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

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

3. 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 DC Revision Status, 2007 Revised Unrevised NYC

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

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 Source ? = mom, records Unrevised:

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

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 of Month 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 1 st PNCV  SAS code to calculate now available from NCHS

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

12. Percent change in 1 st 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  Total cesarean rate Very comparable between revisions Revised Unrevised

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 State BReporting areaState CState A Source: NCHS/CDC/National Vital Statistics System

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

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

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 forreporting if mom had a previous cesarean using prenatal and other medical records

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

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

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

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 Source: NCHS/CDC/National Vital Statistics System Begins to demonstrate the tremendous analytic potential of the revised data

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 !!!  Need validation studies !!!