Comparison of PRAMS Self-report of Selected Pregnancy Morbidities With Birth Certificate Records

1. Comparison of PRAMS Self-report of Selected Pregnancy Morbidities With Birth Certificate Records Laurie Baksh, MPH Shaheen Hossain, PhD Ayanna Harrison, BS Lois Bloebaum, BSN Nan Streeter, MS RN Utah Department of Health, Maternal Child Health Bureau

2. Background • Many studies have been conducted to validate the information contained on birth certificates • Literature review shows validation of medical records done in New York, Georgia, Florida, Alabama, Tennessee, and North Carolina

3. Literature Review • Roohan et al. showed a wide range of sensitivity for maternal risk factors, ranging from 100% for Rh sensitization to 3% for reporting of a previous pre-term infant. Positive predictive values also had a wide range. • Piper et al. found low sensitivity for maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies. Roohan, P. Josberger R. Acar J. Dabir P, Feder H, Gagliano P. Validation of Birth Certificate Data in New York State. Journal of Community Health, 28(5); 335-345 Piper J, Mitchel E, Snowden M, Hall C, Adams M, Taylor P. Validation of 1989 Tennessee Birth Certificates using Maternal and Newborn Hospital Records. American Journal of Epidemiology, 137(7); 758-768

4. Literature Review (Cont.) • Melissa Adams found that sensitivities for the history of poor pregnancy outcomes (previous preterm, previous SGA or LGA) were low. • Buescher et al. found poor accuracy for medical history but high accuracy for method of delivery, prenatal care, and events of labor and delivery. Adams, M. Validiy of Birth Certificate Data for the Outcome of the Previous Pregnancy, Georgia, 1980 – 1995. American Journal of Epidemiology: 154(10); 883-887. Buescher P, Taylor K, Davis M, Bowling M. The Quality of the New Birth Certificate Data: A Validation Study in North Carolina. American Journal of Public Health: 83(8); 1163-1165.

5. Utah’s Vital Records Process • Pregnancy risk factors are abstracted from the medical record by the birth certificate clerks at each hospital. This data comes from the prenatal care record • Birth complications are abstracted from the labor and delivery records by the birth certificate clerk • The physician must have authenticated the condition on the medical record for it to be included on the birth certificate • Yearly quality checks are conducted by the state for each hospital

6. Methodology • 2000 Utah PRAMS file linked to Birth file using the birth certificate number • Looked at agreement between self report of morbidity on PRAMS survey and equivalent category on birth certificate • Kappa Coefficient analysis run to determine reliability between the two reports • Analysis run using SAS and SUDAAN

7. Kappa Coefficient • Measures inter-rater reliability • Measures the extent of exact agreement, adjusting for chance agreement • Interpretation • < .20 poor agreement above chance • .20 - .40 fair agreement above chance • .40 to .60 moderate agreement above chance • .60 to .80 good agreement above chance • .80 to 1.0 very good agreement above chance

8. Not a Validation Study • Without individual chart review, a validation study was not plausible • Sensitivity and specificity cannot be calculated

9. Comparisons Made PRAMS Question: Did you have any of these problems during your pregnancy?

10. PRAMS Survey Did the baby born just before your new one weigh less than 5lbs 8 oz or less at birth? Was the baby just before your new one born more than three weeks before its due date? Birth Certificate Previous SFGA infant Previous preterm infant Comparisons Made (Cont.)

11. Excluded • High blood pressure • PRAMS survey includes edema with high blood pressure – no equivalent on birth certificate • Nausea, vomiting or dehydration, kidney or bladder infection, or car accident are not included on the birth certificate

12. Results

13. Interpretation • Moderate agreement for PROM and diabetes • Fair agreement for placental problems, incompetent cervix, and previous preterm infant • Poor agreement for previous SGA infant

14. Reporting Disagreements • For disagreements in reporting, which way are they attributable? • For all conditions, the majority (80% – 100%) of discrepancies occurred when a woman reported the condition on PRAMS, but it was not reported on the birth certificate.

15. Characteristics of Women With Disagreement • Characteristics examined: • Race • Hispanic ethnic group • Maternal age • Maternal education • Marital status • Income categories • Prenatal care payer • Previous live births • Statistical method: Chi-square tests

16. Characteristics of Women With Disagreement (Cont.)

17. Discussions • Low prevalence of certain conditions, such as (less than 100 for each), affecting results • Women may be over reporting • Vital records data may be in error as supported by literature • Definitions of conditions could be beneficial to PRAMS respondents • Some conditions not exactly the same (e.g. all incompetent cervices are not sewn shut)

18. Conclusions • Continued education of providers on the importance of accurate reporting for providing sound public health data • Pending national certification of birth certificate clerks will be beneficial in improving quality of vital records data • Study should be repeated when additional years of PRAMS data become available