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

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

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

4. Implementation of the 2003 Revised Birth Certificate 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 VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC 2003 or 2004 2005 NOTE: New York State but not New York city implemented for 2004. 20062007 or later Mid-year reviser

5. 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 Methods

6. 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 1 st trimester of pregnancy according to unrevised and revised data: Reporting areas, 2003 and 2004 BDECA Source: NCHS/CDC/National Vital Statistics System

9. Late or no prenatal care according to unrevised and revised data: Reporting areas, 2003 and 2004 BDECA Source: NCHS/CDC/National Vital Statistics System

10. Educational attainment  Y ears of schooling completed (unrevised) Highest degree completed (revised)  Data collected from mother’s worksheet

11. High school completion according to unrevised and revised data: Reporting areas, 2003 and 2004 BDECA NOTE: Unrev = 12+ years of schooling completed; Rev=HS diploma or GED+ Source: NCHS/CDC/National Vital Statistics System

12. College education according to unrevised and revised data:Reporting areas, 2003 and 2004 BDECA 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 Source: NCHS/CDC/National Vital Statistics System 12+ yrs/HS diploma/GED16+ yrs/BA, BS, equivalent+

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

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

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

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

19. 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

20. 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

21. 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

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

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

24. 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

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

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

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

28. 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 <500 g infants

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

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