Assessing the quality of medical and health data from the 2003 birth certificate revision: results from two states.

OBJECTIVES: A primary goal of the 2003 revision of the U.S. Standard Certificate of Live Birth was to improve data quality, in part by improving data sources, definitions, and instructions. This report evaluates the quality of selected medical and health data from the 2003 revision of the birth certificate by comparing birth certificate data with information abstracted from hospital medical records. METHODS: A random sample of records for 600 births that occurred in 2010-2011 in State A, and a convenience sample of 495 births that occurred in State B in 2009 were reviewed. Birth certificate and hospital medical record data were compared for these categories: pregnancy history, prenatal care, gestational age, birthweight, pregnancy risk factors, obstetric procedures, onset of labor, source of payment, characteristics of labor and delivery, fetal presentation, method of delivery, abnormal conditions of the newborn, infant living, and infant breastfed. Levels of missing data, exact agreement, kappa scores, sensitivity, and false discovery rates are presented, where applicable. RESULTS: Exact agreement or sensitivity, was high for a number of items for both states (e.g., number of cesarean deliveries, cephalic presentation, cesarean delivery, and birthweight within 500 grams), but exact agreement or sensitivity was low or extremely low for both states for several items (e.g., total number of prenatal visits, previous preterm birth, meconium staining, and fetal intolerance of labor) (Figure 1). Levels of agreement or sensitivity for most items (e.g., prenatal care beginning in first trimester and source of payment-private insurance) were substantial or moderate. Data quality varied by state, and often, varied widely by hospital.

Source of payment for the delivery: births in a 33-state and District of Columbia reporting area, 2010.

OBJECTIVES: This report presents new data from birth certificates on the principal source of payment for the delivery in 2010 for the following groups: private insurance, Medicaid, self-pay (uninsured), and other payment sources. These data are for the 33 states and District of Columbia that adopted the 2003 U.S. Standard Certificate of Live Birth by January 2010, representing 76% of all 2010 U.S. births. Trend data for the United States for 1990-2010 are also presented from the Centers for Disease Control and Prevention's National Center for Health Statistics, National Hospital Discharge Survey (NHDS), to provide a national comparison and historical context. METHODS: Tabular and graphical data on deliveries by the principal source of payment for 2010 from the birth certificate are compared with NHDS estimates. Trend data for 1990-2010 from NHDS are also presented. Detailed data from the birth certificate on maternal characteristics, prenatal care receipt, and cesarean delivery are provided. RESULTS: Private insurance was the most frequent payment source for deliveries in the birth certificate-revised reporting area in 2010 (45.8% of births), followed closely by Medicaid (44.9%), ''other'' payment sources (5.0%), and self-pay (4.4%). Similarly, NHDS data show that private insurance was the most common payment source for deliveries nationally in 2010, followed by Medicaid. Privately insured deliveries declined over the last decade, while the use of Medicaid insurance increased. Medicaid insurance of deliveries was highest for births to teenagers and for non-Hispanic black and Hispanic mothers, according to the birth certificate data. Privately insured mothers were most likely of all payment groups to receive early prenatal care and to have cesarean deliveries.

Annual summary of vital statistics: 2006.

US births increased 3% between 2005 and 2006 to 4,265,996, the largest number since 1961. The crude birth rate rose 1%, to 14.2 per 1000 population, and the general fertility rate increased 3%, to 68.5 per 1000 women 15 to 44 years. Births and birth rates increased among all race and Hispanic-origin groups. Teen childbearing rose 3% in 2006, to 41.9 per 1000 females aged 15 to 19 years, the first increase after 14 years of steady decline. Birth rates rose 2% to 4% for women aged 20 to 44; rates for the youngest (10-14 years) and oldest (45-49) women were unchanged. Childbearing by unmarried women increased steeply in 2006 and set new historic highs. The cesarean-delivery rate rose by 3% in 2006 to 31.1% of all births; this figure has been up 50% over the last decade. Preterm and low birth weight rates also increased for 2006 to 12.8% and 8.3%, respectively. The 2005 infant mortality rate was 6.89 infant deaths per 1000 live births, not statistically higher than the 2004 level. Non-Hispanic black newborns continued to be more than twice as likely as non-Hispanic white and Hispanic infants to die in the first year of life in 2004. For all gender and race groups combined, expectation of life at birth reached a record high of 77.9 years in 2005. Age-adjusted death rates in the United States continue to decline. The crude death rate for children aged 1 to 19 years decreased significantly between 2000 and 2005. Of the 10 leading causes of death for children in 2005, only the death rate for cerebrovascular disease was up slightly from 2000, whereas accident and chronic lower respiratory disease death rates decreased. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.