What’s new with the new birth items?Source of payment

WICInfant breastfed

June 2-6, 2013 Phoenix, Arizona

Sally C. Curtin, MA, Division of Vital Statistics, NCHS

Daniela Nitcheva, PhD, SC Department of Health and Environmental Control

Phyllis Reed, MPH, WA Center for Health Statistics

Data release plans

NCHS publications

Source of payment

National Vital Statistics Report on the Source of Payment data is forthcoming for a 33-State and DC reporting area for 2010

You are getting an exciting preview of the results today!

Data release for new data

Natality public use files and in Vital Stats for 2009, 2010 and 2011

Re-release the files/VitalStats with the new data and documentation

Source of payment as it appears on the 2003 Standard Certificate of Live Birth

Revised Reporting area, 2010

DC

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

MD

DE

NJ

CT RI

MA

ME

VT

NH

AK

HI

NYC

Revised (33 states+NYC+DC; 76% of births)

Mid year / rolling / partial

Unrevised

Differences between revised Reporting area and U.S. in race/Hispanic distributions, 2010

Non-Hispanic white 53.0254.44**

Non-Hispanic black 13.9414.85**

Hispanic 26.3923.80**

U.S.Revised area

Principal source of payment for delivery: revised reporting area, 2010

Medicaid44.9%

Private insurance

45.8%

Self-Pay (uninsured)

4.4%

Other5.0%

Births with Medicaid as the principal source of payment for the delivery: Revised area, 2010

Under 20 20-24 25-29 30-34 35-39 40 and over0

10

20

30

40

50

60

70

80

90

100White* Black* Hispanic Asian*

Age of mother

Per

cen

t

Medicaid-insured births by state, reporting area, 2010

DC

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

MD

DE

NJ

CT RI

MA

ME

VT

NH

AK

HI

NYC

Less than 30 percent

30-40 percent

50 percent or higher

40-50 percent

Early care (1st trimester) Late (3rd trimester) or no care0

10

20

30

40

50

60

70

80

90

63.8

8.5

85.3

2.4

48.9

19.1

Pe

rce

nt

Prenatal care receipt by principal source of payment for the delivery: Revised reporting area, 2010

Total cesarean Primary cesarean Repeat cesarean0

10

20

30

40

50

60

70

80

90

100

31.6

22.0

91.4

35.2

26.1

91.3

24.3

16.1

82.3

Medicaid Private insurance Self-pay

Pe

rce

nt

Cesarean delivery rates by principal source of payment for the delivery: Revised reporting area, 2010

Primary cesarean rate-cesarean births per 100 births to women with no previous cesarean.Repeat cesarean rate-cesarean births per 100 births to women with a previous cesarean.

Comparison with data from the National Hospital Discharge Survey

National Hospital Discharge Survey – Nationally representative survey of data from discharge records from non-federal, short-stay hospitals in the U.S.

Continuous since 1965, although a major survey redesign in 1988

Total of about 150,000 discharges in 2010 with 13,759 delivery discharges

Payment information is available, both a primary and secondary source

Primary payment source recoded to be as consistent as possible to the birth certificate categories

Birth certificate versus NHDS data on source of payment, 2010

Self-pay Other Medicaid Private insurance0

10

20

30

40

50

60

Birth certificate NHDS

**

* Difference is statistically significant

Quality of the data based on studies in two states

Birth certificate data compared with that of medical records:

State A – 600 births in 4 hospitals (150 each) – random sample

State B – 495 births in 4 hospitals (about 125 each) – convenience sample

Primary measure = sensitivity—percentage of births with a condition indicated on the medical record (the “gold” standard) that was also indicated on the birth certificate.

Quality of the data based on quality studies in two states

Sensitivity for Source of Payment:

State A – Private insurance 82.3%

Medicaid 79.0%

Other 87.9%

Self-pay ---

State B – Private insurance 85.8%

Medicaid 72.6%

Other ---

Self-pay 75.6%

--- Results not available because less than 20 cases

Quality of the data based on studies in two states

State A

State B

State A

State B

0 10 20 30 40 50 60 70 80 90 100

Medicaid

Sensitivity by hospital for source of payment data

Private insurance

Infant breastfed as it appears on the 2003 Standard Certificate of Live Birth

Percent of infants being breastfed for entire reporting area:

75.1%

NOTE: California, while in the revised reporting area, did not report infant breastfed

Births with infant being breastfed at discharge from the hospital: Revised area, 2010

Under 20 20-24 25-29 30-34 35-39 40 and over0

10

20

30

40

50

60

70

80

90

100White* Black* Hispanic Asian*

Age of mother

Per

cen

t

* Non-Hispanic

WIC receipt as it appears on the 2003 Standard Certificate of Live Birth

Percent of mothers with WIC receipt for entire reporting area:

48.2%

Mother received WIC food for herself during pregnancy: Revised area, 2010

Under 20 20-24 25-29 30-34 35-39 40 and over0

10

20

30

40

50

60

70

80

90White* Black* Hispanic Asian*

Age of mother

Per

cen

t

* Non-Hispanic

Quality of the data based on studies in two states

Sensitivity for Infant breastfed at discharge:

State A – 90.7%

State B – 96.2%

Quality information on WIC receipt not available from this study because this information is collected from the mother and is NOT on the medical record

Quality of the data based on quality studies in two states

State A

State B

0 10 20 30 40 50 60 70 80 90 100

Sensitivity by hospital for infant breastfed

Summary Data quality results

Source of payment

Generally good sensitivity (above 80 percent) for private insurance and Medicaid categories

Differences in sensitivity by hospital suggest room for improvement

Infant breastfed

High sensitivity overall for both States, over 90 percent

Above 80 percent sensitivity for all hospitals for both states; 5 out of 8 had over 90-percent sensitivity

WIC receipt

Not included in 2-state quality study because this item is collected from the mother on the Mother’s worksheet

Final thoughts

Data on source of payment will become national (Jan 2014) at the same time that theAffordable Care Act is fully implemented.

These data can be used to track the impact of the ACA on births by payment source.

Birth certificate data facilitate analyses not possible with survey data, for smaller subgroups and rarer events

Important difference in WIC receipt and infant breastfeeding by maternal age and race/Hispanic origin show that these items will be valuable additions to the natality file

Quality results for source of payment and infant breastfeeding so far are encouraging, but more studies are needed

Final final thought

National, high-quality birth certificate data on these topics will be a national

treasure