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Braving the New World: Challenges and Rewards of the Revised Birth Data Improving Security, Braving the New World: Challenges and Rewards of the Revised Birth Data Improving Security, Systems, and Statistics San Diego, CA June 4 th – 8 th, 2006

Authors/Acknowledgments Joyce Martin Stephanie Ventura The Birth Team Brady Hamilton, TJ Mathews, et al Authors/Acknowledgments Joyce Martin Stephanie Ventura The Birth Team Brady Hamilton, TJ Mathews, et al DAEB U. S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System

Braving the New World: ü Comparability of revised & unrevised data ü Rewards of Braving the New World: ü Comparability of revised & unrevised data ü Rewards of revised data ü Updates on some long-standing data issues

Implementation of the 2003 Revised Birth Certificate WA MT ME ND MN OR ID Implementation of the 2003 Revised Birth Certificate WA MT ME ND MN OR ID VT NH WI SD NY WY PA IA NE OH IL UT CT RI MI NV IN CO WV KS CA MO VA KY OK NM NJ DE MD DC NC TN AZ MA AR SC MS AL GA TX LA FL AK HI NOTE: New York State but not New York city implemented for 2004. 2003 or 2004 2005 Mid-year reviser 2006 2007 or later

Methods ü Final 2004 unreleased birth data ü 2 revised states for 2003 ü Methods ü Final 2004 unreleased birth data ü 2 revised states for 2003 ü 7 revised states for 2004 ü 2 of 7 revised during 2004 § Mid-year revisers excluded from comparability analysis

Comparability (or lack thereof) Higher profile items: ü Prenatal care ü Educational attainment ü Comparability (or lack thereof) Higher profile items: ü Prenatal care ü Educational attainment ü Tobacco use during pregnancy

Prenatal care v Month prenatal care began Date of first prenatal visit v Change Prenatal care v Month prenatal care began Date of first prenatal visit v Change in source of data ? mother prenatal records

Prenatal care in the 1 st trimester of pregnancy according to unrevised and revised Prenatal care in the 1 st trimester of pregnancy according to unrevised and revised data: Reporting areas, 2003 and 2004 A B C Source: NCHS/CDC/National Vital Statistics System D E

Late or no prenatal care according to unrevised and revised data: Reporting areas, 2003 Late or no prenatal care according to unrevised and revised data: Reporting areas, 2003 and 2004 A B C Source: NCHS/CDC/National Vital Statistics System D E

Educational attainment v Years of schooling completed (unrevised) Highest degree completed (revised) v Data Educational attainment v Years of schooling completed (unrevised) Highest degree completed (revised) v Data collected from mother’s worksheet

High school completion according to unrevised and revised data: Reporting areas, 2003 and 2004 High school completion according to unrevised and revised data: Reporting areas, 2003 and 2004 A B C D E 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 A College education according to unrevised and revised data: Reporting areas, 2003 and 2004 A B C D E NOTE: Unrev = 16+ yrs of schooling completed; Rev = BA, BS, equivalent or more Source: NCHS/CDC/National Vital Statistics System

High school and college education levels by race and Hispanic origin, according to unrevised 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+ Source: NCHS/CDC/National Vital Statistics System

Smoking during pregnancy v Mother used tobacco during pregnancy [any time during pregnancy] (unrevised) Smoking during pregnancy v Mother used tobacco during pregnancy [any time during pregnancy] (unrevised) Smoking during each trimester of pregnancy [also pre-pregnancy] (revised) v Source: Mother’s worksheet

Maternal smoking rates according to unrevised and revised data: Reporting areas, 2003 and 2004 Maternal smoking rates according to unrevised and revised data: Reporting areas, 2003 and 2004 Unrevised (41 states) Source: NCHS/CDC/National Vital Statistics System Revised in 2004 (5 states)

Maternal smoking rates by race and Hispanic origin and by education, according to unrevised 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 Source: NCHS/CDC/National Vital Statistics System Education

Low birthweight rates by smoking status and race/Hispanic origin: 7 reporting areas, 2004 Low Low birthweight rates by smoking status and race/Hispanic origin: 7 reporting areas, 2004 Low birthweight = <2, 500 gr; 5 lb 8 oz Source: NCHS/CDC/National Vital Statistics System

Comparability - Cesarean delivery Total cesarean delivery data Primary cesarean Repeat cesarean -- Derived Comparability - Cesarean delivery Total cesarean delivery data Primary cesarean Repeat cesarean -- Derived from: “Method of delivery” “Pregnancy risk factors” q”Mother had a previous cesarean”

Average percent change in total cesarean rates for unrevised states and for states which Average percent change in total cesarean rates for unrevised states and for states which revised in 2004: Reporting areas, 2003 and 2004 Total Cesarean Rate Source: NCHS/CDC/National Vital Statistics System

Average percent change in primary cesarean and VBAC* delivery rates for unrevised States, and 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 Primary C Source: NCHS/CDC/National Vital Statistics System VBAC*

Comparability - summary Total cesarean rate = comparable Primary cesarean = ? VBAC = Comparability - summary Total cesarean rate = comparable Primary cesarean = ? VBAC = ? -Linked to under-reporting of previous Cs on new cert ? Prenatal care, tobacco use, educational attainment not comparable ü Detailed comparability crosswalk available

A few insights On revised (old/new) data ü Signs of improved data quality ü A few insights On revised (old/new) data ü Signs of improved data quality ü Use of hospital records ü Variability in quality by state

Maternal weight gain distribution according to unrevised and revised data: 5 States, 2003 and Maternal weight gain distribution according to unrevised and revised data: 5 States, 2003 and 2004 Source: NCHS/CDC/National Vital Statistics System

Maternal diabetes rates according to unrevised and revised data: Reporting areas, 2003 and 2004 Maternal diabetes rates according to unrevised and revised data: Reporting areas, 2003 and 2004 Unrevised (41 States) Source: NCHS/CDC/National Vital Statistics System Revised (2004) (5 States)

Percent of records with not stated data for day of first prenatal visit: 7 Percent of records with not stated data for day of first prenatal visit: 7 revised States, 2004 Source: NCHS/CDC/National Vital Statistics System

Percent of records with not stated data for maternal weight at delivery: 7 revised Percent of records with not stated data for maternal weight at delivery: 7 revised States, 2004 Source: NCHS/CDC/National Vital Statistics System

Update: long-standing issues v Quality of gestational age data v Under-reporting of infant deaths Update: long-standing issues v Quality of gestational age data v Under-reporting of infant deaths (<500 g)

Update ü Postpone introducing changes to NCHS edits of gestational age ü Collaborate with Update ü Postpone introducing changes to NCHS edits of gestational age ü Collaborate with NAPHIS on study to address reporting of LMPbased gestational age/underreporting of dths of <500 g infants

WA MT ME ND MN OR ID WI SD WY IL CO KS CA WA MT ME ND MN OR ID WI SD WY IL CO KS CA AZ Summary PA IA NE O K NM IN OH WV MO KY VA NC TN AR SC MS AL MA CT RI MI NV UT NY VT NH GA TX LA FL AK Trend data, national data, problematic for education, tobacco use, prenatal care, and many others HI Revised data encouraging signs of improved quality wording & sources NJ DE MD D C

Guide to Completing the Facility Worksheet for the Certificate of Live Birth & Report Guide to Completing the Facility Worksheet for the Certificate of Live Birth & Report of Fetal Death Updated!!