Presented by Michelle J.K. Osterman, MHS Division of Vital Statistics, Reproductive Statistics Branch National Conference on Health Statistics August 8,

Presented by

Michelle J.K. Osterman, MHS

Division of Vital Statistics, Reproductive Statistics Branch

National Conference on Health Statistics

August 8, 2012

Washington, DC

Data worth waiting for? Soon-to-be-released health data from the revised birth certificate

Attention!• Preliminary data…

Please, do not quote or cite.

Acknowledgements

Joyce A. Martin

Sally C. Curtin

Sharon E. Kirmeyer

Elizabeth C. Wilson

Stephanie J. Ventura

T.J. Mathews

Brady E. Hamilton

Introduction

• Selected new data items available for first time 2003 U.S. Standard Certificate of Live Birth

New/New Items

• Educational attainment of father• Body mass index (BMI)• Tobacco use 3 months prior to pregnancy

Quit prior to pregnancy

• Mother received WIC food during pregnancy• Pregnancy resulted from infertility therapy• Infections present during pregnancy (e.g., chlamydia)• Source of payment for the delivery (e.g., Medicaid)• Interval since last live birth• Time of birth• Maternal morbidities (e.g., ruptured uterus)• Infant breastfed

New/New Items

•Educational attainment of father

• Body mass index (BMI)• Tobacco use 3 months prior to pregnancy

Quit prior to pregnancy

• Mother received WIC food during pregnancy• Pregnancy resulted from infertility therapy• Infections present during pregnancy (e.g., chlamydia)• Source of payment for the delivery (e.g., Medicaid)•

Interval since last live birth •

Time of birth • Maternal morbidities (e.g., ruptured uterus)• Infant breastfed

Methods

• 2009 data from 28 reporting areas

Revised by January 1, 2009 66% of all U.S. births

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 ALGA

FL

SC

NC

VAWV

OH

MI

NY

PA

MD DE

CT

MA

ME

VTNH

Methods

• Race/Hispanic origin groups: Single-race

o Non-Hispanic whiteo Non-Hispanic black

Hispanic

• Not generalizable to whole U.S. Hispanic women overrepresented Composition of Hispanic population differs from total

U.S.

≠

RESULTS

Pre-pregnancy BMI by race and Hispanic origin:

28-state reporting area, preliminary 2009

Black*

Hispanic

White*

All races

0 10 20 30 40 50 60 70 80 90 100

Underweight Normal Overweight Obese

Percent

Rac

e an

d H

isp

anic

ori

gin

* Non-HispanicSource: CDC/NCHS, National Vital Statistics System

Cesarean delivery by pre-pregnancy BMI:


Source: CDC/NCHS, National Vital Statistics System

Total Underweight Normal Overweight Obese0

5

10

15

20

25

30

35

40

45

50

Pre-pregnancy BMI

Per

cen

t

High weight gain1 for pre-pregnancy BMI:


Underweight Normal Overweight Obese0

10

20

30

40

50

60

70

Pre-pregnancy BMI

Per

cen

t

1 Based on Institute of Medicine recommendation: ≥40 lbs for underweight, ≥35 lbs for normal weight, ≥25 lbs for overweight, ≥20 lbs for obese.Source: CDC/NCHS, National Vital Statistics System NOTE: Singletons only

Smoked and quit prior to pregnancy: 25-state reporting area, preliminary

2009


Hispanic

Black*

White*

All races

0 5 10 15 20 25 30 35 40 45

Smoked 3 months prior to pregnancy Quit prior to pregnancy

Percent

Rac

e an

d H

isp

anic

ori

gin

Smoked and quit prior to pregnancy: 25-state reporting area, preliminary

2009


Hispanic

Black*

White*

All races

0 5 10 15 20 25 30 35 40 45


Percent

Rac

e an

d H

isp

anic

ori

gin

Hispanic

Black*

White*

All races

0 5 10 15 20 25 30 35 40 45


Percent

Rac

e an

d H

isp

anic

ori

gin


Births resulting from infertility therapies, by age and race and

Hispanic origin: 28-state reporting area, preliminary

2009

Total Under 20

20-24 25-29 30-34 35-39 40 and over

White* Black* Hispanic0

10

20

30

40

50

60

70

Age, race, and Hispanic origin

Per

1,0

00

Births resulting from infertility therapies, by plurality: 28-state area,

preliminary 2009

Quadruplets

Triplets

Twins

Singletons

All births

0 10 20 30 40 50 60

Percent

Plu

rali

ty


Receipt of WIC food by age and race and Hispanic origin:


Total Under 20

20-24 25-29 30-34 35-39 40 and over

White* Black* Hispanic0

10

20

30

40

50

60

70

80

90

Age, race, and Hispanic origin

Per

cen

t


Receipt of WIC food by age and race and Hispanic origin:

28-state reporting area, 2009

Under 20 20-24 25-29 30-34 35-39 40 and over

0

10

20

30

40

50

60

70

80

90

White* Hispanic

Age

Per

cen

t


Gonorrhea Syphilis Chlamydia Hepatitis B Hepatitis C0

200

400

600

800

1000

1200

1400

1600

1800

Per

100

,000

bir

ths

Source: CDC/NCHS, National Vital Statistics System.

Infections present and/or treated during this pregnancy:


Total Under 20

20-24 25-29 30-34 35-39 40 and over

0

2,000

4,000

6,000

8,000

10,000

12,000

White* Black*

Age

Per

100

,000

bir

ths

Source: CDC/NCHS, National Vital Statistics System.

Chlamydia by age and race and Hispanic origin:


Principal source of payment for delivery: 28-state reporting area, preliminary 2009

Private insurance

Self payOther

Medicaid


Principal source of payment for delivery by age of mother:


Under 20 20-24 25-29 30-34 35-39 40 or more0

10

20

30

40

50

60

70

80

Medicaid Private Insurance

Age of mom

Per

cen

t


Maternal morbidities: 28-state reporting area, preliminary 2009

Ruptured uterus

Unplanned hysterectomy

ICU admission

Maternal transfusion

Perineal laceration

0 100 200 300 400 500 600 700 800 900 1000

Per 100,000


Ruptured uterus by age and race and Hispanic origin:


Total Under 30 30-39 40 or more White* Black* Hispanic0

10

20

30

40

50

60

70

80

90

Age, race and Hispanic origin

Per

100

,000


Infant breastfed at discharge from hospital by race and Hispanic origin:


Hispanic

White*

Black*

Total

0 10 20 30 40 50 60 70 80 90

Percent

Rac

e an

d H

isp

anic

ori

gin


Infant breastfed at discharge from hospital by maternal educational

attainment: 28-state reporting area, preliminary 2009

Less than HS HS or GED Associate's Degree

Bachelor's Degree

Master's PhD0

10

20

30

40

50

60

70

80

90

100

Educational level

Per

cen

t


DISCUSSION

Data Quality

• Some items appear well-reported: WIC Chlamydia

• Some items are likely underreported Infertility treatment Maternal morbidities Smoking prior to pregnancy

• Differentials by age, race, and Hispanic origin compare well with other sources

Source of payment BMI: Overweight

Gonorrhea BMI: Obese Infant breastfed

Data Quality

• Birth certificate vs. other data sources Can be difficult to compare

o 28-state reporting area vs. nationally representative samples

– Birth certificate reporting area not nationally representative– Many states with higher rates are unrevised (e.g.

infections)o Somewhat different populations

– e.g. All births vs. Survey respondents

o Somewhat different questions– e.g. Ever breastfed vs. during specific period (between birth and

hospital discharge)

o Different data years

Data Quality

• Birth clerk interviews Infertility treatment: availability of information Infant breastfed: confusion on exclusivity and duration

• Good agreement with medical record Interval since last live birth Source of payment Infant breastfed

Stay tuned

• Steps to improve data quality

• Larger revised reporting area: national data by 2014

• Reports/data releases: Births: Expanded data for 2009 (with new/new items) Re-release the 2009 final birth file (with new/new items) Report on quality of revised medical/health data for

medical record review 2010 Final file: Will re-release file with new/new items

later this year

• Data worth waiting for?

•Yes!

Verdict

Births: Expanded data for 2009


0

10

20

30

40

50

60

70

80

White* Black* Hispanic

Pre-pregnancy BMI

Pe

rce

nt

Total

Under

24

24-3

5

36-4

7

48-5

9

60-7

1

72 o

r mor

e

1st b

irths

0

1

2

3

4

5

6

7

8

Months

Pe

rce

nt

Black*

Hispanic

White*

All races

0 10 20 30 40 50 60 70 80 90 100


Percent

Ra

ce

an

d H

isp

an

ic o

rig

in

Under 20 20-24 25-29 30-34 35-39 40 or more

0

10

20

30

40

50

60

70

80

Medicaid Private Insurance

Age of mom

Pe

rce

nt

Under 20 20-24 25-29 30-34 35-39 40 and over

0

10

20

30

40

50

60

70

80

90

White* Black* Hispanic

Age

Pe

rce

nt

Thank you

Documents

Presented by Michelle J.K. Osterman, MHS Division of Vital Statistics, Reproductive Statistics Branch National Conference on Health Statistics August 8,