The Birth Certificate and Medicaid Data Match Project: Initial Findings in Infant Mortality

1. The Birth Certificate and Medicaid Data Match Project: Initial Findings in Infant Mortality John Oswald, PhD Director, Minnesota Center for Health Statistics June 7, 2006 NAPHSIS Annual Meeting

2. Background • The Minnesota IMR in 2002 was 5.3 per 1000 live births • One of the lowest infant mortality rates in the nation • The low rate masks great disparities in infant mortality within the state

3. Background • The Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH) entered into a data sharing agreement to link Minnesota Medicaid data with birth certificate data • This linking allows for comparisons between the Medicaid and non-Medicaid populations • 1997-2001 linked data are analyzed for this presentation

4. Background • The Medicaid population is comprised of both Medical Assistance and MinnesotaCare enrollees • The non-Medicaid population includes those covered by private health insurance, self-insured, or uninsured

5. Linkage Methods • Iterative matching procedure that included mother’s name, mother’s date of birth, and father’s last name. • State of residence of the birth mother was used rather than state of occurrence of the birth

6. Linkage Methods • overall match rate has been 93.1% • No major differences between Medicaid women who matched and those who did not except * Hispanic women * Border communities with North Dakota

7. Linkage Methods • Future methodological issues in data linkage and probabilistic techniques • Agenda for future research: Gyllstrom ME, Oswald JW, et al. Linking Birth Certificates with Medicaid Data to Enhance Population Health Assessment: Methedological Issues Addressed. Journal of Public Health Management and Practice, July 2002, 38-44.

8. Other Methods • Race categories are based upon the race of the mother as reported on the birth certificate and include White, Black/African American, Asian, and Native American • Hispanic ethnicity is also based upon ethnicity of mother as reported on the birth certificate and includes anyone indicating Hispanic/Latina descent regardless of race

9. Other Methods • Age of mother is obtained from the birth certificate • Initiation of prenatal care is also taken from the birth certificate

10. Methods

11. Results Medicaid Births by Maternal Age Minnesota, 1997-2001 Non-Medicaid Births by Maternal Age Minnesota, 1997-2001

12. Results • Minnesota as a whole had an IMR of 5.7 per 1,000 for calendar years 1997-2001 • Medicaid had an IMR of 7.4 per 1,000 • 7.5 per 1,000 for Medical Assistance • 6.2 per 1,000 for MinnesotaCare • Non-Medicaid had an IMR of 5.2 per 1,000

13. Results

14. Results

15. Results

16. Results

17. Discussion • Whites had significantly lower IMR than all other race categories, and White non-Medicaid had significantly lower IMR than White Medicaid • Finding for teenaged mothers supported in results from other states • Those who receive early prenatal care have lower infant mortality in both the Medicaid and non-Medicaid populations

18. Discussion • Unintentional injury deaths accounted for a high proportion of deaths in the Medicaid population • 1 in 3 was related to co-sleeping with adults • Inadequate sleeping accommodations • SIDS also much higher in the Medicaid populations (25.5% vs. 7.3%)

19. Limitations • Small number of events • Lack of clear definition of Non-Medicaid population • Inherent challenges of birth and death records • Unknown enrollment date in Medicaid

20. Further Research • Further investigation into the teen mother finding • Formal analysis of these data to examine the interplay of race and Medicaid status • Ideally, a comparison of Medicaid and those with private insurance