presented by michelle j.k. osterman, mhs division of vital statistics, reproductive statistics...
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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Please, do not quote or cite.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:
28-state reporting area, preliminary 2009
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:
28-state reporting area, preliminary 2009
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
* Non-HispanicSource: CDC/NCHS, National Vital Statistics System
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
* Non-HispanicSource: CDC/NCHS, National Vital Statistics System
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
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
* Non-HispanicSource: CDC/NCHS, National Vital Statistics System
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
Source: CDC/NCHS, National Vital Statistics System
Receipt of WIC food 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
80
90
Age, race, and Hispanic origin
Per
cen
t
* Non-HispanicSource: CDC/NCHS, National Vital Statistics System
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
* Non-HispanicSource: CDC/NCHS, National Vital Statistics System
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:
28-state reporting area, 2009
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:
28-state reporting area, 2009
Principal source of payment for delivery: 28-state reporting area, preliminary 2009
Private insurance
Self payOther
Medicaid
Source: CDC/NCHS, National Vital Statistics System
Principal source of payment for delivery by age of mother:
28-state reporting area, preliminary 2009
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
Source: CDC/NCHS, National Vital Statistics System
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
Source: CDC/NCHS, National Vital Statistics System
Ruptured uterus by age and race and Hispanic origin:
28-state reporting area, preliminary 2009
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
Source: CDC/NCHS, National Vital Statistics System
Infant breastfed at discharge from hospital by race and Hispanic origin:
28-state reporting area, preliminary 2009
Hispanic
White*
Black*
Total
0 10 20 30 40 50 60 70 80 90
Percent
Rac
e an
d H
isp
anic
ori
gin
Source: CDC/NCHS, National Vital Statistics System
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
Source: CDC/NCHS, National Vital Statistics System
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
Underweight Normal Overweight Obese
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
Underweight Normal Overweight Obese
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
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