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 The Minnesota IMR in 2002 was 5.3 per 1000 live births One of the lowest infant mortality rates in the nation One of the lowest infant mortality rates in the nation The low rate masks great disparities in infant mortality within the state 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 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 This linking allows for comparisons between the Medicaid and non-Medicaid populations 1997-2001 linked data are analyzed for this presentation 1997-2001 linked data are analyzed for this presentation

4. Background The Medicaid population is comprised of both Medical Assistance and MinnesotaCare enrollees 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 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. 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 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% overall match rate has been 93.1% No major differences between Medicaid women who matched and those who did not except No major differences between Medicaid women who matched and those who did not except * Hispanic women * Hispanic women * Border communities with North Dakota * Border communities with North Dakota

7. Linkage Methods Future methodological issues in data linkage and probabilistic techniques Future methodological issues in data linkage and probabilistic techniques Agenda for future research: 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. 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 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 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 Age of mother is obtained from the birth certificate Initiation of prenatal care is also taken from the birth certificate Initiation of prenatal care is also taken from the birth certificate

10. Methods International Classification of Diseases (ICD 9 & 10)* Cause of DeathICD-9ICD-10 Congenital Anomalies740 - 795Q00 - Q99 Sudden Infant Death Syndrome (SIDS)798R95 Prematurity765P07 Unintentional Injury800 - 949V01 - X59 Maternal Complications761P01 Placenta or Cord Complications762P02 Perinatal Infections771P35 - P39 Respiratory Distress Syndrome769P22 Intrauterine Hypoxia and Birth Asphyxia771P35 - P39 Pneumonia / Influenza487J10 - J18 *ICD 10 codes were adopted in the U.S. in 1999

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 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 Medicaid had an IMR of 7.4 per 1,000 7.5 per 1,000 for Medical Assistance 7.5 per 1,000 for Medical Assistance 6.2 per 1,000 for MinnesotaCare 6.2 per 1,000 for MinnesotaCare Non-Medicaid had an IMR of 5.2 per 1,000 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 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 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 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 Unintentional injury deaths accounted for a high proportion of deaths in the Medicaid population 1 in 3 was related to co-sleeping with adults 1 in 3 was related to co-sleeping with adults Inadequate sleeping accommodations Inadequate sleeping accommodations SIDS also much higher in the Medicaid populations (25.5% vs. 7.3%) SIDS also much higher in the Medicaid populations (25.5% vs. 7.3%)

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

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