Impact of Medicaid on Birth Defects...The providers with less than 50 patients were group into one category coded as 88. Specifically, for the Birth Defects study, category 88 consisted

FINAL

Impact Of Medicaid Participation During Pregnancy On Birth Defects

Presented to

Florida Agency for Health Care Administration and

Florida Department of Health

June 2, 2003

FINAL

Impact Of Medicaid Participation During Pregnancy On Birth Defects

Prepared by Maternal Child Health and Education Research and Data

Center

June 2, 2003

Impact of Medicaid Participation During Pregnancy on Birth Defects Medicaid Division, Florida Agency for Health Care Administration and Florida Department of Health

Prepared by the Maternal Child Health and Education Research and Data Center at the University of Florida, a branch of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies at University of South Florida

iii

Table of Contents

ACKNOWLEDGEMENTS ......................................................................................................................................................IV

ISSUE BRIEF .................................................................................................................................................................................1

INTRODUCTION.........................................................................................................................................................................2

STATISTICAL METHOD .........................................................................................................................................................6

RESULTS ........................................................................................................................................................................................8

REFERENCES .............................................................................................................................................................................10

APPENDIX A: DEFINITION OF ABBREVIATIONS ....................................................................................................11

APPENDIX B: RAW RATE TABLES ..................................................................................................................................12

APPENDIX C: RELATIVE RISK AND 99% CONFID ENCE INTERVALS TABLES ........................................19



iv

Acknowledgements

Project Director

Michael B. Resnick, Ed.D.

The Maternal Child Health and Education Research and Data Center, a branch of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies would like to acknowledge the following individuals for their diligent work and contributions to this report: University of Florida Faculty and Staff Julie Ackerman, B.A. Ann Jan, B.S. Erin Anderson, B.A. Bong Rae Kim, M.S. Mario Ariet, Ph.D. Changxing Ma, Ph.D. Randy L. Carter, Ph.D. Steven Morse, M.D. Vivian Chang, M. S. Steven Priest, B.S. Wei Cui, M.D. Jeffrey Roth, Ph.D. Rajeeb Das, M.S.P.H Sam Wu, Ph.D. David Figlio, Ph.D. Li Yan, Ph.D. Christina Hayes, B.A. Jie Yang, M.S. University of South Florida Faculty and Staff Edward A. Feaver, M.Div., M.S.E. Charles S. Mahan, M.D. Peter Gorski, M.D. We would also like to thank the following individuals for contributing their support and expertise to this report: Florida Department of Health C. Meade Grigg, M.A. Karen Freeman, B.A.

Agency for Health Care Administration Susan Chen, B.S. Nancy L. Ross, Ph.D. Debbie Walters, R. N.



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Issue Brief Study Description

Impact of Medicaid participation during pregnancy on birth defects (BD) was

investigated using a total of 584,036 births from 1997 to 1999 in Florida.

Main Findings

1. 14,951 cases were identified in Florida’s statewide Birth Defect Registry among

584,036 live births from 1997 to 1999

2. Children of mothers in Medicaid had 1.25 times greater risk of Birth Defects

compared to children of non-Medicaid mothers.

3. Children of mothers in Medicaid had 1.46, 1.32, 1.37, 1.32 and 1.48 times greater risk

of central nervous system defect, chromosomal defect, gastrointestinal defect, heart

defect and musculoskeletal defect, respectively, compared to children of non-

Medicaid mothers. This discrepancy may be due to the fact that Medicaid serves a

poorer population.

4. The Non SOBRA Medicaid group (FFSnsb) had higher risk than other Medicaid

groups with regard to Birth Defects, especially for Heart and Other defects.

5. Children of mothers with less than high school education, inadequate prenatal care,

older than 34, unmarried, who drank or smoked during pregnancy, who had a high

Healthy Start Prenatal Risk Screening Score, had higher risk of Birth Defects

compared to their referent groups.

6. Children of multiple births had higher risk of Birth Defects than singletons.



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7. Male children had higher risk of overall Birth Defects, except for musculoskeletal

defects.

8. Children of Black or Other race mothers tend to have lower risk of Birth Defects after

controlling for other factors.

Discussion:

1. Further analysis is required to better understand the disparities in heart defects among

different types of Medicaid payor types and providers.

2. Preconceptual and interpregnancy counseling (which may include genetic testing)

offers the possibility of reducing the incidence of birth defects.



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Introduction

From 1997 to 1999, there were 260,424 children born to Florida residents who received

prenatal care under Medicaid funding. For these three birth cohorts, we analyzed the impact of

Medicaid participation during pregnancy, WIC participation, and Healthy Start services on eight

categories of birth defects: central nervous system, chromosomal defects, gastrointestinal defects,

genital and urinary defects, heart defects, musculoskeletal defects, oral defects and other

(miscellaneous) defects.

Previous studies have shown that many medical and socio-demographic factors in

pregnant women have significant effects on their offspring. Comparisons of outcomes among

different groups of pregnant women need to take these factors into account. In this study we

analyze pregnancy outcomes by levels of the following socio-demographic and heath related

factors: maternal education, inter-pregnancy interval, adequacy of prenatal care (Kotelchuck

score), maternal age, mother’s race, marital status, mother drank during pregnancy, mother

smoked during pregnancy, previous pregnancy experience, Florida's Healthy Start Prenatal

Screen Score, receipt of Healthy Start Services, WIC participation, plurality, and infant’s sex.

Rules for Assigning Medicaid Payor/Service Types

Florida resident females who were registered for Medicaid for at least one day during

pregnancy (estimated conception date to date of birth) were placed into five Medicaid

payor/service types. Those women who were enrolled in a Medicaid HMO for at least one day

during pregnancy but not enrolled in MediPass for at least one day were placed in the Medicaid

HMO category. Those women who were enrolled in MediPass for at least one day during



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pregnancy but not enrolled in a Medicaid HMO for at least one day were placed in the Medicaid

MPS category. Those women who were enrolled in a Medicaid HMO and MediPass for at least

one day during pregnancy were placed in the Medicaid HMOMPS category. Those women who

were enrolled in Medicaid for at least one day but not enrolled in a Medicaid HMO or MediPass

for at least one day during pregnancy were placed in the fee-for-service category (FFS). The FFS

category was further divided into two groups: (a) FFSsob for mothers who participated in the

SOBRA program. These mothers had family income between 100% and 185% of the federal

poverty level. (b) FFSnsb for mothers who did not participate in the SOBRA program. The

FFSnsb group had family income less than 100% of the federal poverty level.

HMO Provider Classification

During 1997 to 1999, 28 different HMOs provided services to pregnant women in Florida.

The following numerical codes were assigned to these managed care companies: 1) PCA; 2)

Personal Healthy Plan; 3) Physicians Healthy Plan; 4) Preferred Medical Plan; 5) Ultramedix

Health Care System; 6) Stay Well Health Plan; 7) United Health Plan; 8) Foundation Health; 9)

Discovery Health Plan; 10) JMH Health Plan; 11) Medchoice Health Plan; 12) Neighborhood

Health Plan; 13) Healthease; 14) Avmed; 15) Community Choice; 16) Frontier Health Services;

17) Healthcare USA; 18) PacifiCare; 19) St. Augustine Health Care; 20) Sunshine Health Plan;

21) Alpha Health Plan; 22) Beacon Health Plan; 23) Champion Healthcare; 24) Florida 1st Health

Plan; 25) Healthplans of America; 26) Healthy Palm Beaches; 27) Reliable Health Plan; and 99)

Other providers not included in the above list of organizations.

The providers with less than 50 patients were group into one category coded as 88.

Specifically, for the Birth Defects study, category 88 consisted of the following providers:

Personal Healthy Plan, Avmed, Community Choice, Frontier Health Services, PacifiCare,



- 4 -

Sunshine Health Plan, Alpha Health Plan, Beacon Health Plan, Florida 1st Health Plan,

Healthplans of America, Healthy Palm Beaches, and Reliable Health Plan. In addition we labeled

the non-Medicaid as 999 in our analysis.



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Sample Description

We created our analyzable data by merging the Maternal Child Health Master data set

with Birth Defects Registry data. Birth defect cases were identified in the Statewide Birth Defect

Registry. The Maternal Child Health Master data sets for the three birth cohorts were created at

the Maternal Child Health and Education Research and Data Center (MCHERDC) at the

University of Florida College of Medicine. These data sets were compiled from four data

sources: (1) Medicaid eligibility, HMO Enrollment, and MediPass Enrollment data files supplied

by AHCA; (2) the live born birth file for 1997-1999 and death files from 1997 and 2000 supplied

by Vital statistics; (3) Women, Infants and Children Nutritional Supplement Program

certification files supplied by the Florida WIC office; and (4) the Florida Healthy Start prenatal

risk screen data file and the Florida Healthy Start services data file supplied by the state of

Florida Department of Health.

A total of 584,036 birth records for the entire 1997-99 population were used in the

current analysis. Table B-1 gives the comparison of all 8 birth defect categories by Medicaid

participation, residency and plurality. This population was used to compare Medicaid to non-

Medicaid pregnant women.

We excluded non-Medicaid records when we compared Medicaid payor types and

Medicaid providers. In addition, multiple births, RPICC high risk OB, and mothers with missing

social security number were also excluded. The remainder was called Study Population I. It

consisted of 225,990 records, corresponding to singleton births to Florida residents who

partic ipated in Medicaid. Number of infants and raw rates of pregnancy outcomes by explanatory



- 6 -

variables were given in Table B-2. Similar tables were given for multiple births (n=16,359)

[Table B-3] and for the total population (n=584036) [Table B-4].

Statistical Method

For the 1997, 1998, and 1999 birth cohorts, we studied the impact of Medicaid

participation during pregnancy on birth defect (Yes/No). In addition, we also investigated its

impact for eight sub-categories of birth defects: central nervous system, chromosomal defect,

gastrointestinal defect, genital and urinary defect, heart defect, musculoskeletal defect, oral

defect and other remaining defects.

The explanatory variables studied were the following socio-demographic and health

related variables: Infant's Sex (Male, Female); Mother's Education (<HS, if mother's education

is less than or equal to 11 years; HS, if mother's education is equal to 12 years; >HS, if mother's

education is greater than 12 years); Pregnancy Interval (<=15 mo, if Pregnancy Interval if less

than or equal to 15 months; NA; >15 mo, if Pregnancy Interval of greater than 15 months);

Adequacy of Prenatal Care (No, if Kotelchuck score=1; Yes, if Kotelchuck score>1); Mother’s

Age (<20 years, 20-34 years, >34 years); Mother's Race (Black, White, Others); Marital Status

(Married, Unmarried); Mother Drank During Pregnancy (Yes, No); Mother Smoked During

Pregnancy (Yes, No); Previous Pregnancy Experience ( 0, if no previous pregnancy; adverse

experience, if one or more previous pregnanc ies terminated in either a spontaneous or induced

abortion or if one or more previous pregnancies resulted in a liveborn infant who later died; 1-2,

if one or two previous pregnancies resulted in liveborn who are still living and no previous

failures; >2, if three or more previous pregnancy resulted liveborns who are still living and no

previous failures ); Florida's Healthy Start Prenatal Screen Score (High, if score => 4; Low, if



- 7 -

score <4; None, if not screened); Healthy Start Services (0=no contact at all; 1=administrative

contact; 2=care coordination; 3=direct Healthy Start services such as counseling, education and

other support; and WIC participation (No; Yes).

Generalized linear models2 with number of adverse outcomes as the response variable

and log link function, assuming Poisson error distribution and using log of total number of

children in each cell as an offset were fitted using the GENMOD Procedure of SAS3,4. This

approach modeled the log of the mean rate of each outcome as a linear function of Medicaid

factors and socio-demographic and health related variables. Stepwise model building with

backward selection was employed, starting with a model including all main effects and two-way

interactions of these factors. The significance level for deletion from the model was set at 0.01.



- 8 -

Results Impact of Medicaid Participation During Pregnancy on Birth Defects

From 1997 to 1999, 14,951 cases were identified in Statewide Birth Defect Registry

among 584,036 live births. There were 260,424 births to Florida residents who received prenatal

care under Medicaid funding. The Medicaid group had higher risk of birth defect (RR: 1.25;

99%CI: 1.19-1.32), central nervous system (RR: 1.46; 99%CI: 1.20-1.76), chromosomal defect

(RR: 1.32, 99% CI: 0.98-1.78), gastrointestinal defect (RR:1.37; 1.16-1.61), heart defect (RR:

1.32; 99% CI: 1.22-1.42) and musculoskeletal defect (RR: 1.48, 99% CI: 1.26-1.73). Table C-1

presents detailed information about the main effect. These differences may be due to the fact that

Medicaid serves a poor population.

With regard to Medicaid payor types, we found that more than 59% of mothers in

Medicaid were SOBRA participants, e.g., having family income between 25% and 185% of the

federal poverty level. Raw rates of birth defects among Medicaid participants, Medicaid payor

types and Medicaid HMOs are presented in Table B1-B4.

The Fee-For-Service Non SOBRA group (FFSnsb) had a higher risk of Birth Defects

compared to other Medicaid groups, especially for Heart and Other defects. The relative risk of

Birth Defects for the Fee-For-Service Non SOBRA was 1.19 (99% CI: 1.06-1.34) when

compared to Fee-For-Service SOBRA. In the subcategory of Heart defect, Fee-For-Service Non

SOBRA’s risk was 25% higher than Fee-For-Service SOBRA (RR, 1.25; 99% CI: 1.06-1.47).

For the miscellaneous category “Other defect,” the risk for Fee-For-Service Non SOBRA was

more than twice that of SOBRA, RR 2.09 (99% CI: 1.26-3.46).

A few provider type differences were observed with reference to heart defects. Compared

to children served by regular Medicaid, those served by Provider Physicians Health Plan had



- 9 -

64% higher risk (99%CI: 1.13-2.36) and those served by Preferred Medical Plan was more than

four times higher (RR: 4.18; 99%CI: 2.34-7.47).

Effect of WIC Participation

No beneficial effect of WIC participation was found in the eight different categories of

birth defects.

Effects of other medical and socio-demographic factors We also analyzed birth defects by levels of the following socio-demographic and heath-

related factors: 1) infant’s sex, 2) maternal education, 3) adequacy of prenatal care (Kotelchuck

score), 4) mother's age, 5) mother’s race, 6) mother's marital status, 7) mother drank during

pregnancy, 8) mother smoked during pregnancy, 9) previous pregnancy experience, and 10)

Florida's Healthy Start prenatal risk screen score.

Children from mothers with less than a high school education, with inadequate prenatal

care, older than 34, not married, who drank or smoked during pregnancy, and who had a high

Healthy Start Prenatal Screening Score had higher risk of Birth Defects compared to their

referent groups. Male children had a higher risk of Birth Defects except for musculoskeletal

defects. Children of multiple births had higher risk of Birth Defects than singletons. Children

from Black or Other race mothers tended to have a lower risk of Birth Defects after controlling

for other factors.

Table C-1 illustrates the effects of these factors for the entire Florida birth population

(Medicaid and Non Medicaid). Table C-2 illustrates the effects among five payor types within

the Medicaid population. Table C-3 illustrates the effects of these factors among different

Medicaid HMO providers.



- 10 -

References 1. Resnick et al. Temporal Patterns of Socio-demographic Effect in Birth Outcomes. Article

submitted to Pediatrics, 1999.

2. McCullagh P, Nelder JA. Generalized Linear Models. 2nd ed. New York: Chapman and

Hall; 1989.

3. SAS Institute Inc. SAS/STAT User's Guide: Version 6.4th Edition. Cary (NC): SAS Institute;

1990.

4. SAS Institute Inc. SAS/STAT Software: Changes and Enhancement through Release 6.12.

Cary (NC): SAS Institute; 1997.



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Appendix A: Definition of Abbreviations AHCA: The Agency for Health Care Administration (AHCA) develops and carries out policies

related to the Medicaid program. AHCA is responsible for contracts with a fiscal agent

that processes claims and enrolls non- institutional providers.

FFS: Fee-For-Service provided by a private OB or nurse practitioner or through a public health

department.

HMO: A Health Maintenance Organization (HMO) enters in managed care contracts to provide

prepaid services for defined populations of enrolled recipients.

Medicaid: Source of maternity and infant health insurance for a diverse group of pregnant

women and infants, distinguished by varying levels of income and eligibility.

MediPass: Short for Medicaid Provider Access System. Medipass is a Medicaid primary care

case management service provided through a private OB and/or a group practice.

WIC: Women, Infants, and Children Nutritional Supplement serves women who were screened

for nutritional risk during their pregnancy and were found to be in need of physical

and/or financial assistance. Adequate nutrition is one of the simplest and least expensive

ways to support a pregnancy. It is also one of the most important factors for adequate

and healthy growth and development of the fetus and its brain.



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Appendix B: Raw Rate Tables Table B-1 Comparison of Birth Defects by Medicaid Population, Residency and Plurality for All 1997,98,99 Births in Florida Table B-2 Numbers of Infants and Raw Rates (per thousand) of Birth Defects by Explanatory Variables for 1997,98,99 Singleton Births (excluding high risk OB) Table B-3 Numbers of Infants and Raw Rates (per thousand) of Birth Defects by Explanatory Variables for 1997,98,99 Multiple Births Table B-4 Numbers of Infants and Raw Rates (per thousand) of Birth Defects by Explanatory Variables for All 1997,98,99 Births in Florida



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Number of Live Births

Central Nervous System

Chromosomal Defect

Gastrointestinal Defect

Genital and

Urinary Heart Musculoskeletal Oral Other Birth

Defect

Singleton238047 2.8 1.5 3.2 5.9 13.6 3.1 1.8 1.1 29.5

Multiple Birth6207 5.0 0.8 3.4 7.1 24.5 1.9 2.7 1.8 43.3

Singleton15903 1.7 1.8 1.7 2.3 6.2 1.3 1.3 0.4 13.3

Multiple Birth267 0.0 0.0 0.0 7.5 26.2 7.5 3.7 0.0 37.5

Singleton301249 1.4 1.4 2.2 6.0 10.3 2.3 1.4 0.4 23.4

Multiple Birth10152 3.3 1.4 2.9 6.1 14.9 1.8 1.7 0.4 29.3

Singleton11906 1.3 1.3 1.2 0.8 4.2 1.0 1.3 0.3 9.4

Multiple Birth305 3.3 0.0 0.0 6.6 6.6 3.3 3.3 0.0 19.7

13720 9.6 2.8 3.2 13.2 30.0 8.1 3.2 3.3 62.5

225990 2.4 1.4 3.1 5.5 12.7 2.9 1.7 1.0 27.7

584036 2.0 1.4 2.6 5.8 11.6 2.6 1.6 0.7 25.6

Category

Medicaid

Table B-1 : Comparison of Birth Defects by Medicaid Participation, Residency and Plurality for All 1997,1998,1999 Births in Florida

SSN

No SSN

1. Study population contains all singleton births of Medicaid women with social security numbers, excluding RPICC high risk OB.

Study Population I1

Total Population

NonMedicaid

SSN

No SSN

RPICC High Risk OB



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Factor Level Total


Chromo-somal Gastro-intestinal

Genital and

Urinary HeartMusculo-skeletal Oral Other

Birth Defect

HMO 37262 2.3 1.0 3.1 5.2 13.5 2.7 2.0 1.2 27.6MPS 30591 2.6 1.4 3.0 4.8 12.2 2.3 1.6 1.1 25.9HMOMPS 9257 2.8 1.3 2.9 3.9 13.8 1.7 1.7 0.6 26.4FFSnsb 19181 3.4 2.0 3.1 6.2 15.2 3.6 1.7 1.9 32.2FFSsob 129699 2.2 1.5 3.2 5.8 12.2 3.0 1.6 0.8 27.6Male 115617 2.4 1.4 4.4 9.2 12.9 2.0 1.8 1.0 31.9Female 110373 2.4 1.5 1.8 1.6 12.6 3.7 1.6 1.0 23.3< HS 82798 2.5 1.3 3.3 5.2 13.4 3.2 1.8 1.3 29.0HS 96698 2.5 1.4 3.0 5.8 12.5 2.7 1.7 0.8 27.5> HS 46494 1.9 1.8 3.0 5.5 12.0 2.7 1.5 0.8 25.9<=15 mo 51139 2.4 1.4 2.9 4.9 13.4 2.3 1.9 0.9 26.9NA 93483 2.4 1.2 3.4 5.7 12.9 3.6 1.6 0.8 28.7>15 mo 81368 2.4 1.7 3.0 5.7 12.1 2.4 1.7 1.3 27.1No 37268 2.5 1.6 2.6 4.7 13.2 2.9 1.8 2.0 27.7Yes 188722 2.4 1.4 3.2 5.7 12.6 2.9 1.7 0.8 27.7< 20 54400 2.1 0.9 3.1 5.2 11.6 3.0 1.6 0.6 25.7> 34 15075 3.4 6.4 4.0 6.3 17.4 3.4 2.3 3.5 38.120-34 156515 2.4 1.1 3.1 5.6 12.7 2.8 1.7 0.9 27.4Black 81231 2.6 1.2 2.2 4.4 13.4 2.1 1.3 1.1 25.3Other 3777 3.4 1.6 1.3 6.1 9.0 2.9 2.1 0.5 23.8White 140982 2.3 1.5 3.7 6.2 12.4 3.3 2.0 0.9 29.2Unmarried 142402 2.4 1.3 3.1 5.2 12.7 2.8 1.8 1.2 27.4Married 83588 2.4 1.6 3.1 6.0 12.8 3.0 1.6 0.6 28.1Yes 20550 2.7 1.5 4.0 5.6 11.7 3.5 1.7 3.9 30.9No 205440 2.4 1.4 3.1 5.5 12.8 2.8 1.7 0.7 27.4Yes 56894 2.5 1.7 4.6 5.6 12.7 2.7 2.2 2.4 30.4No 169096 2.4 1.4 2.7 5.5 12.8 2.9 1.5 0.5 26.81-2 72183 2.0 1.3 3.1 5.5 12.0 2.4 1.3 0.7 25.4> 2 18124 2.8 2.5 2.8 4.6 14.6 2.2 2.3 1.5 29.3Fail 62191 3.0 1.8 3.2 5.7 13.8 2.8 2.0 1.6 30.10 73492 2.3 1.0 3.3 5.6 12.1 3.6 1.7 0.6 27.5High 70003 2.7 1.3 2.7 5.0 13.6 2.8 1.8 1.4 28.2None 79909 2.5 1.7 3.5 5.6 12.7 2.8 1.6 1.1 27.8Low 76078 2.1 1.3 3.2 5.9 12.0 3.0 1.7 0.5 27.1Yes 137530 2.3 1.4 3.2 5.5 12.6 3.0 1.6 0.9 27.6No 88460 2.6 1.5 3.0 5.5 12.9 2.7 1.8 1.1 27.9

5770 1.7 1 2.8 5.2 11.1 2.1 1.7 1.4 23.72419 2.1 2.1 1.7 5.4 21.1 2.9 1.7 0.8 32.7370 2.7 0.0 2.7 2.7 54.1 2.7 0.0 0.0 64.9189 0.0 0.0 0.0 5.3 5.3 0.0 0.0 5.3 15.9

2497 1.6 2.0 4.8 7.6 12.8 2.8 1.2 1.6 28.01969 3.6 0.5 3.0 5.1 11.2 3.0 1.5 0.5 25.9995 1.0 0.0 2.0 4.0 10.1 8.0 3.0 0.0 26.1453 6.6 2.2 0.0 2.2 15.5 2.2 2.2 0.0 24.3276 3.6 0.0 0.0 0.0 14.5 0.0 0.0 7.2 25.4113 0.0 0.0 0.0 0.0 17.7 0.0 0.0 0.0 17.7410 2.4 0.0 2.4 2.4 7.3 0.0 2.4 0.0 17.1231 0.0 0.0 0.0 4.3 8.7 0.0 0.0 4.3 17.3275 3.6 0.0 0.0 7.3 10.9 10.9 3.6 0.0 29.1501 4.0 2.0 6.0 4.0 8.0 4.0 2.0 0.0 24.091 11.0 0.0 0.0 0.0 0.0 11.0 0.0 0.0 22.0245 8.2 0.0 4.1 4.1 16.3 4.1 0.0 0.0 24.5

209186 2.4 1.5 3.2 5.6 12.7 2.9 1.7 1.0 27.8225990 2.4 1.4 3.1 5.5 12.7 2.9 1.7 1.0 27.7

St. Augustine Health CareChampion Healthcare providers < 50 pt Other providers

PCA Physicians Healthy Plan Preferred Medical Plan Ultramedix Health Care

Healthease

Stay Well Health Plan United Health Plan Foundation Health Discovery Health Plan

Mother's Education

JMH Health Plan

Pregnancy Interval

Total (Study Population I)

Previous Pregnancy Experience

WIC Participation

Floria's Healthy Start Prenatal Screening

Name of Providers

Medchoice Health Plan Neighborhood Health Plan

Adequacy of Prenatal Care

Healthcare USA

Table B-2: Numbers of Infants and Raw Rates (per thousand) of Birth Defects by Explanatory Variables for 1997,1998,1999 Study Population (Singleton Medicaid Births excluding highrisk OB)

Marital Status

Drink

Smoking

Medicaid Payor Type

Mother's Age

Mother's Race

Infant Sex



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Factor Level Total


Chromo-somal

Gastro-intestinal

Genital and


Birth Defect

HMO 1157 7.8 1.7 0.9 2.6 24.2 1.7 0.9 4.3 37.2MPS 849 4.7 1.2 0.0 5.9 25.9 3.5 2.4 2.4 41.2HMOMPS 247 4.0 0.0 12.1 8.1 20.2 0.0 0.0 0.0 32.4FFSnsb 655 6.1 0.0 7.6 7.6 36.6 3.1 6.1 1.5 64.1FFSsob 3299 3.9 0.6 3.6 8.8 22.1 1.5 3.0 0.9 42.7Non-Medicaid 10152 3.3 1.4 2.9 6.1 14.9 1.8 1.7 0.4 29.3Male 8143 4.1 0.9 3.8 11.7 17.8 1.6 2.2 0.9 38.4Female 8216 3.9 1.5 2.3 1.3 19.2 2.1 1.9 1.0 30.8< HS 2340 5.1 0.4 3.8 9.4 23.5 3.0 2.6 0.9 42.7HS 5172 4.8 1.4 2.5 7.5 20.9 2.3 1.9 1.7 40.2> HS 8766 3.2 1.3 3.2 5.1 15.7 1.3 1.9 0.5 29.1<=15 months 1649 1.8 1.2 3 6.1 21.2 3 1.8 2.4 36.4NA 11659 4.1 1 3.3 6.7 19.6 1.8 2.3 0.5 35.9>15 months 3051 4.6 1.6 2.3 5.9 12.8 1.3 1.3 1.6 28.5No 987 3.0 0.0 4.1 5.1 24.3 2.0 1.0 2.0 40.5Yes 15372 4.0 1.2 3.0 6.6 18.1 1.8 2.1 0.8 34.2< 20 1114 9.9 0.9 3.6 11.7 23.3 3.6 0.9 0.0 51.2> 34 3269 3.1 3.7 2.8 4.3 20.5 2.1 2.4 0.0 33.620-34 11976 3.7 0.5 3.1 6.6 17.5 1.6 2.1 1.3 33.3Black 3677 6.0 1.1 1.6 4.6 23.7 1.4 1.6 1.9 38.3Other 381 2.6 0.0 2.6 10.5 10.5 2.6 2.6 2.6 31.5White 12301 3.4 1.2 3.5 6.9 17.2 2.0 2.2 0.6 33.6Unmarried 4779 5.0 0.8 2.5 5.9 23.9 1.9 2.3 1.9 40.4Married 11575 3.5 1.3 3.3 6.7 16.3 1.8 2.0 0.5 32.2Yes 894 2.2 0.0 2.2 6.7 13.4 1.1 0.0 2.2 26.8No 15465 4.1 1.2 3.1 6.5 18.8 1.9 2.2 0.8 35.0Yes 2249 4.4 0.9 2.2 10.2 19.1 2.7 4.0 0.9 40.5No 14110 3.9 1.2 3.2 5.9 18.4 1.7 1.8 0.9 33.71-2 6660 3.2 1.4 3.2 7.7 16.4 1.5 1.5 1.4 33.3> 2 1834 6.0 0.0 2.2 4.4 19.1 1.1 1.6 0.0 29.4Fail 5257 3.8 1.3 3.0 5.1 22.6 1.7 3.4 1.1 38.20 2597 5.0 1.2 3.5 7.7 15.0 3.5 1.2 0.0 33.9High 2077 5.8 1.4 2.4 8.7 26.0 2.9 3.4 1.9 47.2None 10339 3.7 1.5 2.7 5.6 17.5 1.3 1.7 0.5 31.3Low 3943 3.8 0.0 4.3 7.6 17.2 2.8 2.3 1.5 36.5Yes 5476 4.0 1.3 3.5 6.9 22.1 1.8 2.4 1.5 38.9No 10883 4.0 1.1 2.8 6.2 16.7 1.8 1.9 0.6 32.4

154 13.0 6.5 0.0 6.5 19.5 6.5 0.0 19.5 51.9109 0.0 0.0 9.2 0.0 27.5 0.0 0.0 9.2 36.710 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.08 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

67 0.0 0.0 0.0 0.0 14.9 0.0 0.0 0.0 14.947 21.3 0.0 21.3 0.0 42.6 0.0 0.0 21.3 85.130 0.0 33.3 0.0 0.0 33.3 0.0 0.0 0.0 33.312 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.012 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.07 142.9 0.0 0.0 0.0 0.0 0.0 142.9 0.0 142.9

11 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.012 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.018 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.01 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

11 90.9 0.0 0.0 0.0 90.9 0.0 0.0 0.0 90.915850 3.8 1.1 3.0 6.6 18.4 1.8 2.1 0.6 34.416359 4.0 1.2 3.1 6.5 18.5 1.8 2.1 0.9 34.6

Champion Healthcare providers < 50 pt Other providers

Neighborhood Health Plan Healthease Healthcare USA St. Augustine Health Care

United Health Plan Foundation Health Discovery Health Plan JMH Health Plan

Physicians Healthy Plan Preferred Medical Plan Ultramedix Health Care Stay Well Health Plan

Total

Medicaid Payor Type

Infant Sex

Mother's Education

Pregnancy Interval

Drink

Smoke


Name of ProvidersPCA

Table B-3: Numbers of Infants and Raw Rates (per thousand) of Birth Defects by Explanatory Variables for All 1997,1998,1999 MULTIPLE Births

Floria's Healthy Start Prenatal Screening Score

WIC Participation

Adequacy of Prenatal CareMother's Age

Mother's Race

Marital Status



- 18 -

Factor Level Total


Chromo-somal

Gastro-intestinal

Genital and


Birth Defect

HMO 40348 2.8 1.1 3.0 5.4 14.3 2.8 2.0 1.3 29.0MPS 33321 3.1 1.4 2.8 5.3 13.1 2.5 1.6 1.3 27.9HMOMPS 10117 2.9 1.4 3.3 4.6 14.2 2.0 1.7 0.8 27.9FFSnsb 23576 3.8 2.0 3.0 6.3 16.3 3.4 2.1 2.0 33.6FFSsob 153062 2.5 1.5 3.1 5.9 12.7 3.2 1.7 0.9 28.3NonMedicaid 323612 1.5 1.4 2.2 5.8 10.3 2.2 1.4 0.4 23.0Male 299244 2.0 1.4 3.6 9.8 11.7 1.8 1.7 0.7 29.8Female 284785 2.1 1.4 1.5 1.6 11.6 3.4 1.5 0.7 21.2< HS 123107 2.8 1.4 2.9 5.4 12.9 3.0 1.8 1.2 28.3HS 201331 2.2 1.4 2.8 5.8 12.1 2.6 1.7 0.7 26.5> HS 257216 1.5 1.5 2.2 5.9 10.7 2.3 1.3 0.4 23.6<=15 mo 113679 2.0 1.5 2.4 5.5 11.7 2.1 1.7 0.7 25.0NA 251688 2.2 1.2 2.7 6.1 12.0 3.2 1.5 0.7 26.8>15 mo 218669 1.9 1.7 2.5 5.6 11.2 2.1 1.5 0.8 24.6No 59801 2.6 1.6 2.4 4.8 12.4 2.6 1.7 2.0 26.6Yes 524235 2.0 1.4 2.6 5.9 11.6 2.6 1.6 0.6 25.5< 20 76277 2.6 1.0 2.8 5.4 11.2 3.0 1.7 0.5 25.7> 34 79033 1.9 4.0 2.5 6.0 14.1 2.7 1.6 1.3 29.620-34 428608 2.0 1.0 2.5 5.8 11.3 2.5 1.6 0.6 24.9Black 132650 2.8 1.3 2.0 4.8 13.4 1.9 1.2 1.2 25.5Other 16016 1.7 1.2 1.4 4.3 8.4 2.0 1.4 0.4 19.1White 435370 1.8 1.5 2.8 6.2 11.2 2.8 1.7 0.6 25.9Unmarried 212131 2.7 1.3 2.9 5.4 12.8 2.9 1.8 1.3 27.7Married 371771 1.7 1.5 2.4 6.0 11.0 2.4 1.5 0.4 24.4Yes 40096 2.4 1.4 3.1 5.6 11.3 3.4 1.7 3.1 29.1No 543940 2.0 1.4 2.5 5.8 11.7 2.5 1.6 0.5 25.4Yes 90960 2.6 1.6 3.9 5.8 12.7 2.8 2.3 2.3 30.2No 493076 2.0 1.4 2.3 5.8 11.5 2.5 1.4 0.4 24.81-2 195653 1.7 1.4 2.5 5.6 10.8 2.0 1.4 0.5 23.4> 2 34392 2.6 2.5 2.3 4.7 14.0 1.8 1.7 1.5 27.4Fail 160346 2.4 1.8 2.6 5.9 12.9 2.6 1.9 1.1 28.00 193376 2.0 1.0 2.6 6.1 11.0 3.3 1.5 0.5 25.6High 92512 2.9 1.4 2.6 5.4 14.0 2.7 1.8 1.4 28.8None 336105 1.8 1.5 2.4 5.9 11.1 2.3 1.4 0.6 24.5Low 155419 2.0 1.3 2.8 5.8 11.4 3.0 1.8 0.4 26.1Yes 202170 2.4 1.4 3.0 5.6 12.6 2.9 1.6 0.8 27.3No 381866 1.9 1.5 2.3 5.9 11.1 2.4 1.5 0.6 24.8

6252 2.7 1.1 2.6 5.3 11.7 2.1 1.9 1.9 25.12621 1.9 2.3 1.9 5.7 22.5 2.7 1.5 1.1 34.3393 2.5 0.0 2.5 2.5 50.9 2.5 0.0 0.0 61.1203 0.0 0.0 0.0 4.9 4.9 0.0 0.0 4.9 14.8

2654 1.9 2.3 4.5 8.3 13.6 2.6 1.1 1.5 28.62074 4.8 0.5 3.4 4.8 12.1 3.4 1.4 1.0 28.01080 0.9 0.9 1.9 3.7 11.1 7.4 2.8 0.0 25.9479 6.3 2.1 0.0 2.1 14.6 2.1 2.1 0.0 23.0320 9.4 0.0 0.0 0.0 12.5 3.1 0.0 6.3 28.1114 0.0 0.0 0.0 0.0 17.5 0.0 0.0 0.0 17.5426 4.7 0.0 2.3 2.3 7.0 0.0 4.7 0.0 18.8289 0.0 0.0 0.0 3.5 10.4 0.0 0.0 3.5 17.3335 6.0 0.0 0.0 6.0 11.9 9.0 3.0 3.0 26.9541 3.7 1.8 5.5 3.7 7.4 5.5 1.8 1.8 25.992 10.9 0.0 0.0 0.0 0.0 10.9 0.0 0.0 21.7

272 11.0 0.0 3.7 3.7 22.1 3.7 3.7 0.0 33.1242279 2.7 1.4 3.1 5.8 13.3 3.1 1.9 1.1 29.1584036 2.0 1.4 2.6 5.8 11.6 2.6 1.6 0.7 25.6

providers < 50 pt Other providers

Healthease Healthcare USA St. Augustine Health CareChampion Healthcare

Discovery Health Plan JMH Health Plan Medchoice Health Plan Neighborhood Health Plan

Ultramedix Health Care Stay Well Health Plan United Health Plan Foundation Health

Name of ProvidersPCA Physicians Healthy Plan Preferred Medical Plan

WIC Participation


Marital Status

Drink

Smoking

Total

Table B-4: Numbers of Infants and Raw Rates (per thousand) of Birth Defects by Explanatory Variables for All 1997,1998,1999 Births in Florida

Medicaid Payor Type

Mother's Age

Mother's Race

Infant Sex

Mother's Education


Pregnancy Interval




- 19 -

Appendix C: Relative Risk and 99% Confidence Intervals Tables Table C-1 Relative Risks of Birth Defects and 99% Confidence Intervals for Main Effects of Risk Factors in the Analyses of Medicaid Participation for 1997,1998,1999 total population Table C-2 Relative Risks of Birth Defects and 99% Confidence Intervals for Main Effects of Risk Factors in the Analyses of Medicaid Payor Type for 1997,1998,1999 Study Population (Singleton Medicaid Births excluding high-risk OB) Table C-3 Relative Risks of Birth Defects and 99% Confidence Intervals for Main Effects of Risk Factors in the Analyses of Providers for 1997,1998,1999 Study Population (Singleton Medicaid Births excluding high-risk OB)



- 20 -

Table C-1 : Relative Risks of Birth Defects and 99% Confidence Intervals for Main Effects of Risk Factors in the Analyses of MEDICAID PARTICIPATION for 1997,1998,1999 total population 1

RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99)

Medicaid 1.25 ( 1.19, 1.32) 1.46 ( 1.20, 1.76) 1.32 ( 0.98, 1.78) 1.37 ( 1.16, 1.61) 1.32 ( 1.22, 1.42) 1.48 ( 1.26, 1.73)

NonMedicaid 1 1 1 1 1 1

Male 1.39 ( 1.33, 1.45) 2.48 ( 2.14, 2.88) 6.09 ( 5.35, 6.94) 0.56 ( 0.48, 0.64)

Female 1 1 1 1

< HS 1.31 ( 1.13, 1.51) 1.29 ( 1.03, 1.61) 1.65 ( 1.13, 2.40)

HS 1.05 ( 0.92, 1.20) 1.20 ( 0.99, 1.45) 1.16 ( 0.83, 1.64)

> HS 1 1 1

<=15 mo 1.01 ( 0.95, 1.07) 1.02 ( 0.94, 1.12) 0.98 ( 0.64, 1.50)

NA 1.17 ( 1.08, 1.26) 1.24 ( 1.11, 1.38) 1.41 ( 0.93, 2.14)

>15 mo 1 1 1

No 1.04 ( 0.96, 1.13) 0.88 ( 0.69, 1.13) 1.04 ( 0.93, 1.17) 2.25 ( 1.62, 3.13)

Yes 1 1 1 1

< 20 0.99 ( 0.78, 1.25) 1.07 ( 0.71, 1.61) 0.86 ( 0.78, 0.96) 0.90 ( 0.73, 1.11) 0.58 ( 0.36, 0.95)

> 34 1.30 ( 1.09, 1.55) 4.11 ( 3.37, 5.01) 1.31 ( 1.20, 1.43) 1.26 ( 1.03, 1.53) 1.91 ( 1.37, 2.67)

20-34 1 1 1 1 1

Black 0.93 ( 0.88, 0.98) 0.85 ( 0.67, 1.08) 0.67 ( 0.55, 0.80) 0.77 ( 0.68, 0.86) 1.08 ( 1.00, 1.17) 0.62 ( 0.51, 0.74) 0.67 ( 0.53, 0.86) 1.56 ( 1.15, 2.11)

Other 0.76 ( 0.65, 0.88) 0.92 ( 0.50, 1.69) 0.55 ( 0.32, 0.96) 0.70 ( 0.51, 0.97) 0.77 ( 0.61, 0.96) 0.68 ( 0.42, 1.10) 0.95 ( 0.55, 1.64) 0.92 ( 0.32, 2.68)

White 1 1 1 1 1 1 1 1

Unmarried 1.22 ( 1.01, 1.46) 1.06 ( 0.84, 1.34) 1.17 ( 0.99, 1.39) 1.93 ( 1.41, 2.63)

Married 1 1 1 1

Yes 1.02 ( 0.91, 1.14) 1.39 ( 1.01, 1.92) 1.28 ( 1.06, 1.55)

No 1 1 1

Yes 1.20 ( 1.11, 1.30) 1.68 ( 1.32, 2.14) 1.10 ( 0.98, 1.25) 3.44 ( 2.26, 5.24)

No 1 1 1 1

>1 1.40 ( 1.20, 1.63) 2.11 ( 1.52, 2.93) 1.44 ( 1.23, 1.69) 1.37 ( 1.10, 1.70) 3.57 ( 2.42, 5.28)

1 1 1 1 1 1

1-2 1.00 ( 0.92, 1.09) 0.87 ( 0.71, 1.05) 1.16 ( 0.90, 1.49) 1.12 ( 0.99, 1.26) 0.59 ( 0.50, 0.70) 0.95 ( 0.76, 1.19) 1.27 ( 0.77, 2.08)

> 2 1.06 ( 0.94, 1.19) 1.09 ( 0.80, 1.48) 1.56 ( 1.09, 2.24) 1.26 ( 1.07, 1.48) 0.53 ( 0.37, 0.75) 1.22 ( 0.84, 1.77) 1.8 ( 1.01, 3.22)

Fail 1.14 ( 1.06, 1.24) 1.20 ( 0.99, 1.45) 1.35 ( 1.05, 1.74) 1.25 ( 1.12, 1.40) 0.73 ( 0.62, 0.87) 1.26 ( 1.01, 1.56) 1.87 ( 1.20, 2.93)

0 1 1 1 1 1 1 1

High 1.27 ( 0.91, 1.76) 1.13 ( 1.02, 1.26) 1.69 ( 0.94, 3.04)

None 1.96 ( 1.26, 3.05) 1.02 ( 0.94, 1.10) 3.74 ( 2.09, 6.69)

Low 1 1 1

Yes 1.15 ( 0.74, 1.79) 0.89 ( 0.70, 1.14)

No 1 1

2. Reference levels were chosen to be the category with the lowest expected risk, a priori.

3. If a confidence interval contains 1, then the level of the factor is not significantlly different from the reference level, at the 0.01 level.Protective if less than 1; adverse if greater than 1

1. Blank cells indicate that the factor was not statistically significant and was not involved in any significant two-way interaction with other main effects, at the 0.01 level. If a confidence interval contains 1, then the level of the factor is not sig

WIC Participation

Drink

Smoking

Plurality



Mother's Race

Factor

Marital Status

Payer Type

Infant Sex


Mother's Age

Mother's Education

Pregnancy Interval

Central Nervous System Chromosomal Defect Gastrointestinal DefectLevel2

Birth Defect OtherGenital and Urinary Heart Musculoskeletal Oral



- 21 -

RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RRHMO 1.05 ( 0.95, 1.16) 1.12 ( 0.98, 1.29) 1.21MPS 0.97 ( 0.88, 1.08) 1.01 ( 0.87, 1.18) 1.18HMOMPS 1.00 ( 0.84, 1.19) 1.15 ( 0.90, 1.46) 0.69FFSnsb 1.19 ( 1.06, 1.34) 1.25 ( 1.06, 1.47) 2.09FFSsob 1 1 1Male 1.38 ( 1.29, 1.47) 2.49 ( 2.01, 3.09) 5.62 ( 4.56, 6.91) 0.58 ( 0.44, 0.76)Female 1 1 1 1< HS 1.19 ( 1.08, 1.31) 1.21 ( 1.05, 1.40)HS 1.10 ( 1.01, 1.21) 1.08 ( 0.95, 1.24)> HS 1 1<=15 mo 1.01 ( 0.92, 1.11) 1.14 ( 1.00, 1.30)NA 1.20 ( 1.06, 1.35) 1.20 ( 1.06, 1.35)>15 mo 1 1No 1.13 ( 0.97, 1.32) 1.14 ( 0.76, 1.71) 2.18Yes 1 1 1< 20 0.86 ( 0.78, 0.94) 0.80 ( 0.53, 1.22) 0.75 ( 0.64, 0.89) 0.57> 34 1.38 ( 1.23, 1.56) 5.71 ( 4.12, 7.93) 1.43 ( 1.21, 1.70) 3.1620-34 1 1 1 1Black 0.86 ( 0.78, 0.94) 1.26 ( 0.93, 1.70) 0.90 ( 0.65, 1.24) 0.66 ( 0.52, 0.83) 0.71 ( 0.60, 0.83) 0.65 ( 0.52, 0.83) 0.63 ( 0.47, 0.86)Other 1.38 ( 1.23, 1.56) 1.11 ( 0.29, 4.27) 0.67 ( 0.16, 2.80) 0.39 ( 0.12, 1.24) 0.98 ( 0.57, 1.69) 0.89 ( 0.40, 1.95) 1.10 ( 0.44, 2.77)White 1 1 1 1 1 1 1Unmarried 1.02 ( 0.75, 1.39) 1.13 ( 0.97, 1.32) 1.87Married 1 1 1Yes 1.46 ( 1.22, 1.73) 1.4 ( 0.86, 2.29) 1.38 ( 0.91, 2.08) 4.38No 1 1 1 1Yes 0.81 ( 0.32, 2.04) 1.51 ( 1.21, 1.88) 2.84No 1 1 11-2 1.02 ( 0.89, 1.17) 0.87 ( 0.64, 1.17) 0.67 ( 0.51, 0.88) 0.81 ( 0.57, 1.15)> 2 1.10 ( 0.93, 1.31) 1.17 ( 0.77, 1.78) 0.69 ( 0.44, 1.09) 1.48 ( 0.93, 2.37)Fail 1.14 ( 1.01, 1.29) 1.30 ( 0.99, 1.72) 0.85 ( 0.66, 1.10) 1.21 ( 0.87, 1.68)0 1 1 1 1High 1.12 ( 0.98, 1.27) 1.75 ( 0.95, 3.21) 2.05None 1.48 ( 1.18, 1.87) 3.86 ( 1.95, 7.62) 4.12Low 1 1 1Yes 0.94 ( 0.86, 1.02) 0.88 ( 0.70, 1.11) 1.32 ( 0.50, 3.46) 0.76 ( 0.57, 1.03)No 1 1 1 1


Drink

Smoking



Mother's Age

Mother's Race

Marital Status

Genital and Urinary

WIC Participation

Factor Level2

Birth Defect

Medicaid Payor Type

Infant Sex

Mother's Education

Pregnancy Interval



Table C-2 : Relative Risks of Birth Defects and 99% Confidence Intervals for Main Effects of Risk Factors in the Analyses of Medicaid PAYOR TYPE for 1997,1998,1999 Study Population (Singleton Medicaid Births excluding highrisk OB)1


Heart Musculoskeletal OralCentral Nervous

System Chromosomal Defect

Gastrointestinal Defect



- 22 -



- 23 -

RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99) RR (LCI99,UCI99)

0.86 ( 0.62, 1.19)1.64 ( 1.13, 2.36)4.18 ( 2.34, 7.47)0.41 ( 0.03, 5.40)0.99 ( 0.62, 1.57)0.85 ( 0.49, 1.48)0.78 ( 0.34, 1.76)1.22 ( 0.46, 3.24)1.08 ( 0.30, 3.95)1.37 ( 0.22, 8.48)0.56 ( 0.13, 2.51)0.67 ( 0.11, 4.15)0.84 ( 0.19, 3.71)0.63 ( 0.17, 2.29)0.33 ( 0.01, 2.30)1.26 ( 0.35, 4.58)

1Male 1.38 ( 1.29, 1.47) 2.49 ( 2.01, 3.09) 5.62 ( 4.56, 6.91) 0.58 ( 0.44, 0.76)Female 1 1 1 1< HS 1.19 ( 1.08, 1.31) 1.20 ( 1.04, 1.39)HS 1.10 ( 1.01, 1.21) 1.08 ( 0.94, 1.23)> HS 1 1<=15 mo 1.01 ( 0.92, 1.11) 1.13 ( 0.99, 1.28)NA 1.20 ( 1.06, 1.35) 1.31 ( 1.11, 1.56)>15 mo 1 1No 1.14 ( 0.98, 1.33) 1.14 ( 0.76, 1.71)Yes 1 1< 20 0.86 ( 0.78, 0.95) 0.80 ( 0.53, 1.22) 0.81 ( 0.68, 0.96)> 34 1.38 ( 1.23, 1.56) 5.71 ( 4.12, 7.93) 1.40 ( 1.18, 1.67)20-34 1 1 1Black 0.85 ( 0.79, 0.92) 1.26 ( 0.93, 1.70) 0.90 ( 0.65, 1.24) 0.66 ( 0.52, 0.83) 0.71 ( 0.60, 0.83) 0.65 ( 0.52, 0.83) 0.63 ( 0.47, 0.86)Other 0.81 ( 0.62, 1.07) 1.11 ( 0.29, 4.27) 0.67 ( 0.16, 2.80) 0.39 ( 0.12, 1.24) 0.98 ( 0.57, 1.69) 0.89 ( 0.40, 1.95) 1.10 ( 0.44, 2.77)White 1 1 1 1 1 1 1Unmarried 1.02 ( 0.75, 1.39) 1.15 ( 0.99, 1.34)Married 1 1Yes 1.45 ( 1.22, 1.73) 1.40 ( 0.86, 2.29) 1.38 ( 0.91, 2.08) 0.84 ( 0.69, 1.03)No 1 1 1 1Yes 0.81 ( 0.32, 2.04) 1.51 ( 1.21, 1.88) 1.17 ( 0.95, 1.44)No 1 1 11-2 1.03 ( 0.90, 1.18) 0.87 ( 0.64, 1.17) 1.14 ( 0.94, 1.39) 0.67 ( 0.51, 0.88) 0.81 ( 0.57, 1.15)> 2 1.11 ( 0.94, 1.32) 1.17 ( 0.77, 1.78) 1.28 ( 1.01, 1.63) 0.69 ( 0.44, 1.09) 1.48 ( 0.93, 2.37)Fail 1.15 ( 1.01, 1.30) 1.30 ( 0.99, 1.72) 1.25 ( 1.04, 1.49) 0.85 ( 0.66, 1.10) 1.21 ( 0.87, 1.68)0 1 1 1 1 1

High 1.12 ( 0.98, 1.28) 1.75 ( 0.95, 3.21)None 1.50 ( 1.19, 1.89) 3.86 ( 1.95, 7.62)Low 1 1Yes 0.93 ( 0.85, 1.02) 0.88 ( 0.70, 1.11) 1.32 ( 0.50, 3.46) 0.76 ( 0.57, 1.03) 0.91 ( 0.80, 1.04)No 1 1 1 1 1


providers < 50 pt

Other providers

Healthease

Healthcare USA St. Augustine Health Care

Champion Healthcare

Discovery Health Plan

JMH Health Plan

Medchoice Health Plan

Neighborhood Health Plan

Ultramedix Health Care

Stay Well Health Plan

United Health Plan

Foundation Health

Name of Providers

PCA

Physicians Healthy Plan Preferred Medical Plan

Gastrointestinal Defect Genital and Urinary



Heart Musculoskeletal Oral

WIC Participation

Factor Level2

Table C-3 : Relative Risks of Birth Defects and 99% Confidence Intervals for Main Effects of Risk Factors in the Analyses of PROVIDERS for 1997,1998,1999 Study Population (Singleton Medicaid Births excluding highrisk OB)1

Adequacy of Prenatal CareMother's Age

Mother's Race

Birth Defect

Infant Sex

Mother's Education

Central Nervous System Chromosomal Defect

Pregnancy Interval

Smoking



Marital Status

Drink

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Impact of Medicaid on Birth Defects...The providers with less than 50 patients were group into one category coded as 88. Specifically, for the Birth Defects study, category 88 consisted