweight Rates 1-8 Low Birthweight Births Per 100 Live Births 13.8-14.3 10.6-12.1 8.5-10.3 7.2-8.4 5.8-6.9 North Carolina Resident Data 1997-2001 Figure 3

Out-of-Wedlock Birth Rates 1-9 Out-of-Wedlock Births Per 100 Live Births 52.6-60.5 40.7-50.5 30.5-39.9 24.1-29.4 16.9-23.6 North Carolina Resident Data 1997-2001 Figure 4

Fetal Death Rates 1-10 Fetal Deaths Per 1,000 Deliveries 17.3-18.8 13.3-15.0 8.4-12.3 3.7-8.3 0.0-2.4 North Carolina Resident Data 1997-2001 Figure 5

Neonatal Death Rates 1-11 Neonatal Deaths Per 1,000 Live Births 16.6 13.5-14.8 10.4-11.8 7.3-9.8 1.1-7.0 North Carolina Resident Data 1997-2001 Figure 6

Postneonatal Death Rates 1-12 Postneonatal Death Rates Per 1,000 Neonatal Survivors 4.4-5.4 3.3-4.1 2.3-3.2 1.5-2.2 0.0-0.7 North Carolina Resident Data 1997-2001 Figure 7

Infant Death Rates 1-13 Infant Deaths Per 1,000 Live Births 16.8-18.7 13.4-14.4 10.4-12.8 6.2-10.0 3.4-5.7 North Carolina Resident Data 1997-2001 Figure 8

Death Rates 1-14 Total Deaths Per 1,000 Population 14.4 12.8-13.5 10.2-12.5 7.7-10.1 5.0-6.8 North Carolina Resident Data 1997-2001 Figure 9

III. REGISTRATION OF VITAL EVENTS The origin, flow, and disposition of North Carolina vital records are illustrated in the flow diagram on the following page. A brief history of vital records processing and current registration practice in North Carolina is presented. The Bureau of Vital Statistics was created by an act of the General Assembly in 1913. The Vital Statistics office became a part of the Department of Human Resources in 1973. In 1989, the General Assembly combined the Department of Human Resources Division of Health Services and the environmental and natural resources divisions of the Department of Natural Resources and Community Development to create the new Department of Environment, Health, and Natural Resources. In 1997 the public health divisions, including the Vital Statistics office, were combined back with the human resources division to form a new Department of Health and Human Services. The public health authority of this department and the laws that it administers are contained in Chapter 130A, Article 4, of the General Statutes of North Carolina. Within the organizational structure of the Department of Health and Human Services, the State Registrar of Vital Statistics is appointed by the State Health Director. Duties of the State Registrar are accomplished primarily by the Vital Records Section. Birth and Death The collection of birth and death records began on October 1, 1913. The Department of Health and Human Services is the custodian of these records. The hospital administrator or person attending a non-hospital delivery is required to file a birth certificate or fetal death report within 10 days after delivery. The funeral director or person burying or otherwise disposing of a body is responsible for filing a death certificate with the local registrar within five days after death. The local registrar is the county health director. A clerk of the county health department, designated by the local registrar as deputy registrar, carries out registration procedures locally. The deputy registrar forwards the original birth and death certificates to the Department of Health and Human Services on the fifth day of the month following the birth or death, where they are processed and permanently preserved. Microfilmed copies and computerized data from birth and death certificates are sent to the National Center for Health Statistics. North Carolina was admitted into the National Death Registration Area in 1916 and into the National Birth Registration Area in 1917. Fetal Death North Carolina law requires the filing of a fetal death report for fetal deaths (stillbirths) of 20 or more weeks gestation. Legislation enacted by the 1971 General Assembly and subsequent legislation requires that therapeutic abortions be reported separately, effective May 19, 1971. Thus, the induced abortion report form now replaces a fetal death report for the very few therapeutic abortions occurring at 20 or more weeks gestation. For this reason, counts of fetal deaths and perinatal deaths since 1971 are not strictly comparable to counts in previous years. Marriage and Divorce In 1957, the General Assembly enacted legislation requiring that the duties of the clerk of court include the registration of divorces and annulments of marriage effective January 1, 1958. Certificates of divorce and annulments are required to be sent to the Department of Health and Human Services on or before the 15th day of the month following the event. The filing of certificates of divorce rather than divorce listings was started January 1, 1984, following legislation in 1983. By virtue of legislation enacted in 1961, the duties of the county register of deeds include the registration of marriages occurring on or after January 1, 1962. Copies of the certificates of marriage are required to be forwarded to the Department of Health and Human Services on or before the 15th day of the month following the marriage. The original certificates are filed with the county register of deeds. In January 1964, North Carolina was admitted to the National Marriage Registration Area. North Carolina is not a member of the National Divorce Registration Area. 1-15

THE ORIGIN, FLOW, AND DISPOSITION OF VITAL RECORDS NORTH CAROLINA HOSPITAL ADMINISTRATOR Statutory Citation G.S. 130A-101 & 114 Completes birth certificate or fetal death report for hospital deliveries. Obtains certifier s signature. Sends birth certificate or fetal death report to county registrar. Responds to requests for information. PHYSICIAN Statutory Citation G.S. 130A-101 & 114 Signs birth certificate or fetal death report. Completes birth certificate or fetal death report for non-hospital delivery; sends to county registrar. Completes cause of death and signs certificate for all non-medical-examiner deaths. FUNERAL DIRECTOR Statutory Citation G.S. 130A-112 & 115 Sends notification of death to registrar and completes death certificate. Obtains cause of death and signature of physician. Obtains burial transit permit when necessary. Delivers death certificate to county registrar within five days. MEDICAL EXAMINER Statutory Citation G.S. 130A-114, 115 & 383 Initiates certificate for a death resulting from injury, suicide, or homicide, and for certain unattended deaths and fetal deaths. Investigates circumstances surrounding aforementioned deaths and certifies cause and manner of death. REGISTER OF DEEDS Statutory Citation G.S. 130A-110 Completes marriage certificates for all marriages. Sends copy of marriage certificate to Department of Health and Human Services. Prepares delayed certificates and sends to DHHS for approval. Initiates amendment applications. CLERK OF COURT Statutory Citation G.S. 130A-111 Completes divorce certificate and forwards to Department of Health and Human Services. COUNTY REGISTRAR (COUNTY HEALTH DEPARTMENT) Statutory Citation G.S. 130A-97 Checks records for accuracy and completeness. Requests further information when necessary. Prepares copy of birth and death certificates for register of deeds. Sends original birth and death certificates to the Department of Health and Human Services. Issues burial transit permits. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) VITAL RECORDS SECTION REPORT PROCESSING Receives and processes current reports of births, deaths, marriages, and divorces and delayed birth certificates. Codes demographic data. Provides consultation and assistance to individuals involved with vital records registration. CORRECTIONS Receives and processes all requests for change to prior records. SPECIAL REGISTRATION Reviews and processes all requests for adoption, legitimation, and judicial determinations of paternity. NOSOLOGY Codes all conditions at death using current revision of the ICD. Codes underlying cause on fetal death report. Codes congenital anomalies on birth certificates. MICROFILM AND PRESERVATION Microfilms all vital records. Prepares certifications, verifications, and manuscripts from microfilm and xerox. Stores and preserves all original records. STATE CENTER FOR HEALTH STATISTICS Answers requests for vital statistics data. Publishes annual reports; conducts special studies. Keys data from vital records births, deaths, fetal deaths, marriages, and divorces. Performs selective edit of variables and maintains cumulative files. Transmits data to the National Center for Health Statistics. SOCIAL SERVICES Sends adoption reports to special registration. NATIONAL CENTER FOR HEALTH STATISTICS Receives microfilm and data from state. Performs sample quality control and assures receipt of all records and corrections. Publishes United States reports. Provides technical assistance. Provides classes in registration (ASTI). OTHER STATES Exchange birth and death records. 1-16

IV. TECHNICAL NOTES Residence Allocation Except as otherwise indicated, births and deaths in this report are based on place of residence. In the case of a birth or fetal death, residence is the usual residence of the mother. For deaths of persons in long-term institutions (mental, penal, old age, orphan, nursing home, rest home, etc.), the institution is considered the usual residence, provided the decedent has resided in the institution at least one year. College students and military personnel are considered residents of the college or military community. North Carolina participates in an interchange program whereby nonresident birth and death certificates are required to be sent to the state of residence within two months of the date of occurrence. The National Center for Health Statistics acts as a control for this interchange through a report from each state that lists the number of each type of vital record sent to every other state. However, delays or omissions in the interchange undoubtedly occur. Occurrence Allocation Items 9 and 18 of the tables allocate live births and deaths respectively to place of occurrence regardless of place of residence. Marriage and divorce data are compiled only by place of occurrence county of license for marriages and county of decree for divorces and annulments because (i) all states do not engage in an interchange program whereby we receive notification of North Carolina residents who marry or divorce in other states and (ii) the two parties to these proceedings are often residents of different counties or states. Race or Color Allocation Two broad categories, white and minority, are used in this report. Minority is predominantly black (>90%) in North Carolina. For births and fetal deaths, the child is considered to be the same race as the mother. Due to some cases of different races of the two parties involved in marriage and divorce/annulment proceedings and to a number of not stated race cases, frequencies and rates for these events are not shown by race. Completeness of Registration of Vital Events Completeness of registration is defined as the degree to which reported birth and death counts agree with the true counts in a given time frame. Birth registration, tested for completeness in 1940 and 1950, was found to be 86 and 96 percent complete respectively. 2 Death registration is believed to be even more complete than birth registration. Fetal death registration, tested for completeness in 1974, was found to be 99 percent complete. 3 Marriage registration was tested for completeness in 1963. Over 99 percent of performed marriages had a properly recorded certificate of marriage. 4 Delayed registration results in incomplete recording of vital events for a specific time period. Frequency counts in this report are based on 2001 events filed with the local registrar prior to April 1, 2002, and processed in the state office before the end of June 2002. Based on examinations of lagtimes in prior years, the number of calendar year events filed after April 1 of the subsequent year is considered negligible. In addition to the above, a source of incompleteness in residence data could involve failure of other states to send photocopies for North Carolina resident events occurring in their states. The extent to which this occurs is unknown. 1-17

Accuracy of Items on Certificate The Vital Records Section maintains continuous surveillance of certificates to detect inconsistencies in related items (e.g., newborn s name vs. sex). However, the true extent of bias and unreliability of vital records data is not known. One study by the State Center for Health Statistics has addressed the issue of the validity of selected birth certificate items, as compared with information recorded in the mother's hospital medical record. 5 Treatment of Missing Values As a result of efforts to reconcile inconsistencies in the data and to complete unanswered items, missing values are rare for the characteristics included in this report. These not stated cases are treated in one of two ways: (1) not allocated because they are believed to have an unknown distribution that is different from the distribution for stated cases; or (2) randomly distributed in the same proportion as the stated cases for the state. The following table shows the number and treatment of missing values in the statistical files underlying this report. In the case of race, marital status, mother smoked, and method of delivery, most of the missing values are due to absence of these items on certificates from other states. Number of Missing Values by Item and Treatment North Carolina 2001 Treatment of Missing Values Treatment 1 Treatment 2 Live Births Sex 0 0 Birth Weight 42 0 Marital Status 40 0 Race 0 0 Mother Smoked 238 0 Method of Delivery 33 0 Deaths Age 0 0 Race 0 30 Sex 0 2 Fetal Deaths Marital Status 3 0 Race 3 0 1-18

V. POPULATION DATA AND VITAL STATISTICS RATES Every 10 years (years ending in zero) the U.S. Bureau of the Census counts the United States population, which includes a profile of the population s characteristics such as age, race, and sex. After a census year, estimates of population size and composition are based on knowledge of the population in the census year plus subsequent events such as births, deaths, and migration. In the latter years of a decade, estimates may depart considerably from true population values to the extent that assumptions, particularly about in- and out- migration, depart from what has actually occurred. Thus, vital statistics rates that are based on population counts in the denominator may be subject to some degree of error. In this report on 2001 North Carolina vital statistics, we have used population estimates projected from the 2000 census for the denominators of the 2001 rates. For the denominators of the 1997-2001 rates, we have used smoothed population files where information from the 1990 and 2000 censuses was used to adjust the previous 1997-1999 population estimates. 1-19

1-20

VI. DEFINITIONS AND FORMULAS Caution: Any percentage or rate with a small number of events in the numerator will have substantial random variation over time. A rule of thumb is that any percentage or rate with fewer than 20 events in the numerator may be subject to serious random error. Therefore, many of the percentages and rates in this volume should be interpreted with caution. Births and deaths are exhibited in the tables of this report by frequencies and rates. The term rate usually means the number of vital events in a given period of time divided by the average number of people at risk during that period. In this report, the average number of people at risk is usually the midyear population, the period is one year or five years, and the rate is expressed per 1,000 population. For example, the formula for a single-year birth rate is B x 1,000 P where B is the number of births in the year and P is the midyear population. Similarly, the formula for a 5-year birth rate is B 1 + B 2 + B 3 + B 4 + B 5 x 1,000 P 1 + P 2 + P 3 + P 4 + P 5 where B 1, B, etc. are the numbers of births in the particular years and P, P, etc. are the midyear populations 2 1 2 in those years. The term rate is also used in this report to mean a simple proportion expressed per 100 or per 1,000. These rates are the ratio of two related vital event counts. An example of this type of rate is the single-year infant mortality rate. The formula is D x 1,000 B where D represents deaths of infants during a year and B represents live births during the same year. Another example is the low birthweight rate which is the ratio of low birthweight births to total births expressed as a percentage. LBW x 100 B Rates are rounded to one decimal place for publication. Except for marriages and divorces for which racespecific rates are not calculated, a blank in the rate column indicates that both the numerator and the denominator are zero. A rate of 0.0 is shown for rates less than 0.05. Inaccurate reporting, under-registration, and missing values have been discussed (Section V). These factors affect the validity of information involved in rate computation. The users of vital statistics measures should be aware of these possible limitations. Furthermore, you should cautiously interpret rates that are based on small frequencies since they may be associated with relatively large chance fluctuation. For this reason, 5-year rates are included. Based on an increased number of events, these average annual rates are more stable than the single-year rates. In comparing rates, consider carefully the factors to which a difference in rates might be attributed. Unless the populations are equivalent in all factors except the one for which the comparison is made, conclusions about differences in rates may not be clearly drawn. Age-adjusted rates or other further analyses may be necessary in order to make valid comparisons. 1-21

Definitions and formulas are given in the numerical order of their appearance in the tables. Except for items 9 and 18-20, rates are for resident events. Definitions 1. Population is the expected population of an area as of July 1 of the event year. Figures shown in the tables of this report are summations over age-race-sex-specific estimates provided by the Office of State Planning. 2. Natural Increase is the excess of births over deaths among residents of an area. 3. A Live Birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or any definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached (definition adopted by World Health Organization in 1950). is a physician (M.D. or D.O.) in a hospital, a physician not in a hospital, a certified nursemidwife (CNM), or other attendant. Legislation during 1983 (H.B. 814) regulates the practices of CNMs; these practitioners must have certification by the American College of Nurse-Midwives. 5. Low Birthweight includes liveborn infants weighing under 2,500 grams (5 pounds, 8 ounces or less) at birth, regardless of the period of gestation. (Birthweight index recommended by the Expert Group on Prematurity of the World Health Organization, 1950). 6. Birth Out of Wedlock is birth to a woman who has never been legally married or who has been widowed or legally divorced from her husband in excess of 280 days. 6 7. Mother Smoked is based on birth certificate reporting that the mother used tobacco during the pregnancy. 8. C-Section indicates that the method of delivery was either a primary or a repeat C-section. 9. An Occurrence Birth is one that occurs in an area irrespective of place of residence. Live births occurring in an area to residents of the area are also shown in the tables. Complementary totals, i.e., nonresident births occurring in the area and resident births occurring elsewhere, may be obtained by subtraction. 10. Perinatal Deaths are the sum of registered fetal deaths and neonatal deaths (see definitions below). 11. Fetal Death is death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, as indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles (definition adopted by World Health Organization in 1950). Consistent with North Carolina law, this report includes only fetal deaths which do not qualify as therapeutic abortions and which result from pregnancies of 20 or more weeks gestation (see Section IV). 12. Neonatal Death is death of a liveborn child under 28 days of age. 13. Postneonatal Death is death of an infant age 28 days and over but less than one year of age. 14. Infant Death is defined as death of a liveborn infant under one year of age. 15. Death is defined as the permanent disappearance of any evidence of life at any time after live birth. 7 Also, North Carolina law (G.S. 90-322) defines criteria for certifying brain death. 1-22

at Death is reported age in completed years as of the last birthday. Errors in reporting are believed to include underestimates for ages 22 through middle age and overestimates for persons nearing their 21st and 65th birthdays and for those over age 65. Preferences for ages ending in certain digits (e.g., age ending in 0 and 5) may also result in undue concentrations of reported ages. 8 is the hospital, other institution, or noninstitution place of death. 18. An Occurrence Death is one that occurs in an area regardless of place of residence. 19. Marriage is defined as the legal union of a male and a female (North Carolina G.S. 51-1). Marriages are by place of occurrence; race-specific data are not shown (see Section V). 20. Divorces and Annulments can occur only by decree of an authorized court. Annulments, which void marriage from the beginning, constitute less than one percent of the sum of these events. A divorce from bed and board is a judicial separation suspending cohabitation but not otherwise affecting the marriage bond. Divorces from bed and board are not included in this report. Divorces and annulments are by place of occurrence; race-specific data are not shown (see Section V). Formulas 1. Population Percentage of N.C. population Population of area residing in area = --------------------------------------------- X 100 Population of North Carolina Percentage male population Male population of area in area = --------------------------------------------- X 100 Total population of area Percentage female population Female population of area in area = --------------------------------------------- X 100 Total population of area 2. Natural Increase Number of live births Rate of minus number of deaths natural increase = -------------------------------------------- X 1,000 Population of area 3. Live Births Number of live births Birth rate = -------------------------------------------- X 1,000 Population of area Number of male live births Male birth rate = -------------------------------------------- X 1,000 Population of area Number of female live births Female birth rate = -------------------------------------------- X 1,000 Population of area 1-23

Number of live births attended Percentage of live births attended by physician in hospital = by physician in hospital -------------------------------------------- X 100 Number of live births Number of live births attended Percentage of live births attended by physician not in hospital by physician not in hospital = -------------------------------------------- Number of live births X 100 Number of live births attended Percentage of live births attended by certified nurse-midwife by certified nurse-midwife = -------------------------------------------- X 100 Number of live births Number of live births Percentage of live births attended by other attended by other = -------------------------------------------- X 100 Number of live births 5. Low Birthweight Percentage of live births Number of low-weight live births classified as low weight = -------------------------------------------- X 100 Number of live births 6. Births out of Wedlock Number of live births Percentage of live births occurring out of wedlock occurring out of wedlock = -------------------------------------------- X 100 Number of live births 7. Mother Smoked Number of live births to mothers Percentage of live births to mothers who used tobacco who used tobacco during pregnancy = -------------------------------------------- X 100 Number of live births 8. C-Section Number of live births by C-section Percentage of live births by C-section = -------------------------------------------- X 100 Number of live births Births Number of live births Percentage of N.C. live births occurring in area occurring in area = -------------------------------------------- X 100 Number of live births occurring in N.C. Number of resident live Percentage of area live births births occurring in area occurring to residents of area = -------------------------------------------- X 100 Number of total live births occurring in area 1-24

10. Perinatal Deaths Number of fetal deaths plus number of neonatal deaths Perinatal mortality rate = -------------------------------------------- X 1,000 Number of live births plus number of fetal deaths 11. Fetal Deaths 12. Neonatal Deaths Number of fetal deaths Fetal mortality rate = -------------------------------------------- X 1,000 Number of live births plus number of fetal deaths Number of neonatal deaths Neonatal mortality rate = -------------------------------------------- X 1,000 Number of live births 13. Postneonatal Deaths 14. Infant Deaths 15. Deaths Number of postneonatal deaths Postneonatal mortality rate = -------------------------------------------- X 1,000 Number of live births minus number of neonatal deaths Number of infant deaths Infant mortality rate = -------------------------------------------- X 1,000 Number of live births Number of deaths Death rate = -------------------------------------------- X 1,000 Population of area Number of male deaths Male-specific death rate = -------------------------------------------- X 1,000 Male population of area Number of female deaths Female-specific death rate = -------------------------------------------- X 1,000 Female population of area -specific Deaths Number of deaths in age group Age-specific death rate = -------------------------------------------- X 1,000 Population in age group 1-25

Percentage of deaths Number of deaths in hospitals occurring in hospitals = -------------------------------------------- X 100 Number of deaths Number of deaths in non- Percentage of deaths occurring hospital institutions in nonhospital institutions = -------------------------------------------- X 100 Number of deaths Number of deaths in Percentage of deaths occurring home or noninstitutions in home or noninstitution = -------------------------------------------- X 100 Number of deaths Deaths Number of deaths Percentage of N.C. deaths occurring in area occurring in area = -------------------------------------------- X 100 Number of deaths occurring in North Carolina Number of resident deaths Percentage of area deaths occurring in area occurring to residents of area = -------------------------------------------- X 100 Number of total deaths occurring in area 19. Marriages Number of marriages occurring in area Marriage rate = -------------------------------------------- X 1,000 Population of area 20. Divorces and Annulments Number of divorces and annulments occurring in area Divorce/Annulment rate = --------------------------------------------- X 1,000 Population of area Symbols Quantity (frequency) is zero... 0 Rate is less than 0.05... 0.0 Rate is not applicable... blank space 1-26

REFERENCES (1) Barr, Anthony J.; Goodnight, James H.; Sals, John P.; and Helwig, Jane T. Statistical Analysis System, Cluster Procedure. SAS Institute, Inc., Raleigh, N.C. 1976. (2) U.S. Department of Health, Education, and Welfare. Birth Registration Completeness in the United States and Geographical Areas, 1950. Vol. 39, No. 2. Public Health Service, National Office of Vital Statistics. September 21, 1954. (3) Lucas, I.J. A Study of Completeness of Fetal Death Registration in North Carolina. North Carolina Department of Human Resources, Division of Health Services Statistical Report Series. No. SRS-5141-07-28-75. Raleigh, N.C. 1975. (4) North Carolina State Board of Health, Public Health Statistics Section. Test conducted in compliance with procedures of the National Office of Vital Statistics, 1963. (5) Buescher, P.A.; Taylor, K.P.; Davis, M.H.; and Bowling, J.M. "The Quality of the New Birth Certificate Data: A Validation Study in North Carolina." American Journal of Public Health, Vol. 83, 1993: 1163-1165. (6) North Carolina Department of Environment, Health, and Natural Resources, Division of Epidemiology, Vital Records Section. Hospital Handbook on Births, Deaths and Fetal Deaths Registration. Raleigh, N.C., 1993. (7) Grove, R.D. and Hetzel, A.M. Vital Statistics Rates in the United States: 1940-1960. Public Health Service Publication No. 1677. Washington, D.C.: U.S. Government Printing Office. 1968. (8) Spiegelman, M. Introduction to Demography. Cambridge, Mass.: Harvard University Press. 1969. 1-27

1-28

1-29 STATE TABLE

NORTH CAROLINA 1. Total 8188010 100.0 100.0 6124883 100.0 100.0 2063127 100.0 100.0 Males 4016180 49.0 48.6 3038908 49.6 49.2 977272 47.4 46.9 Females 4171830 51.0 51.4 3085975 50.4 50.8 1085855 52.6 53.1 2. Natural Increase 47374 5.8 5.7 30836 5.0 4.8 16538 8.0 8.1 3. Total 118112 14.4 14.4 85204 13.9 13.8 32908 16.0 16.0 Males 60161 7.3 7.4 43554 7.1 7.1 16607 8.0 8.2 Females 57951 7.1 7.0 41650 6.8 6.7 16301 7.9 7.9 Physician in Hospital 107542 91.1 91.8 77272 90.7 91.6 30270 92.0 92.3 Physician Not in Hospital 38 0.0 0.0 19 0.0 0.0 19 0.1 0.1 Certified Nurse Midwife 10175 8.6 7.8 7614 8.9 8.0 2561 7.8 7.4 Other Attendant 357 0.3 0.3 299 0.4 0.4 58 0.2 0.2 5. Low Birthweight 10579 9.0 8.9 6254 7.3 7.2 4325 13.1 13.1 6. Out of Wedlock 40487 34.3 33.2 20472 24.0 21.8 20015 60.8 61.5 7. Mother Smoked 16479 14.0 14.4 12806 15.0 15.7 3673 11.2 11.1 8. C-Section 29829 25.3 23.0 21145 24.8 22.8 8684 26.4 23.7 Total 119139 100.0 100.0 86080 100.0 100.0 33059 100.0 100.0 To Residents 116951 98.2 98.0 84291 97.9 97.8 32660 98.8 98.7 10. Perinatal Deaths 1541 13.0 14.0 798 9.3 10.3 743 22.3 23.1 11. Fetal Deaths 836 7.0 7.6 446 5.2 5.8 390 11.7 12.3 12. Neonatal (Under 28 Days) 705 6.0 6.4 352 4.1 4.6 353 10.7 10.8 13. Postneonatal (28 Days- 1 Year) 300 2.6 2.6 166 2.0 1.9 134 4.1 4.2 14. Infant Deaths (Under 1 Year) 1005 8.5 8.9 518 6.1 6.5 487 14.8 15.0 15. Total 70738 8.6 8.7 54368 8.9 9.0 16370 7.9 7.9 Males 34810 8.7 8.9 26603 8.8 9.0 8207 8.4 8.5 Females 35928 8.6 8.6 27765 9.0 9.0 8163 7.5 7.3 00-04 Years 1138 2.0 2.1 593 1.5 1.6 545 3.2 3.1 05-14 Years 207 0.2 0.2 147 0.2 0.2 60 0.2 0.2 15-24 Years 1009 0.9 0.9 668 0.8 0.8 341 1.0 1.1 25-34 Years 1306 1.1 1.2 819 0.9 1.0 487 1.6 1.7 35-44 Years 2935 2.3 2.2 1843 1.9 1.8 1092 3.4 3.5 45-54 Years 5324 4.7 4.6 3481 4.0 3.9 1843 7.1 7.2 55-64 Years 7913 10.6 10.8 5762 9.5 9.7 2151 15.1 15.6 65 and Over 50906 51.8 50.2 41055 50.5 49.4 9851 58.0 54.2 Hospital 35358 50.0 51.6 25737 47.3 49.2 9621 58.8 59.6 Other Institution 19255 27.2 25.8 15694 28.9 27.3 3561 21.8 20.8 Home or Non-Institution 16125 22.8 22.6 12937 23.8 23.5 3188 19.5 19.6 Total 71543 100.0 100.0 55061 100.0 100.0 16482 100.0 100.0 To Residents 69438 97.1 96.9 53305 96.8 96.7 16133 97.9 97.7 19. Marriages 65296 8.0 8.2 20. Divorces and Annulments 37381 4.6 4.7 2-1

Perinatal Care Regions REGION TABLES 1-31

North Carolina Perinatal Care Regions 1 2 4 3 5 6

P.C. REGION I - WESTERN 1. Total 681840 8.3 8.4 631323 10.3 10.4 50517 2.4 2.5 Males 329990 48.4 48.2 305078 48.3 48.1 24912 49.3 48.8 Females 351850 51.6 51.8 326245 51.7 51.9 25605 50.7 51.2 2. Natural Increase 153 0.2 0.3-93 -0.1-0.1 246 4.9 4.5 3. Total 7798 11.4 11.5 7115 11.3 11.4 683 13.5 13.0 Males 4034 5.9 5.9 3686 5.8 5.8 348 6.9 6.7 Females 3764 5.5 5.6 3429 5.4 5.6 335 6.6 6.3 Physician in Hospital 6761 86.7 88.8 6146 86.4 88.4 615 90.0 92.1 Physician Not in Hospital 2 0.0 0.1 2 0.0 0.1 0 0.0 0.1 Certified Nurse Midwife 982 12.6 10.5 921 12.9 10.8 61 8.9 7.3 Other Attendant 53 0.7 0.7 46 0.6 0.7 7 1.0 0.6 5. Low Birthweight 663 8.5 8.0 584 8.2 7.7 79 11.6 10.9 6. Out of Wedlock 2372 30.4 28.7 1927 27.1 25.2 445 65.2 66.2 7. Mother Smoked 1564 20.1 20.2 1449 20.4 20.6 115 16.8 16.0 8. C-Section 1810 23.2 21.0 1651 23.2 21.0 159 23.3 21.4 Total 7610 6.4 6.5 6933 8.1 8.2 677 2.0 2.0 10. Perinatal Deaths 97 12.4 12.5 86 12.0 11.8 11 16.0 19.4 11. Fetal Deaths 52 6.6 6.7 47 6.6 6.5 5 7.3 9.2 12. Neonatal (Under 28 Days) 45 5.8 5.8 39 5.5 5.4 6 8.8 10.2 13. Postneonatal (28 Days- 1 Year) 20 2.6 2.7 16 2.3 2.3 4 5.9 6.7 14. Infant Deaths (Under 1 Year) 65 8.3 8.5 55 7.7 7.7 10 14.6 16.8 15. Total 7645 11.2 11.3 7208 11.4 11.5 437 8.7 8.5 Males 3698 11.2 11.6 3492 11.4 11.9 206 8.3 8.8 Females 3947 11.2 10.9 3716 11.4 11.2 231 9.0 8.2 00-04 Years 72 1.9 1.9 62 1.8 1.8 10 2.4 2.9 05-14 Years 18 0.2 0.2 17 0.2 0.2 1 0.1 0.2 15-24 Years 54 0.7 0.8 49 0.7 0.8 5 0.6 0.8 25-34 Years 93 1.1 1.2 81 1.1 1.1 12 1.7 1.7 35-44 Years 240 2.5 2.3 215 2.4 2.2 25 3.4 3.7 45-54 Years 432 4.3 4.5 383 4.1 4.3 49 7.5 7.2 55-64 Years 781 10.0 9.7 718 9.7 9.5 63 16.5 15.2 65 and Over 5955 49.6 47.7 5683 49.4 47.6 272 54.9 51.1 Hospital 3112 40.7 43.5 2892 40.1 43.2 220 50.3 49.3 Other Institution 2670 34.9 32.9 2546 35.3 33.1 124 28.4 29.1 Home or Non-Institution 1863 24.4 23.6 1770 24.6 23.7 93 21.3 21.5 Total 7748 10.8 10.8 7292 13.2 13.3 456 2.8 2.8 19. Marriages 6329 9.3 9.5 20. Divorces and Annulments 3198 4.7 4.8 3-1

P.C. REGION II - NORTHWESTERN 1. Total 2064280 25.2 25.4 1692543 27.6 27.9 371737 18.0 18.0 Males 1008198 48.8 48.5 832468 49.2 48.8 175730 47.3 46.9 Females 1056082 51.2 51.5 860075 50.8 51.2 196007 52.7 53.1 2. Natural Increase 9140 4.4 4.4 6266 3.7 3.7 2874 7.7 7.7 3. Total 27686 13.4 13.5 22124 13.1 13.1 5562 15.0 15.1 Males 14153 6.9 6.9 11315 6.7 6.7 2838 7.6 7.8 Females 13533 6.6 6.6 10809 6.4 6.4 2724 7.3 7.4 Physician in Hospital 25445 91.9 92.9 20328 91.9 93.0 5117 92.0 92.4 Physician Not in Hospital 3 0.0 0.0 3 0.0 0.0 0 0.0 0.0 Certified Nurse Midwife 2143 7.7 6.6 1707 7.7 6.5 436 7.8 7.3 Other Attendant 95 0.3 0.4 86 0.4 0.5 9 0.2 0.2 5. Low Birthweight 2508 9.1 8.9 1725 7.8 7.7 783 14.1 13.6 6. Out of Wedlock 9273 33.5 31.6 5877 26.6 24.0 3396 61.1 61.2 7. Mother Smoked 4662 16.8 17.8 3950 17.9 19.0 712 12.8 12.9 8. C-Section 6812 24.6 22.8 5376 24.3 22.8 1436 25.8 22.8 Total 27510 23.1 23.3 21950 25.5 25.9 5560 16.8 16.9 10. Perinatal Deaths 315 11.3 13.1 194 8.7 10.8 121 21.5 21.7 11. Fetal Deaths 161 5.8 7.1 100 4.5 6.1 61 10.8 10.9 12. Neonatal (Under 28 Days) 154 5.6 6.0 94 4.2 4.8 60 10.8 10.9 13. Postneonatal (28 Days- 1 Year) 77 2.8 2.6 52 2.4 2.2 25 4.5 4.5 14. Infant Deaths (Under 1 Year) 231 8.3 8.7 146 6.6 7.0 85 15.3 15.3 15. Total 18546 9.0 9.1 15858 9.4 9.4 2688 7.2 7.4 Males 9057 9.0 9.2 7713 9.3 9.5 1344 7.6 8.0 Females 9489 9.0 8.9 8145 9.5 9.4 1344 6.9 6.9 00-04 Years 259 1.9 2.0 167 1.6 1.7 92 3.0 2.9 05-14 Years 41 0.1 0.2 38 0.2 0.2 3 0.0 0.2 15-24 Years 205 0.8 0.8 155 0.7 0.8 50 0.8 0.9 25-34 Years 304 1.0 1.1 221 0.9 1.0 83 1.4 1.6 35-44 Years 684 2.1 2.1 514 1.9 1.9 170 3.0 3.0 45-54 Years 1319 4.5 4.4 997 4.1 3.9 322 7.1 7.1 55-64 Years 1995 10.0 10.5 1625 9.3 9.8 370 14.3 15.0 65 and Over 13739 51.7 50.2 12141 51.4 50.0 1598 54.5 51.7 Hospital 9103 49.1 50.9 7578 47.8 49.7 1525 56.7 58.0 Other Institution 5348 28.8 26.9 4661 29.4 27.7 687 25.6 22.8 Home or Non-Institution 4095 22.1 22.2 3619 22.8 22.7 476 17.7 19.3 Total 18778 26.2 26.5 16016 29.1 29.2 2762 16.8 17.4 19. Marriages 15850 7.7 8.1 20. Divorces and Annulments 9186 4.4 4.7 3-2

P.C. REGION III - SOUTHWESTERN 1. Total 1419614 17.3 17.1 1070017 17.5 17.3 349597 16.9 16.6 Males 697985 49.2 48.6 532880 49.8 49.2 165105 47.2 46.8 Females 721629 50.8 51.4 537137 50.2 50.8 184492 52.8 53.2 2. Natural Increase 11479 8.1 7.6 7885 7.4 6.7 3594 10.3 10.4 3. Total 22317 15.7 15.4 16402 15.3 14.9 5915 16.9 17.1 Males 11397 8.0 7.9 8379 7.8 7.6 3018 8.6 8.7 Females 10920 7.7 7.5 8023 7.5 7.2 2897 8.3 8.4 Physician in Hospital 19772 88.6 90.9 14452 88.1 90.4 5320 89.9 92.1 Physician Not in Hospital 8 0.0 0.0 5 0.0 0.0 3 0.1 0.0 Certified Nurse Midwife 2438 10.9 8.7 1864 11.4 9.1 574 9.7 7.6 Other Attendant 99 0.4 0.4 81 0.5 0.5 18 0.3 0.2 5. Low Birthweight 1916 8.6 8.7 1166 7.1 7.1 750 12.7 12.8 6. Out of Wedlock 7183 32.2 31.5 3699 22.6 20.6 3484 58.9 60.2 7. Mother Smoked 2526 11.3 12.3 1989 12.1 13.4 537 9.1 9.4 8. C-Section 5568 24.9 23.0 3993 24.3 22.7 1575 26.6 23.7 Total 24293 20.4 20.0 18128 21.1 20.6 6165 18.6 18.3 10. Perinatal Deaths 287 12.8 13.7 150 9.1 9.9 137 22.9 23.7 11. Fetal Deaths 159 7.1 7.9 91 5.5 5.5 68 11.4 14.1 12. Neonatal (Under 28 Days) 128 5.7 5.8 59 3.6 4.3 69 11.7 9.8 13. Postneonatal (28 Days- 1 Year) 53 2.4 2.3 28 1.7 1.7 25 4.3 3.9 14. Infant Deaths (Under 1 Year) 181 8.1 8.2 87 5.3 6.1 94 15.9 13.7 15. Total 10838 7.6 7.8 8517 8.0 8.1 2321 6.6 6.7 Males 5372 7.7 7.9 4166 7.8 8.0 1206 7.3 7.5 Females 5466 7.6 7.7 4351 8.1 8.3 1115 6.0 6.0 00-04 Years 206 2.0 1.9 102 1.4 1.5 104 3.5 2.9 05-14 Years 31 0.2 0.2 22 0.2 0.2 9 0.1 0.2 15-24 Years 197 1.1 1.0 133 1.0 0.9 64 1.2 1.2 25-34 Years 242 1.0 1.1 146 0.8 0.9 96 1.6 1.7 35-44 Years 563 2.4 2.2 334 1.8 1.7 229 4.0 3.7 45-54 Years 881 4.6 4.3 591 3.9 3.6 290 6.8 6.9 55-64 Years 1238 10.4 10.4 942 9.7 9.4 296 13.7 14.9 65 and Over 7480 51.8 50.7 6247 51.0 50.3 1233 56.1 52.5 Hospital 5457 50.4 51.3 4066 47.7 49.0 1391 59.9 59.8 Other Institution 2757 25.4 25.0 2305 27.1 26.3 452 19.5 20.1 Home or Non-Institution 2624 24.2 23.7 2146 25.2 24.7 478 20.6 20.1 Total 11238 15.7 15.6 8884 16.1 16.1 2354 14.3 14.1 19. Marriages 10068 7.1 7.3 20. Divorces and Annulments 7148 5.0 4.9 3-3

P.C. REGION IV - NORTHEASTERN 1. Total 1591315 19.4 19.0 1146974 18.7 18.3 444341 21.5 21.2 Males 782363 49.2 48.5 572235 49.9 49.1 210128 47.3 46.9 Females 808952 50.8 51.5 574739 50.1 50.9 234213 52.7 53.1 2. Natural Increase 12979 8.2 7.6 9078 7.9 7.3 3901 8.8 8.4 3. Total 24096 15.1 14.8 16989 14.8 14.4 7107 16.0 15.7 Males 12212 7.7 7.6 8678 7.6 7.4 3534 8.0 7.9 Females 11884 7.5 7.3 8311 7.2 7.0 3573 8.0 7.8 Physician in Hospital 22898 95.0 95.7 16061 94.5 95.2 6837 96.2 96.9 Physician Not in Hospital 8 0.0 0.0 4 0.0 0.0 4 0.1 0.1 Certified Nurse Midwife 1134 4.7 4.0 878 5.2 4.5 256 3.6 2.8 Other Attendant 56 0.2 0.3 46 0.3 0.3 10 0.1 0.2 5. Low Birthweight 2062 8.6 8.5 1132 6.7 6.5 930 13.1 13.2 6. Out of Wedlock 7286 30.2 29.4 3488 20.5 18.1 3798 53.4 55.5 7. Mother Smoked 2115 8.8 9.5 1432 8.4 9.3 683 9.6 9.8 8. C-Section 6172 25.6 23.5 4316 25.4 23.2 1856 26.1 24.3 Total 24864 20.9 20.0 17555 20.4 19.5 7309 22.1 21.4 10. Perinatal Deaths 291 12.0 13.7 143 8.4 9.6 148 20.6 23.2 11. Fetal Deaths 163 6.7 7.7 83 4.9 5.5 80 11.1 12.6 12. Neonatal (Under 28 Days) 128 5.3 6.1 60 3.5 4.1 68 9.6 10.7 13. Postneonatal (28 Days- 1 Year) 48 2.0 2.3 21 1.2 1.6 27 3.8 4.0 14. Infant Deaths (Under 1 Year) 176 7.3 8.4 81 4.8 5.7 95 13.4 14.6 15. Total 11117 7.0 7.2 7911 6.9 7.2 3206 7.2 7.3 Males 5474 7.0 7.3 3858 6.7 7.0 1616 7.7 7.9 Females 5643 7.0 7.2 4053 7.1 7.3 1590 6.8 6.8 00-04 Years 194 1.7 2.0 87 1.1 1.4 107 3.1 3.1 05-14 Years 40 0.2 0.2 26 0.2 0.2 14 0.2 0.2 15-24 Years 164 0.7 0.7 110 0.7 0.7 54 0.8 0.8 25-34 Years 218 0.8 1.0 127 0.7 0.8 91 1.2 1.5 35-44 Years 503 1.9 1.9 273 1.4 1.5 230 3.2 3.2 45-54 Years 909 4.2 4.0 534 3.3 3.2 375 6.7 6.5 55-64 Years 1245 9.8 9.8 837 8.5 8.3 408 13.8 14.6 65 and Over 7844 51.2 49.4 5917 49.6 48.5 1927 56.8 52.5 Hospital 5548 49.9 50.5 3719 47.0 48.0 1829 57.0 56.5 Other Institution 3056 27.5 26.8 2304 29.1 28.4 752 23.5 23.1 Home or Non-Institution 2513 22.6 22.7 1888 23.9 23.6 625 19.5 20.4 Total 12229 17.1 17.3 8743 15.9 16.0 3486 21.2 21.6 19. Marriages 11294 7.1 7.3 20. Divorces and Annulments 6352 4.0 4.1 3-4

P.C. REGION V - SOUTHEASTERN 1. Total 1170327 14.3 14.4 766527 12.5 12.5 403800 19.6 19.8 Males 577475 49.3 48.9 384640 50.2 49.8 192835 47.8 47.2 Females 592852 50.7 51.1 381887 49.8 50.2 210965 52.2 52.8 2. Natural Increase 7265 6.2 6.7 3984 5.2 5.5 3281 8.1 8.8 3. Total 17668 15.1 15.4 10993 14.3 14.6 6675 16.5 16.9 Males 8973 7.7 7.9 5584 7.3 7.5 3389 8.4 8.6 Females 8695 7.4 7.6 5409 7.1 7.2 3286 8.1 8.3 Physician in Hospital 15698 88.8 87.7 9897 90.0 88.9 5801 86.9 85.8 Physician Not in Hospital 5 0.0 0.0 1 0.0 0.0 4 0.1 0.1 Certified Nurse Midwife 1926 10.9 12.0 1068 9.7 10.8 858 12.9 13.8 Other Attendant 39 0.2 0.3 27 0.2 0.3 12 0.2 0.4 5. Low Birthweight 1665 9.4 9.4 796 7.2 7.2 869 13.0 12.8 6. Out of Wedlock 7036 39.8 38.8 2842 25.9 23.6 4194 62.8 62.8 7. Mother Smoked 2977 16.8 16.4 2042 18.6 18.0 935 14.0 13.7 8. C-Section 4720 26.7 23.7 2823 25.7 22.9 1897 28.4 24.8 Total 17005 14.3 14.7 10498 12.2 12.5 6507 19.7 20.1 10. Perinatal Deaths 240 13.5 14.7 99 9.0 10.4 141 20.9 21.7 11. Fetal Deaths 132 7.4 7.8 59 5.3 5.9 73 10.8 10.8 12. Neonatal (Under 28 Days) 108 6.1 7.0 40 3.6 4.5 68 10.2 11.0 13. Postneonatal (28 Days- 1 Year) 46 2.6 2.7 22 2.0 1.9 24 3.6 4.0 14. Infant Deaths (Under 1 Year) 154 8.7 9.7 62 5.6 6.4 92 13.8 14.9 15. Total 10403 8.9 8.7 7009 9.1 9.1 3394 8.4 8.0 Males 5230 9.1 9.1 3518 9.1 9.3 1712 8.9 8.7 Females 5173 8.7 8.4 3491 9.1 8.9 1682 8.0 7.5 00-04 Years 181 2.2 2.2 76 1.5 1.6 105 3.1 3.0 05-14 Years 38 0.2 0.3 16 0.2 0.2 22 0.3 0.3 15-24 Years 216 1.2 1.1 117 1.1 1.0 99 1.5 1.3 25-34 Years 225 1.3 1.4 123 1.1 1.2 102 1.8 1.9 35-44 Years 440 2.5 2.7 245 2.1 2.2 195 3.2 3.6 45-54 Years 827 5.4 5.3 470 4.6 4.4 357 7.1 7.2 55-64 Years 1319 12.3 11.9 838 10.6 10.5 481 16.7 15.9 65 and Over 7157 51.5 48.6 5124 48.8 46.4 2033 60.1 55.5 Hospital 5499 52.9 54.2 3458 49.3 50.7 2041 60.1 61.5 Other Institution 2604 25.0 23.2 1922 27.4 25.2 682 20.1 19.1 Home or Non-Institution 2300 22.1 22.6 1629 23.2 24.1 671 19.8 19.4 Total 9841 13.8 13.4 6612 12.0 11.7 3229 19.6 18.8 19. Marriages 9891 8.5 8.6 20. Divorces and Annulments 5731 4.9 5.0 3-5

P.C. REGION VI - EASTERN 1. Total 1260634 15.4 15.7 817499 13.3 13.6 443135 21.5 21.9 Males 620169 49.2 49.2 411607 50.3 50.6 208562 47.1 46.6 Females 640465 50.8 50.8 405892 49.7 49.4 234573 52.9 53.4 2. Natural Increase 6358 5.0 5.3 3716 4.5 4.7 2642 6.0 6.3 3. Total 18547 14.7 14.8 11581 14.2 14.3 6966 15.7 15.9 Males 9392 7.5 7.6 5912 7.2 7.3 3480 7.9 8.1 Females 9155 7.3 7.3 5669 6.9 7.0 3486 7.9 7.8 Physician in Hospital 16968 91.5 91.7 10388 89.7 90.0 6580 94.5 94.4 Physician Not in Hospital 12 0.1 0.1 4 0.0 0.0 8 0.1 0.1 Certified Nurse Midwife 1552 8.4 8.1 1176 10.2 9.8 376 5.4 5.4 Other Attendant 15 0.1 0.2 13 0.1 0.2 2 0.0 0.2 5. Low Birthweight 1765 9.5 9.3 851 7.3 6.8 914 13.1 13.4 6. Out of Wedlock 7337 39.6 38.4 2639 22.8 20.8 4698 67.4 66.9 7. Mother Smoked 2635 14.2 13.6 1944 16.8 16.2 691 9.9 9.5 8. C-Section 4747 25.6 23.0 2986 25.8 23.0 1761 25.3 23.0 Total 17857 15.0 15.6 11016 12.8 13.3 6841 20.7 21.3 10. Perinatal Deaths 311 16.6 15.8 126 10.8 9.9 185 26.2 25.2 11. Fetal Deaths 169 9.0 8.5 66 5.7 5.3 103 14.6 13.6 12. Neonatal (Under 28 Days) 142 7.7 7.4 60 5.2 4.7 82 11.8 11.8 13. Postneonatal (28 Days- 1 Year) 56 3.0 2.9 27 2.3 2.0 29 4.2 4.4 14. Infant Deaths (Under 1 Year) 198 10.7 10.3 87 7.5 6.7 111 15.9 16.1 15. Total 12189 9.7 9.6 7865 9.6 9.6 4324 9.8 9.6 Males 5979 9.6 9.7 3856 9.4 9.4 2123 10.2 10.2 Females 6210 9.7 9.5 4009 9.9 9.8 2201 9.4 9.0 00-04 Years 226 2.6 2.5 99 1.9 1.8 127 3.7 3.6 05-14 Years 39 0.2 0.3 28 0.3 0.2 11 0.1 0.3 15-24 Years 173 0.9 1.0 104 0.8 0.8 69 1.0 1.1 25-34 Years 224 1.4 1.3 121 1.1 1.0 103 1.8 2.0 35-44 Years 505 2.7 2.5 262 2.2 1.9 243 3.6 3.8 45-54 Years 956 5.6 5.6 506 4.5 4.3 450 7.7 8.2 55-64 Years 1335 11.4 12.4 802 9.5 10.5 533 16.2 17.1 65 and Over 8731 54.4 54.1 5943 51.8 52.7 2788 60.9 57.5 Hospital 6639 54.5 56.8 4024 51.2 53.8 2615 60.5 62.3 Other Institution 2820 23.1 21.5 1956 24.9 23.0 864 20.0 18.7 Home or Non-Institution 2730 22.4 21.7 1885 24.0 23.2 845 19.5 19.0 Total 11709 16.4 16.4 7514 13.6 13.7 4195 25.5 25.3 19. Marriages 11864 9.4 9.6 20. Divorces and Annulments 5766 4.6 4.7 3-6