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Hopeful signs of change amid struggle

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 Hamilton Fay Menacker

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Hopeful signs of change amid struggle

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  1. The Revised Birth Data: Hopeful signs of change amid struggle The NAPHSIS/NCHS Collaboration Past Successes and Future Challenges Salt Lake City, UT June 3rd-7th, 2007

  2. Authors/Acknowledgments Joyce Martin Stephanie Ventura The Birth Team: Brady Hamilton Fay Menacker Sharon Kirmeyer Martha Munson Marian MacDorman Paul Sutton TJ Mathews U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System

  3. WA ME MT ND MN VT OR NH MA ID WI NY SD CT WY MI RI PA IA NJ NE NV OH DE IN IL UT MD CO WV VA KS MO CA KY NC TN OK AZ AR SC NM GA AL MS DC TX LA FL AK HI Revision Status, 2007 Revised NYC Unrevised

  4. Today’s Topics • Key items on both revised & unrevised birth certificates • Prenatal care • Cesarean delivery • Checkboxes items • Diabetes and hypertension

  5. Methods • Total 2005 revised states (12) (1.3 m births) • Excludes mid-year revisers • Trends - states which revised in 2004 (5) or 2005 (3) • Excludes mid-year revisers

  6. Prenatal Care Unrevised: Source ? = mom, records

  7. Prenatal Care Revised: Source = prenatal records, mom ?

  8. Percent of Records with Not Stated Day & Month of 1st prenatal visit: 12 Revised States, 2005 Source: NCHS/CDC/National Vital Statistics System

  9. Percent of Records with Not Stated Day of 1st Prenatal Visit: 12 Revised States, 2005 Source: NCHS/CDC/National Vital Statistics System

  10. 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

  11. 1st Trimester Prenatal Care by Revised Status:3 Revised states, 2004 and 2005 State A State B State C Source: NCHS/CDC/National Vital Statistics System

  12. Percent change in 1st Trimester Prenatal Care, Unrevised and Revised Reporting Areas: 2004-2005 Unrevised Revised Source: NCHS/CDC/National Vital Statistics System

  13. 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

  14. Cesarean Delivery • 3 commonly used measures: • Total cesarean delivery rate • Primary cesarean rate • Vaginal birth after previous cesarean (VBAC)

  15. Cesarean Delivery Revised Unrevised • Total cesarean rate • Very comparable between revisions

  16. Cesarean Delivery - Revised • Primary cesarean • VBAC/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)

  17. Cesarean Delivery- Revised

  18. Primary Cesarean Delivery Rates for Unrevised States and for States which Revised in 2005: Reporting Area, 2004-2005 Reporting area State A State B State C Source: NCHS/CDC/National Vital Statistics System

  19. VBAC Rates for Unrevised States and for States which Revised in 2005: Reporting Area, 2004-2005 Reporting area State A State B State C Source: NCHS/CDC/National Vital Statistics System

  20. Primary Cesarean Delivery and VBAC Rates by Revised Status: Reporting area, 2005 Primary VBAC Source: NCHS/CDC/National Vital Statistics System

  21. 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

  22. Cesarean Delivery BUT, possible under-reporting • of # previous cesareans • Developing enhanced • instructions for reporting • if mom had a previous • cesarean using prenatal • and other medical records

  23. Pregnancy Risk Factors • 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 Source: NCHS/CDC/National Vital Statistics System

  24. Total Diabetes (Pre-pregnancy + Gestational) for states which revised in 2004 and 2005: Reporting Area, 2003-2005 G A B C D E F H Source: NCHS/CDC/National Vital Statistics System

  25. Gestational Hypertension Rates for States which Revised in 2004 and 2005: Reporting Area, 2003-2005 G A B C D E F H Source: NCHS/CDC/National Vital Statistics System

  26. Diabetes and Pre-pregnancy Hypertension: Unrevised Reporting Area: 2004-2005 Pre-pregnancy hypertension Diabetes Source: NCHS/CDC/National Vital Statistics System

  27. New Report • Begins to • demonstrate • the tremendous • analytic potential • of the revised data Source: NCHS/CDC/National Vital Statistics System

  28. 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 !!!

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