Hopeful signs of change amid struggle
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Transcript of Hopeful signs of change amid struggle
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Hopeful signs ofHopeful signs ofchange amid strugglechange amid struggle
The Revised Birth Data:
The NAPHSIS/NCHS CollaborationPast Successes and Future ChallengesSalt Lake City, UT June 3rd-7th, 2007
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U.S. Department of Health and Human ServicesCenters for Disease Control and Prevention
National Center for Health StatisticsNational Vital Statistics System
Authors/Acknowledgments
Joyce MartinStephanie VenturaThe Birth Team:Brady Hamilton Fay MenackerSharon Kirmeyer Martha MunsonMarian MacDorman Paul SuttonTJ Mathews
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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
VAWV
OH
MI
NY
PA
MDDE
NJ
CT RI
MA
ME
VTNH
AK
HI
DC
Revision Status, 2007
Revised
UnrevisedNYC
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Key items on both revised & unrevised birth certificates
Prenatal careCesarean deliveryCheckboxes items
Diabetes and hypertension
Today’s Topics
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Methods
Total 2005 revised states (12)(1.3 m births)
Excludes mid-year revisers
Trends - states which revised in2004 (5) or 2005 (3)
Excludes mid-year revisers
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Prenatal Care
Source ? = mom, records
Unrevised:
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Prenatal Care
Source = prenatal records, mom ?
Revised:
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Percent of Records with Not Stated Day & Month of 1st prenatal visit: 12 Revised States, 2005
0
2
4
6
8
10
12
14
16
18
20
Day Month
Pe
rce
nt
Source: NCHS/CDC/National Vital Statistics System
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Percent of Records with Not Stated Day of 1st Prenatal Visit: 12 Revised States, 2005
0
5
10
15
20
25
30
Total
State
A
State
B
State
C
State
D
State
E
State
F
State
G
Stage
H
State
I
State
J
State
K
State
L
Pe
rce
nt
Source: NCHS/CDC/National Vital Statistics System
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NCHS Calculation ofMonth 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 1st PNCV
SAS code to calculate now available from NCHS
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1st Trimester Prenatal Care by Revised Status:3 Revised states, 2004 and 2005
0
10
20
30
40
50
60
70
80
90
100
Unrev-04 Rev-05 Unrev-04 Rev-05 Unrev-04 Rev-05
Pe
rce
nt
State B State CState A
Source: NCHS/CDC/National Vital Statistics System
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Percent change in 1st Trimester Prenatal Care, Unrevised and Revised Reporting Areas: 2004-2005
-5
-4
-3
-2
-1
0
1
2
3
4
5
Percent change Percent changePe
rce
nt
UnrevisedRevised
Source: NCHS/CDC/National Vital Statistics System
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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
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Cesarean Delivery
3 commonly used measures:Total cesarean delivery rate
Primary cesarean rate Vaginal birth after previous cesarean (VBAC)
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Cesarean Delivery
Total cesarean rate Very comparable between revisions
RevisedUnrevised
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Cesarean Delivery - Revised
Primary cesareanVBAC/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)
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Cesarean Delivery- Revised
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Primary Cesarean Delivery Rates for Unrevised States and for States which Revised in 2005: Reporting Area, 2004-2005
0
5
10
15
20
25
30
35
Unrev 04
Unrev 05
Unrev 04
Rev 05
Unrev 04
Rev 05
Unrev 04
Rev 05
Pe
rce
nt
State BReporting area State CState A
Source: NCHS/CDC/National Vital Statistics System
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VBAC Rates for Unrevised States and for States which Revised in 2005: Reporting Area, 2004-2005
1
3
5
7
9
11
13
15
Unrev04
Unrev05
Unrev 04
Rev 05
Unrev04
Rev 05
Unrev04
Rev 05
Pe
rce
nt
State BReporting area State CState A
Source: NCHS/CDC/National Vital Statistics System
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Primary Cesarean Delivery and VBAC Rates by Revised Status: Reporting area, 2005
0
5
10
15
20
25
30
Unrevised Revised Unrevised Revised
Pe
rce
nt
Source: NCHS/CDC/National Vital Statistics System
Primary VBAC
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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
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Cesarean Delivery
BUT, possible under-reporting of # previous cesareans
Developing enhanced instructions for reporting if mom had a previouscesarean using prenataland other medical records
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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
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Total Diabetes (Pre-pregnancy + Gestational) for states which revised in 2004 and 2005: Reporting Area, 2003-2005
01020304050
60708090
100
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-04
Rev-0
5
Unrev
-04
Rev-0
5
Unrev
-04
Rev-0
5
Pe
r 1
,00
0
B D ECA
Source: NCHS/CDC/National Vital Statistics System
F G H
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Gestational Hypertension Rates for States which Revised in 2004 and 2005: Reporting Area, 2003-2005
01020304050
60708090
100
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-03
Rev-0
4
Unrev
-04
Rev-0
5
Unrev
-04
Rev-0
5
Unrev
-04
Rev-0
5
Pe
r 1
,00
0
B D ECA
Source: NCHS/CDC/National Vital Statistics System
F G H
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Diabetes and Pre-pregnancy Hypertension: Unrevised Reporting Area: 2004-2005
0
10
20
30
40
50
60
2003 2004 2005 2003 2004 2005
Pe
r 1
,00
0
Pre-pregnancyhypertension
Diabetes
Source: NCHS/CDC/National Vital Statistics System
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New Report
Source: NCHS/CDC/National Vital Statistics System
Begins to demonstrate the tremendous analytic potential of the revised data
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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 !!!