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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
Source: NCHS/CDC/National Vital Statistics System
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+
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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)
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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*
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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)
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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
Source: NCHS/CDC/National Vital Statistics System
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!!