hopeful signs of change amid struggle
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The Revised Birth Data:. Hopeful signs of change amid struggle. The NAPHSIS/NCHS Collaboration Past Successes and Future Challenges Salt Lake City, UT June 3 rd -7 th , 2007. Authors/Acknowledgments. Joyce Martin Stephanie Ventura The Birth Team: Brady HamiltonFay Menacker - PowerPoint PPT PresentationTRANSCRIPT
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 !!!