What’s new with the new birth items? Source of payment WIC Infant breastfed June 2-6, 2013 Phoenix, Arizona Sally C. Curtin, MA, Division of Vital Statistics, NCHS Daniela Nitcheva, PhD, SC Department of Health and Environmental Control Phyllis Reed, MPH, WA Center for Health Statistics

Data release plans Data release for new data Natality public use files and in Vital Stats for 2009, 2010 and 2011 Re-release the files/VitalStats with the new data and documentation

Source of payment as it appears on the 2003 Standard Certificate of Live Birth

Revised Reporting area, 2010 DC 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 NYC Revised (33 states+NYC+DC; 76% of births) Mid year / rolling / partial Unrevised

Differences between revised Reporting area and U.S. in race/Hispanic distributions, 2010 Non-Hispanic white ** Non-Hispanic black ** Hispanic ** U.S. Revised area

Principal source of payment for delivery: revised reporting area, 2010 Medicaid 44.9% Private insurance 45.8% Self-Pay (uninsured) 4.4% Other 5.0%

Births with Medicaid as the principal source of payment for the delivery: Revised area, 2010

Medicaid-insured births by state, reporting area, 2010 DC 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 NYC Less than 30 percent percent 50 percent or higher percent

Prenatal care receipt by principal source of payment for the delivery: Revised reporting area, 2010

Cesarean delivery rates by principal source of payment for the delivery: Revised reporting area, 2010 Primary cesarean rate-cesarean births per 100 births to women with no previous cesarean. Repeat cesarean rate-cesarean births per 100 births to women with a previous cesarean.

Comparison with data from the National Hospital Discharge Survey National Hospital Discharge Survey – Nationally representative survey of data from discharge records from non-federal, short- stay hospitals in the U.S. Continuous since 1965, although a major survey redesign in 1988 Total of about 150,000 discharges in 2010 with 13,759 delivery discharges Payment information is available, both a primary and secondary source Primary payment source recoded to be as consistent as possible to the birth certificate categories

Birth certificate versus NHDS data on source of payment, 2010 * * Difference is statistically significant

Quality of the data based on studies in two states Birth certificate data compared with that of medical records: State A – 600 births in 4 hospitals (150 each) – random sample State B – 495 births in 4 hospitals (about 125 each) – convenience sample Primary measure = sensitivity—percentage of births with a condition indicated on the medical record (the “gold” standard) that was also indicated on the birth certificate.

Quality of the data based on quality studies in two states Sensitivity for Source of Payment: State A – Private insurance 82.3% Medicaid 79.0% Other 87.9% Self-pay --- State B – Private insurance 85.8% Medicaid 72.6% Other --- Self-pay 75.6% --- Results not available because less than 20 cases

Quality of the data based on studies in two states Sensitivity by hospital for source of payment data Private insurance

Infant breastfed as it appears on the 2003 Standard Certificate of Live Birth Percent of infants being breastfed for entire reporting area: 75.1% NOTE: California, while in the revised reporting area, did not report infant breastfed

Births with infant being breastfed at discharge from the hospital: Revised area, 2010 * Non-Hispanic

WIC receipt as it appears on the 2003 Standard Certificate of Live Birth Percent of mothers with WIC receipt for entire reporting area: 48.2%

Mother received WIC food for herself during pregnancy: Revised area, 2010 * Non-Hispanic

Quality of the data based on studies in two states Sensitivity for Infant breastfed at discharge: State A – 90.7% State B – 96.2% Quality information on WIC receipt not available from this study because this information is collected from the mother and is NOT on the medical record

Quality of the data based on quality studies in two states Sensitivity by hospital for infant breastfed

Summary Data quality results Source of payment  Generally good sensitivity (above 80 percent) for private insurance and Medicaid categories  Differences in sensitivity by hospital suggest room for improvement Infant breastfed  High sensitivity overall for both States, over 90 percent  Above 80 percent sensitivity for all hospitals for both states; 5 out of 8 had over 90-percent sensitivity WIC receipt  Not included in 2-state quality study because this item is collected from the mother on the Mother’s worksheet

Final thoughts  Data on source of payment will become national (Jan 2014) at the same time that the Affordable Care Act is fully implemented. These data can be used to track the impact of the ACA on births by payment source. Birth certificate data facilitate analyses not possible with survey data, for smaller subgroups and rarer events  Important difference in WIC receipt and infant breastfeeding by maternal age and race/Hispanic origin show that these items will be valuable additions to the natality file  Quality results for source of payment and infant breastfeeding so far are encouraging, but more studies are needed

Final final thought National, high-quality birth certificate data on these topics will be a national treasure