hopeful signs of change amid struggle

Hopeful signs ofHopeful signs ofchange amid strugglechange amid struggle

The Revised Birth Data:

The NAPHSIS/NCHS CollaborationPast Successes and Future ChallengesSalt Lake City, UT June 3rd-7th, 2007

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 VenturaThe Birth Team:Brady Hamilton Fay MenackerSharon Kirmeyer Martha MunsonMarian MacDorman Paul SuttonTJ Mathews

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

Revision Status, 2007

Revised

UnrevisedNYC

Key items on both revised & unrevised birth certificates

Prenatal careCesarean deliveryCheckboxes items

Diabetes and hypertension

Today’s Topics

Methods

Total 2005 revised states (12)(1.3 m births)

Excludes mid-year revisers

Trends - states which revised in2004 (5) or 2005 (3)

Excludes mid-year revisers

Prenatal Care

Source ? = mom, records

Unrevised:

Prenatal Care

Source = prenatal records, mom ?

Revised:

Percent of Records with Not Stated Day & Month of 1st prenatal visit: 12 Revised States, 2005

0

2

4

6

8

10

12

14

16

18

20

Day Month

Pe

rce

nt

Source: NCHS/CDC/National Vital Statistics System

Percent of Records with Not Stated Day of 1st Prenatal Visit: 12 Revised States, 2005

0

5

10

15

20

25

30

Total

State

A

State

B

State

C

State

D

State

E

State

F

State

G

Stage

H

State

I

State

J

State

K

State

L

Pe

rce

nt

Source: NCHS/CDC/National Vital Statistics System

NCHS Calculation ofMonth Prenatal Care Began

Difference between Date of 1st PNCV & Date of last normal menses

If day of 1st PNCV = unk, impute day from last record w/ same month of 1st PNCV

SAS code to calculate now available from NCHS

1st Trimester Prenatal Care by Revised Status:3 Revised states, 2004 and 2005

0

10

20

30

40

50

60

70

80

90

100

Unrev-04 Rev-05 Unrev-04 Rev-05 Unrev-04 Rev-05

Pe

rce

nt

State B State CState A

Source: NCHS/CDC/National Vital Statistics System

Percent change in 1st Trimester Prenatal Care, Unrevised and Revised Reporting Areas: 2004-2005

-5

-4

-3

-2

-1

0

1

2

3

4

5

Percent change Percent changePe

rce

nt

UnrevisedRevised

Source: NCHS/CDC/National Vital Statistics System

Timing of Prenatal Care

Large discontinuity between unrevised and revised PNC data

Revised levels much less favorable Some difference was expected Changes in question & sources of data?

Studies show moms tend to over-report Wide differences in unknown levels by

reporting area

Cesarean Delivery

3 commonly used measures:Total cesarean delivery rate

Primary cesarean rate Vaginal birth after previous cesarean (VBAC)

Cesarean Delivery

Total cesarean rate Very comparable between revisions

RevisedUnrevised

Cesarean Delivery - Revised

Primary cesareanVBAC/Repeat cesarean

Need info on both current and previous deliveries -derived from 2 separate items:

“Method of delivery” “Pregnancy risk factors”

“Mother had a previous cesarean” (from mom’s prenatal

records)

Cesarean Delivery- Revised

Primary Cesarean Delivery Rates for Unrevised States and for States which Revised in 2005: Reporting Area, 2004-2005

0

5

10

15

20

25

30

35

Unrev 04

Unrev 05

Unrev 04

Rev 05

Unrev 04

Rev 05

Unrev 04

Rev 05

Pe

rce

nt

State BReporting area State CState A

Source: NCHS/CDC/National Vital Statistics System

VBAC Rates for Unrevised States and for States which Revised in 2005: Reporting Area, 2004-2005

1

3

5

7

9

11

13

15

Unrev04

Unrev05

Unrev 04

Rev 05

Unrev04

Rev 05

Unrev04

Rev 05

Pe

rce

nt

State BReporting area State CState A

Source: NCHS/CDC/National Vital Statistics System

Primary Cesarean Delivery and VBAC Rates by Revised Status: Reporting area, 2005

0

5

10

15

20

25

30

Unrevised Revised Unrevised Revised

Pe

rce

nt

Source: NCHS/CDC/National Vital Statistics System

Primary VBAC

Cesarean Delivery

NCHS no longer considers Primary Cesarean and VBAC data comparable across revisions Revised data may be improved

Revised rates higher than unrevised (previously thought under-reported)

Better agreement w/other sources

Cesarean Delivery

BUT, possible under-reporting of # previous cesareans

Developing enhanced instructions for reporting if mom had a previouscesarean using prenataland other medical records

Pregnancy Risk Factors

Source: NCHS/CDC/National Vital Statistics System

Diabetes Unrevised = Total Diabetes only Revised = Pre-pregnancy + gestational diabetes Possible change in source of data

Gestational hypertension No change except possibly to sources of data

Total Diabetes (Pre-pregnancy + Gestational) for states which revised in 2004 and 2005: Reporting Area, 2003-2005

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

Unrev

-04

Rev-0

5

Unrev

-04

Rev-0

5

Unrev

-04

Rev-0

5

Pe

r 1

,00

0

B D ECA

Source: NCHS/CDC/National Vital Statistics System

F G H

Gestational Hypertension Rates for States which Revised in 2004 and 2005: Reporting Area, 2003-2005

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

Unrev

-04

Rev-0

5

Unrev

-04

Rev-0

5

Unrev

-04

Rev-0

5

Pe

r 1

,00

0

B D ECA

Source: NCHS/CDC/National Vital Statistics System

F G H

Diabetes and Pre-pregnancy Hypertension: Unrevised Reporting Area: 2004-2005

0

10

20

30

40

50

60

2003 2004 2005 2003 2004 2005

Pe

r 1

,00

0

Pre-pregnancyhypertension

Diabetes

Source: NCHS/CDC/National Vital Statistics System

New Report

Source: NCHS/CDC/National Vital Statistics System

Begins to demonstrate the tremendous analytic potential of the revised data

Summary Prenatal care

Large discontinuities; higher levels of unknowns; revised data may still be more accurate

Primary, Repeat and VBAC Not comparable; developing improved

instructions for hospitals Very encouraging signs of improved

data quality for checkbox items Need validation studies !!!Need validation studies !!!