birth certificate data: essential for improving the nation’s health marian f. macdorman, ph.d....
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Birth Certificate Data: Essential for Improving the Nation’s Health
Marian F. MacDorman, Ph.D.Statistician, Division of Vital Statistics
National Center for Health Statistics, CDC
Acknowledgements: Fay Menacker and Joyce Martin, NCHS
Introduction
1. Importance and uses of birth certificate data.
2. The new, revised birth certificate – new data items, and efforts to improve data quality.
3. Special studies of data quality.
Importance and Uses
of Birth Certificate Data
Importance of Birth Certificate Data
• Birth certificate data are used to:– Monitor the characteristics and health of women
giving birth and their infants. – Determine public policy and funding for local,
state, and national maternal and child health programs.
– Research to improve maternal and infant health.• Thus, accuracy of reported data is essential to
making the correct decisions about how to improve maternal and child health.
• State and Local Health Departments • Federal govt. programs: Healthy Start, WIC, SCHIP, etc.• National Institutes of Health (NIH)• Centers for Disease Control and Prevention (CDC)• National Campaign to Prevent Teen Pregnancy• March of Dimes (birth defects, preterm birth)• Children’s Defense Fund• Marketing, Investment, Insurance, Pharmaceutical,
Healthcare and Law Firms• Independent researchers
Major Users of Birth Certificate Data
Selected Birth Certificate Data Items used for Health Monitoring
• Mother’s age (e.g., teen births, older mothers) • Mother’s race and Hispanic origin
• Medical risks (e.g., diabetes, hypertension)
• Method of delivery (cesarean)• Prenatal care• Gestational age (preterm birth)• Birthweight (low birthweight)And many more!
Important Uses of Birth DataFigure 2. Live births and fertility rates: United States, final
1930-2006 and preliminary 2007-2008
0
1
2
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1930 1940 1950 1960 1970 1980 1990 2000
Year
Mil
lio
ns
of
bir
ths
0
20
40
60
80
100
120
140
160
180
200
Ra
te p
er
1,0
00
wo
me
n a
ge
d
15
-44
ye
ars
Number Rate
0
10
20
30
40
50
60
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80
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100
1980 1985 1990 1995 2000 2005 2008Rat
es p
er 1
,000
wo
men
in
sp
ecif
ied
ag
e g
rou
p18-19
15-19
15-17
Figure 1. Birth rates for teenagers by age: United States, final 1980-2006 and preliminary 2007-2008
Important Uses of Birth Data (continued)
Cesarean Delivery
6
8
10
12
14
16
18
20
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Non-Hispanic black
All races
Non-Hispanic white
Preterm Birth
Important Uses of Birth Data (continued)
Figure 3. Cesarean Delivery Rate: United States, final 1995-2006 and preliminary 2007-2008
Figure 4. Preterm birth rates by race and Hispanic origin of mother: United States, final 1990-2006 and preliminary 2007-2008
Birth Data in Research
The New, Revised Birth
Certificate: New Data Items, and
Efforts to Improve Data Quality
The 2003 Revision
• The 2003 revision of the U.S. Standard Certificate of Live Birth includes improved and new data items
• Major goal of the revision: improved data quality.
• Quality improved through standardized:– Data sources and definitions– Worksheets– Guidebook– Electronic systems
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
The 2003 U.S. Standard Certificate of Live Birth: Revision Status - 2009
64% of all births by close of 2009
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
The 2003 U.S. Standard Certificate of Live Birth: Revision Status - 2010
90% of all births by close of 2010
New Birth Certificate: Important New Items
– Breast feeding– Did mother get WIC food
during this pregnancy?– Principal source of
payment for the delivery – Fertility therapy– Infections during
pregnancy– Maternal morbidity
New Birth Certificate: Modified Items– Mother’s and father’s race,
captures multiple race identification
– Mother’s and father’s education, captures highest degree attained
– Cigarette smoking before and during pregnancy, captures levels of smoking
– Method of delivery includes fetal presentation and trial of labor prior to cesarean delivery
– Pre-pregnancy weight, weight at delivery and height, used to calculate Body Mass Index
– Congenital anomalies
New WorksheetsTo encourage collection from the best sources,
two standard worksheets have been developed and tested.
– Mother’s Worksheet (MWS)– Facility Worksheet (FWS)
Mother’s Worksheet
Data are obtained directly from the mother for certain items:- Race- Hispanic origin- Education- Cigarette smoking- WIC participation
Facility Worksheet
Data are obtained directly from medical records of the mother and infant for certain items, such as:
- Date of last menstrual period (LMP)- Obstetric estimate of gestation- Birthweight- Apgar score- Congenital anomalies- Pregnancy risk factors- Method of delivery- Prenatal care items- Obstetric procedures
Guide to Completing Facility Worksheet
To assist hospital staff in completing the Facility Worksheet, a comprehensive instruction manual has been developed. It includes:– Definitions, key words and common abbreviations.– Preferred sources within the medical record (e.g., prenatal care record,
labor and delivery record)
The Guide is available at: http://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf
Expanded Health Reports for 2004-2006 are now available. These highlight new data items, such as:
- Neonatal intensive care unit (NICU) admission.
- Smoking by trimester of pregnancy
- Steroid and surfactant administration (treatment)
Reports on Revised Birth Data
Distribution of Singleton Births Admitted to a Neonatal Intensive Care Unit (NICU) by Gestational Age:
19-State Reporting Area, 2006
16.6%
24.7% 10.4%
46.9%
37+ weeks
34-36 weeks
32-33 weeks
<32 weeks
Source: CDC/NCHS National vital statistics system.
Percent Low Birth Weight by Smoking Status: 17-state Reporting Area, 2006
Source: CDC/NCHS National vital statistics system.
Special Studies of Data Quality
NCHS is fielding two different types of studies to evaluate the health/medical items on the birth certificate
1)In-depth interviews with birth record specialists in Florida, Kansas, Vermont, and Washington.
2)Validity studies that compare data from the birth certificate with data from hospital medical records.
Special Studies of Data Quality
Data Quality Study: Results
Important to collect information from the best data sources!
From the mother: Demographic and behavioral risk factors- Smoking during pregnancy- WIC use
From the medical record: Medical and health information- Date of last menstrual period- Obstetric estimate of gestation- Prenatal care information- Previous cesarean delivery
Data Quality Study Results: Gestational Age
Date of LMP:• Enter the first day of the mother’s LMP from the prenatal care
record• Do not ask the mother!• Do not use a pregnancy wheel to estimate gestational age.
Obstetric estimate of gestation• Enter the best obstetric estimate of the infant’s gestational
age (in completed weeks).• Gestation should be determined by all perinatal factors and
assessments, but not from the neonatal exam.• Ultrasound taken early in pregnancy is a preferred source.• Information most often found in labor and delivery record.• Do not complete this item based solely on the infant’s date of
birth and mother’s date of last menstrual period.
Data Quality Study Results: Number of Prenatal Care Visits
Problem: - Prenatal care records often sent to the hospital a few
weeks before delivery. - This can lead to underreporting of number of prenatal
visits.Solution: - Contact prenatal care provider to get the updated
number of prenatal visits.- If not possible, use the latest information available.- Do not attempt to estimate additional visits.
Data Quality Study Results: Breastfeeding
Item: Is infant being breastfed at discharge?- Mark “yes” if infant is breastfed at any time between
birth and hospital discharge
Data Quality Study Results: Trial of Labor
• New item: If cesarean, was a trial of labor attempted?• Problem: Item does not exactly correspond to an item
in the medical records.• Solution: Review labor and delivery record for
indications of labor, such as augmentation, induction, precipitous labor, prolonged labor, etc.
• If the woman had labor prior to the cesarean, this item should be marked “yes.”
Data Quality Study Results: Mother Had a Previous Cesarean Delivery?
• An item under Risk Factors in the Pregnancy asks if the mother had a previous cesarean delivery, and if yes, how many?
• This item, when combined with the Method of Delivery item will tell us for a cesarean delivery, whether it is primary or repeat cesarean delivery. And for a vaginal delivery, whether is a vaginal birth after cesarean, or VBAC delivery.
• Information available from the prenatal care, or labor and delivery records.
NCHS Developing Improved Reference Materials
• Guide to Completing the Facility Worksheet being revised.
• Other approaches under consideration:– Detailed definitions and instructions available online– Webinars with periodic updates– On-going training– Setting up HELP lines for immediate access to state and
national experts.
As you gain experience with the revised birth certificate, we would love to hear your ideas and questions.
- What are the hardest items to fill out on the birth certificate? - What do you struggle with?- What questions do you have?
Your feedback will help us to improve data quality and also to ask the right questions in future studies.
Your Feedback is Important!
Conclusions • Birth certificates are the most important national data source for assessing and improving the health of mothers and infants.
• Virtually every data item collected on the birth certificate is used for research to improve mother’s and infant’s health.• Examples of the most important data items include:
- Maternal age- Race/ethnicity- Gestational age- Birthweight- Method of delivery
•By the end of 2010 almost all states will be using the Revised Birth Certificate.
•New and modified data items provide important infor-mation to improve the health of mothers and infants.
•Studies are currently underway to assess the quality of birth certificate data and to develop strategies for improvement. First results will be presented at the NAPHSIS meeting in June.
• By the end of 2010 most states will be using the Revised Birth Certificate.
• New birth certificate provides essential information to improve the health of mothers and infants.
• Data quality has improved, but more work is needed.
• NCHS collaborating with state colleagues to further improve quality
• Your feedback is important to data improvement efforts!
Conclusions
Thank you for all that you do to improve
the health of mothers and babies!
