Challenges and Rewards of the Revised Birth Data Braving the New World: Improving Security, Systems,...

Challenges andChallenges andRewards of the Revised Birth DataRewards of the Revised Birth Data

Braving the New World:

Improving Security, Systems, and StatisticsSan Diego, CA

June 4th – 8th, 2006

U.S. Department of Health and Human ServicesCenters for Disease Control and Prevention

National Center for Health StatisticsNational Vital Statistics System

Authors/Acknowledgments

Joyce MartinStephanie Ventura

The Birth TeamBrady Hamilton, TJ Mathews, et al

DAEB

Comparability of revised& unrevised data

Rewards of revised data

Updates on some long-standing data issues

Braving the New World:

Implementation of the2003 Revised Birth Certificate

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MDDE

NJ

CT RI

MA

ME

VTNH

AK

HI

DC

2003 or 2004

2005

NOTE: New York State but not New York city implemented for 2004.2006 2007 or later

Mid-year reviser

Final 2004 unreleased birth data

2 revised states for 2003 7 revised states for 2004

2 of 7 revised during 2004 Mid-year revisers excluded from comparability analysis

Methods

Comparability (or lack thereof)

Higher profile items:

Prenatal care Educational attainment Tobacco use during pregnancy

Prenatal care

Month prenatal care began Date of first prenatal visit

Change in source of data ? mother prenatal records

Prenatal care in the 1st trimester of pregnancy according to unrevised and revised data:Reporting areas, 2003 and 2004

01020304050

60708090

100

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Pe

rce

nt

B D ECA

Source: NCHS/CDC/National Vital Statistics System

Late or no prenatal care according to unrevised and revised data: Reporting areas, 2003 and 2004

0

2

4

6

8

10

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Pe

rce

nt

B D ECA


Educational attainment Years of schooling completed (unrevised)

Highest degree completed (revised)

Data collected from mother’s worksheet

High school completion according to unrevised and revised data: Reporting areas, 2003 and 2004

01020304050

60708090

100

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Pe

rce

nt

B D ECA

NOTE: Unrev = 12+ years of schooling completed; Rev=HS diploma or GED+


College education according to unrevised and revised data:Reporting areas, 2003 and 2004

0

5

10

15

20

25

30

35

40

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Unrev

-03

Rev-0

4

Pe

rce

nt

B D ECA

NOTE: Unrev = 16+ yrs of schooling completed; Rev = BA, BS, equivalent or moreSource: NCHS/CDC/National Vital Statistics System

0

10

20

30

40

50

60

70

80

90

100

NH White NH Black Hispanic NH White NH Black Hispanic

Perc

en

t

Unrevised - 2003 Revised 2004group

High school and college education levels by race and Hispanic origin, according to unrevised and revised data: Reporting areas, 2003 and 2004


12+ yrs/HS diploma/GED 16+ yrs/BA, BS, equivalent+

Smoking during pregnancy

Mother used tobacco during pregnancy [any time during pregnancy] (unrevised)

Smoking during each trimester of pregnancy [also pre-pregnancy] (revised)

Source: Mother’s worksheet

Maternal smoking rates according to unrevised and revised data: Reporting areas, 2003 and 2004

0

5

10

15

20

2003 2004 2003 2004

Pe

rce

nt

Revised in 2004(5 states)

Unrevised(41 states)


0

5

10

15

20

25

30

35

NH White NH Black Hispanic < HS HS Somecollege+

Perc

en

t

Unrevised 2003 Revised 2004group

Maternal smoking rates by race and Hispanic origin and by education, according to unrevised and revised data: 5 Reporting areas, 2003 and 2004


Race/Hispanic origin Education

0

2

4

6

8

10

12

14

16

18

20

All NH White NH Black Hispanic API AI/AN

Perc

en

t

Yes Nogroup

Low birthweight rates by smoking status and race/Hispanic origin: 7 reporting areas, 2004


Low birthweight = <2,500 gr; 5 lb 8 oz

Total cesarean delivery data

Primary cesareanRepeat cesarean

-- Derived from:“Method of delivery” “Pregnancy risk factors”

”Mother had a previous cesarean”

Comparability - Cesarean delivery

Average percent change in total cesarean rates for unrevised states and for states which revised in 2004: Reporting areas, 2003 and 2004

0

1

2

3

4

5

6

7

8

9

10

Unrevised Revised (in 2004)

Pe

rce

nt

Total Cesarean Rate


Average percent change in primary cesarean and VBAC* delivery rates for unrevised States, and for States which revised in 2004: Reporting areas, 2003 and 2004

-20

-15

-10

-5

0

5

10

15

20

25

30

Unrevised Revised (in2004)

Unrevised Revised (in2004)

Pe

rce

nt

Primary C VBAC*


Comparability - summary

Total cesarean rate = comparablePrimary cesarean = ?VBAC = ?-Linked to under-reporting of previous Cs on new cert ?

Prenatal care, tobacco use, educational attainment not comparable Detailed comparability crosswalk available

A few insightsOn revised (old/new) data

Signs of improved data quality Use of hospital records

Variability in quality by state

Maternal weight gain distribution according to unrevised and revised data: 5 States, 2003 and 2004

0

1

2

3

4

5

6

7

8

9

10

01 5 10 15 20 25 30 35 40 45 50

Pounds

Pe

rce

nt Unrevised

Revised


Maternal diabetes rates according to unrevised and revised data: Reporting areas, 2003 and 2004

0

10

20

30

40

50

60

2003 2004 2003 2004

Pe

r 1

,00

0

Revised (2004)(5 States)

Unrevised(41 States)


Percent of records with not stated data for day of first prenatal visit: 7 revised States, 2004

0

2

4

6

8

10

12

14

16

18

20

StateA

StateB

StateC

StateD

StateE

StateF

StateG

Pe

rce

nt


Percent of records with not stated data for maternal weight at delivery:7 revised States, 2004

-1

1

3

5

7

9

11

13

15

StateA

StateB

StateC

StateD

StateE

StateF

StateG

Pe

rce

nt


Update: long-standing issues

Quality of gestational age data

Under-reporting of infant deaths (<500 g)

Update

Postpone introducing changes to NCHS edits of gestational age Collaborate with NAPHIS on study to address reporting of LMP-based gestational age/under-reporting of dths of <500 g infants

Summary

Trend data,national data, problematic for education, tobacco use,prenatal care, and many others

Revised data encouraging signs

of improved quality wording & sources

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MDDE

NJ

CT RI

MA

ME

VTNH

AK

HI

DC

Guide to Completingthe Facility Worksheetfor the Certificate ofLive Birth & Reportof Fetal Death

Updated!!

Challenges and Rewards of the Revised Birth Data Braving the New World: Improving Security, Systems,...

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