Challenges and

1

Braving the New World
Challenges and Rewards of the Revised Birth Data
Improving Security, Systems, and Statistics San
Diego, CA June 4th 8th, 2006
2

Authors/Acknowledgments
Joyce Martin Stephanie Ventura The Birth
Team Brady Hamilton, TJ Mathews, et al DAEB
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Braving the New World

• Comparability of revised
• unrevised data
• Rewards of revised data
• Updates on some long-standing data issues

4
Implementation of the2003 Revised Birth
Certificate
2003 or 2004
2005
Mid-year reviser
2006
2007 or later
NOTE New York State but not New York city
implemented for 2004.
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Methods

• 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

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Comparability (or lack thereof)

• Higher profile items
• Prenatal care
• Educational attainment
• Tobacco use during pregnancy

7

Prenatal care

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

8
Prenatal care in the 1st trimester of pregnancy
according to unrevised and revised
dataReporting areas, 2003 and 2004
B
D
E
C
A
Source NCHS/CDC/National Vital Statistics System
9
Late or no prenatal care according to unrevised
and revised data Reporting areas, 2003 and 2004

B
D
E
C
A
Source NCHS/CDC/National Vital Statistics System
10

Educational attainment

• Years of schooling completed (unrevised)
  
• Highest degree completed (revised)
• Data collected from mothers worksheet

11
High school completion according to unrevised and
revised data Reporting areas, 2003 and 2004
B
D
E
C
A
NOTE Unrev 12 years of schooling completed
RevHS diploma or GED
Source NCHS/CDC/National Vital Statistics System
12
College education according to unrevised and
revised dataReporting areas, 2003 and 2004
B
D
E
C
A
NOTE Unrev 16 yrs of schooling completed Rev
BA, BS, equivalent or more
Source NCHS/CDC/National Vital Statistics System
13
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
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Smoking during pregnancy

• Mother used tobacco during pregnancy any time
  during pregnancy (unrevised)
  
• Smoking during each trimester of pregnancy
  also pre-pregnancy (revised)
• Source Mothers worksheet

15
Maternal smoking rates according to unrevised and
revised data Reporting areas, 2003 and 2004

Unrevised (41 states)
Revised in 2004 (5 states)
Source NCHS/CDC/National Vital Statistics System
16
Maternal smoking rates by race and Hispanic
origin and by education, according to unrevised
and revised data 5 Reporting areas, 2003 and 2004
Education
Race/Hispanic origin
Source NCHS/CDC/National Vital Statistics System
17
Low birthweight rates by smoking status and
race/Hispanic origin 7 reporting areas, 2004
Low birthweight Source NCHS/CDC/National Vital Statistics System
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Comparability - Cesarean delivery

• Total cesarean delivery data
• Primary cesarean
• Repeat cesarean
• -- Derived from
• Method of delivery
• Pregnancy risk factors
• Mother had a previous cesarean

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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
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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
VBAC
Source NCHS/CDC/National Vital Statistics System
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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
• Detailed comparability crosswalk available

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A few insights On revised (old/new) data

• Signs of improved data quality
• Use of hospital records
• Variability in quality by state

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

Revised (2004) (5 States)
Unrevised (41 States)
Source NCHS/CDC/National Vital Statistics System
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Percent of records with not stated data for day
of first prenatal visit 7 revised States, 2004
Source NCHS/CDC/National Vital Statistics System
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Percent of records with not stated data for
maternal weight at delivery7 revised States,
2004
Source NCHS/CDC/National Vital Statistics System
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Update long-standing issues

• Quality of gestational age data
• Under-reporting of infant deaths (

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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

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Summary

• Trend data,
• national data, problematic
• for education, tobacco use,
• prenatal care, and many others
• Revised data encouraging signs of improved
  quality
• wording sources

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