The quality of data reported on birth certificates

Neonatal Mortality After Interhospital Transfer of Pregnant Women for Imminent Very Preterm Birth in Illinois

IMPORTANCE

Reducing neonatal mortality is a national health care priority. Understanding the association between neonatal mortality and antenatal transfer of pregnant women to a level III perinatal hospital for delivery of infants who are very preterm (VPT) may help identify opportunities for improvement.

OBJECTIVE

To assess whether antenatal transfer to a level III hospital is associated with neonatal mortality in infants who are VPT.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study included infants who were born VPT to Illinois residents in Illinois perinatal-network hospitals between January 1, 2015, and December 31, 2016, and followed up for 28 days after birth. Data analysis was conducted from June 2017 to September 2018.

EXPOSURES

Delivery of an infant who was VPT at a (1) level III hospital after maternal presentation at that hospital (reference group), (2) a level III hospital after antenatal (in utero) transfer from another hospital, or (3) a non-level III hospital.

MAIN OUTCOMES AND MEASURES

Neonatal mortality.

RESULTS

The study included 4817 infants who were VPT (gestational age, 22-31 completed weeks) and were born to Illinois residents in 2015 and 2016. Of those, 3302 infants (68.5%) were born at a level III hospital after maternal presentation at that hospital, 677 (14.1%) were born at a level III hospital after antenatal transfer, and 838 (17.4%) were born at a non-level III hospital. Neonatal mortality for all infants who were VPT included in this study was 573 of 4817 infants (11.9%). The neonatal mortality was 10.7% for the reference group (362 of 3302 infants), 9.8% for the antenatal transfer group (66 of 677 infants), and 17.3% for the non-level III birth group (145 of 838 infants). When adjusted for significant social and medical characteristics, infants born VPT at a level III hospital after antenatal transfer from another facility had a similar risk of neonatal mortality as infants born at a level III hospital (odds ratio, 0.79 [95% CI, 0.56-1.13]) after maternal presentation at the same hospital. Infants born at a non-level III hospital had an increased risk of neonatal mortality compared with infants born at a level III hospital after maternal presentation to the same hospital (odds ratio, 1.52 [95% CI, 1.14-2.02]).

CONCLUSIONS AND RELEVANCE

The risk of neonatal mortality was similar for infants who were VPT, whether women initially presented at a level III hospital or were transferred to a level III hospital before delivery. This suggests that the increased risk of mortality associated with delivery at a non-level III hospital may be mitigated by optimizing opportunities for early maternal transfer to a level III hospital.

Birth Settings and the Validation of Neonatal Seizures Recorded in Birth Certificates Compared to Medicaid Claims and Hospital Discharge Abstracts Among Live Births in South Carolina, 1996-2013

Objective Neonatal seizures in the first 28 days of life often reflect underlying brain injury or abnormalities, and measure the quality of perinatal care in out-of-hospital births. Using the 2003 revision of birth certificates only, three studies reported more neonatal seizures recorded among home births ​or planned out-of-hospital births compared to hospital births. However, the validity of recording neonatal seizures or serious neurologic dysfunction across birth settings in birth certificates has not been evaluated. We aimed to validate seizure recording in birth certificates across birth settings using multiple datasets. Methods We examined checkbox items "seizures" and "seizure or serious neurologic dysfunction" in the 1989 and 2003 revisions of birth certificates in South Carolina from 1996 to 2013. Gold standards were ICD-9-CM codes 779.0, 345.X, and 780.3 in either hospital discharge abstracts or Medicaid encounters jointly. Results Sensitivity, positive predictive value, false positive rate, and the kappa statistic of neonatal seizures recording were 7%, 66%, 34%, and 0.12 for the 2003 revision of birth certificates in 547,177 hospital births from 2004 to 2013 and 5%, 33%, 67%, and 0.09 for the 1998 revision in 396,776 hospital births from 1996 to 2003, and 0, 0, 100%, -0.002 among 660 intended home births from 2004 to 2013 and 920 home births from 1996 to 2003, respectively. Conclusions for Practice Despite slight improvement across revisions, South Carolina birth certificates under-reported or falsely reported seizures among hospital births and especially home births. Birth certificates alone should not be used to measure neonatal seizures or serious neurologic dysfunction.

The effect of maternal age on fetal and neonatal mortality

OBJECTIVE

Determine the gestational age at which the risk of fetal or neonatal death associated with delaying delivery by 1 week exceeds the risk of neonatal death associated with immediate delivery, stratified by maternal age intervals.

STUDY DESIGN

We conducted a retrospective cohort study of live births, stillbirths and neonatal deaths that occurred in the United States between 2010 and 2013 using birth data. Women were classified into six age categories. Singleton, non-anomalous pregnancies without hypertensive disease or diabetes were included. Relative risks were obtained using a generalized linear model comparing the rate of death associated with immediate delivery to those of expectant management.

RESULTS

For all age groups with the exception of women 44 years and older, immediate delivery was associated with lower relative risk of death by 39 weeks. For <25, 25 to 29, 30 to 34, 35 to 39, 40 to 44, odds ratios (OR) and confidence intervals (CI) were 1.0 (0.32 to 3.10), 0.67 (0.19 to 2.37), 0.80 (0.21 to 2.98), 0.67 (0.19 to 2.36) and 0.45 (0.16 to 1.31), respectively. In women 44 years and older, immediate delivery was associated with a lower relative risk of death by 38 weeks (OR: 0.35, CI: 0.14 to 0.90).

CONCLUSION

Women greater than 44 years old may benefit from delivery by 38 weeks gestational age to reduce the risk of stillbirth.

The Accuracy of Hospital Discharge Diagnosis Codes for Major Birth Defects: Evaluation of a Statewide Registry With Passive Case Ascertainment

CONTEXT

Birth defects prevention, research, education, and support activities can be improved through surveillance systems that collect high-quality data.

OBJECTIVE

To estimate the overall and defect-specific accuracy of Florida Birth Defects Registry (FBDR) data, describe reasons for false-positive diagnoses, and evaluate the impact of statewide case confirmation on frequencies and prevalence estimates.

DESIGN

Retrospective cohort evaluation study.

PARTICIPANTS

A total of 8479 infants born to Florida resident mothers between January 1, 2007, and December 31, 2011, and diagnosed with 1 of 13 major birth defects in the first year of life.

MAIN OUTCOME MEASURES

Positive predictive value: calculated overall (proportion of FBDR-identified cases confirmed by medical record review, regardless of which of the 13 defects were confirmed) and defect-specific (proportion of FBDR-identified cases confirmed by medical record review with the same defect) indices.

RESULTS

The FBDR's overall positive predictive value was 93.3% (95% confidence interval, 92.7-93.8); however, there was variation in accuracy across defects, with positive predictive values ranging from 96.0% for gastroschisis to 54.4% for reduction deformities of the lower limb. Analyses suggested that International Classification of Diseases, Ninth Edition, Clinical Modification, codes, upon which FBDR diagnoses are based, capture the general occurrence of a defect well but often fail to identify the specific defect with high accuracy. Most infants with false-positive diagnoses had some type of birth defect that was incorrectly documented or coded. If prevalence rates reported by the FBDR for these 13 defects were adjusted to incorporate statewide case confirmation, there would be an overall 6.2% rate reduction from 82.6 to 77.5 per 10 000 live births.

CONCLUSIONS

A statewide birth defects surveillance system, relying on linkage of administrative databases, is capable of achieving high accuracy (>93%) for identifying infants with any one of the 13 major defects included in this study. However, the level of accuracy and the ability to minimize false-positive diagnoses vary depending on the defect.

Evaluation of the Sensitivity and Accuracy of Birth Defects Indicators on the 2003 Revision of the U.S. Birth Certificate: Has Data Quality Improved?

BACKGROUND

The 2003 revision of the U.S. Birth Certificate was restricted to birth defects readily identifiable at birth. Despite being the lone source of birth defects cases in some studies, we lack population-based information on the quality of birth defects data from the most recent revision of the birth certificate.

METHODS

We linked birth certificate data to confirmed cases from the Florida Birth Defects Registry (FBDR) to assess the sensitivity and positive predictive value (PPV) of birth defects indicators on the birth certificate. Descriptive statistics and log-binomial regression were used to examine variation in data quality measures by defect type and other characteristics. We also evaluated the contribution of birth certificates as a case ascertainment source for the FBDR.

RESULTS

Sensitivity of the birth certificate was poor (19.1%) with variation across defects ranging from 55% for anencephaly and 54% for gastroschisis, to <10% for other defects. PPV was better (87.1%) and ranged from >93% for orofacial clefts and gastroschisis to <55% for anencephaly and limb reduction defects. We also observed variation in data quality across maternal, infant, and hospital characteristics. Of cases identified by the birth certificate and not any other FBDR data source, 54.9% were false-positive diagnoses.

CONCLUSIONS

Efforts to restrict the 2003 revision of the birth certificate to defects identifiable at birth have not improved the likelihood that birth certificates will identify infants born with those defects. We do not recommend the use of birth certificates as a source of birth defects data without case verification strategies.

Comparison of birth certificates and hospital-based birth data on pregnancy complications in Los Angeles and Orange County, California

Background

The incidence of both gestational diabetes mellitus and preeclampsia is on the rise; however, these pregnancy complications may not be systematically reported. This study aimed to examine differences in reporting of preeclampsia and gestational diabetes between hospital records and birth certificate data, and to determine if such differences vary by maternal socioeconomic status indicators.

Methods

We obtained over 70,000 birth records from 2001 to 2006 from the perinatal research database of the Memorial Care system, a network of four hospitals in Los Angeles and Orange Counties, California. Memorial birth records were matched to corresponding state birth certificate records and analyzed to determine differential rates of reporting of preeclampsia and diabetes. Additionally, the influence of maternal socioeconomic factors on the reported incidence of such adverse pregnancy outcomes was analyzed. Socioeconomic factors of interest included maternal education levels, race, and type of health insurance (private or public).

Results

It was found that the birth certificate data significantly underreported the incidence of both preeclampsia (1.38 % vs. 3.13 %) and diabetes (1.97 % vs. 5.56 %) when compared to Memorial data. For both outcomes of interest, the degree of underreporting was significantly higher among women with lower education levels, among Hispanic women compared to Non-Hispanic White women, and among women with public health insurance.

Conclusion

The Memorial Care database is a more reliable source of information than birth certificate data for analyzing the incidence of preeclampsia and diabetes among women in Los Angeles and Orange Counties, especially for subpopulations of lower socioeconomic status.

Estimates of the live births, natural losses, and elective terminations with Down syndrome in the United States

The present and future live birth prevalence of Down syndrome (DS) is of practical importance for planning services and prioritizing research to support people living with the condition. Live birth prevalence is influenced by changes in prenatal screening technologies and policies. To predict the future impact of these changes, a model for estimating the live births of people with DS is required. In this study, we combine diverse and robust datasets with validated estimation techniques to describe the non-selective and live birth prevalence of DS in the United States from 1900-2010. Additionally, for the period 1974-2010, we estimate the impact of DS-related elective pregnancy terminations (following a prenatal diagnosis of DS) on the live births with DS. The live birth prevalence for DS in the most recent years (2006-2010) was estimated at 12.6 per 10,000 (95% CI 12.4-12.8), with around 5,300 births annually. During this period, an estimated 3,100 DS-related elective pregnancy terminations were performed in the U.S. annually. As of 2007, the estimated rates at which live births with DS were reduced as a consequence of DS-related elective pregnancy terminations were 30% (95% CI: 27.3-31.9) for the U.S. as a whole. Our results and our model provide data on the impact of elective pregnancy terminations on live births with DS and may provide a baseline from which future trends for live births with DS can be estimated.

Development and implementation of the first national data quality standards for population-based birth defects surveillance programs in the United States

Background

Population-based birth defects surveillance is a core public health activity in the United States (U.S.); however, the lack of national data quality standards has limited the use of birth defects surveillance data across state programs. Development of national standards will facilitate data aggregation and utilization across birth defects surveillance programs in the U.S.

Methods

Based on national standards for other U.S. public health surveillance programs, existing National Birth Defects Prevention Network (NBDPN) guidelines for conducting birth defects surveillance, and information from birth defects surveillance programs regarding their current data quality practices, we developed 11 data quality measures that focused on data completeness (n = 5 measures), timeliness (n = 2), and accuracy (n = 4). For each measure, we established tri-level performance criteria (1 = rudimentary, 2 = essential, 3 = optimal). In January 2014, we sent birth defects surveillance programs in each state, District of Columbia, Puerto Rico, Centers for Disease Control and Prevention (CDC), and the U.S. Department of Defense Birth and Infant Health Registry an invitation to complete a self-administered NBDPN Standards Data Quality Assessment Tool. The completed forms were electronically submitted to the CDC for analyses.

Results

Of 47 eligible population-based surveillance programs, 45 submitted a completed assessment tool. Two of the 45 programs did not meet minimum inclusion criteria and were excluded; thus, the final analysis included information from 43 programs. Average scores for four of the five completeness performance measures were above level 2. Conversely, the average scores for both timeliness measures and three of the four accuracy measures were below level 2. Surveillance programs using an active case-finding approach scored higher than programs using passive case-finding approaches for the completeness and accuracy measures, whereas their average scores were lower for timeliness measures.

Conclusions

This initial, nation-wide assessment of data quality across U.S. population-based birth defects surveillance programs highlights areas for improvement. Using this information to identify strengths and weaknesses, the birth defects surveillance community, working through the NBDPN, can enhance and implement a consistent set of standards that can promote uniformity and enable surveillance programs to work towards improving the potential of these programs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2223-2) contains supplementary material, which is available to authorized users.

Are residents of mountain-top mining counties more likely to have infants with birth defects? The West Virginia experience

BACKGROUND

Pooled 1996 to 2003 birth certificate data for four central states in Appalachia indicated higher rates of infants with birth defects born to residents of counties with mountain-top mining (MTM) than born to residents of non-mining-counties (Ahern 2011). However, those analyses did not consider sources of uncertainty such as unbalanced distributions or quality of data. Quality issues have been a continuing problem with birth certificate analyses. We used 1990 to 2009 live birth certificate data for West Virginia to reassess this hypothesis.

METHODS

Forty-four hospitals contributed 98% of the MTM-county births and 95% of the non-mining-county births, of which six had more than 1000 births from both MTM and nonmining counties. Adjusted and stratified prevalence rate ratios (PRRs) were computed both by using Poisson regression and Mantel-Haenszel analysis.

RESULTS

Unbalanced distribution of hospital births was observed by mining groups. The prevalence rate of infants with reported birth defects, higher in MTM-counties (0.021) than in non-mining-counties (0.015), yielded a significant crude PRR (cPRR = 1.43; 95% confidence interval [CI] = 1.36-1.52) but a nonsignificant hospital-adjusted PRR (adjPRR = 1.08; 95% CI = 0.97-1.20; p = 0.16) for the 44 hospitals. So did the six hospital data analysis ([cPRR = 2.39; 95% CI = 2.15-2.65] and [adjPRR = 1.01; 95% CI, 0.89-1.14; p = 0.87]).

CONCLUSION

No increased risk of birth defects was observed for births from MTM-counties after adjustment for, or stratification by, hospital of birth. These results have consistently demonstrated that the reported association between birth defect rates and MTM coal mining was a consequence of data heterogeneity. The data do not demonstrate evidence of a "Mountain-top Mining" effect on the prevalence of infants with reported birth defects in WV.

Adjusting for multiple-misclassified variables in a study using birth certificates

PURPOSE

Birth certificates are a convenient source of population data for epidemiologic studies. It is well documented, however, that birth certificate data can be highly inaccurate. Nonetheless, studies based on birth certificates are routinely analyzed without accounting for sources of data errors. We focused on the association between maternal cigarette smoking and cleft lip and palate based on birth certificate data.

METHODS

We adjusted odds ratio estimates simultaneously for exposure and outcome misclassification. We also calculated odds ratios adjusted for exposure misclassification only and outcome misclassification only.

RESULTS

Adjustment for both maternal smoking during pregnancy and clefting resulted in adjusted odds ratios that ranged from less than 1.0 to much greater than the unadjusted estimate of 1.16, with most adjusted estimates outside of the 95% confidence limits (1.01, 1.33).

CONCLUSIONS

Because of the potentially large impact of birth certificate classification errors, we suggest that inferences from these or similar records employ quantitative methods for incorporating uncertainties caused by data errors.

SIM e SINASC: representação social de enfermeiros e profissionais de setores administrativos que atuam em hospitais no município de São Paulo

Poucos estudos analisaram o SINASC e SIM com metodologia qualitativa, visando compreender os processos e os contextos na produção dos dados. O objetivo deste artigo é estudar a representação social dos profissionais de saúde sobre as Declaração de Nascido Vivo (DN) e Declarações de Óbito (DO) perinatais. Foram realizadas 24 entrevistas com enfermeiros e outros profissionais em 16 hospitais, SUS e Não SUS, no município de São Paulo, em 2009. Foi utilizada metodologia qualitativa com a técnica do Discurso do Sujeito Coletivo. Os profissionais se reconhecem como parte integrante do processo de produção da informação do SINASC e os discursos indicam sua incorporação na rotina de trabalho, e percebem que o treinamento é um espaço de retorno, e a compreensão das informações que produzem e conhecem sobre a utilidade das informações registradas nas DN. Apesar do médico ser legalmente responsável pela DO, frequentemente outros profissionais preenchem parte das informações. Os profissionais se sentem participantes na operação do SINASC, porém apesar de preencherem informações da DO, estes não são incorporados e se percebem como integrantes da operação do SIM.

Missing information in birth certificates in Brussels after reinforcement of data collection, and variation according to immigration status. A population-based study

BACKGROUND

A problem repeatedly reported in birth certificate data is the presence of missing data. In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region to check birth certificates. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status.

METHODS

Birth certificates from the birth registry of 2008 and 2009 of Brussels were considered. We evaluated the initial missing information in January 2008 (baseline situation) and the corresponding rate at the end of 2008 after oral and written information had been given to the city civil servants and health providers. The data were evaluated again at the end of 2009 where no reinforcement rules were adopted. We also measured residual missing data after correction in socio-economic and medical data, for the entire population and according to maternal nationality of origin. Changes in registration of stillbirths were estimated by comparison to 2007 baseline data, and all multiple births were checked for complete identification of pairs.

RESULTS

Missing information initially accounted for 64.0%, 20.8% and 19.5% of certificates in January 2008, December 2008, and 2009 respectively. After correction with lists sent back to the hospitals or city offices, the mean residual missing data rate was 2.1% in 2008 and 0.8% in 2009. Education level and employment status were missing more often in immigrant mothers compared to Belgian natives both in 2008 and 2009. Mothers from Sub-Saharan Africa had the highest missing rate of socio-economic data. The stillbirth rate increased from 4.6 ‰ in 2007 to 8.2 ‰ in 2009. All twin pairs were identified, but early loss of a co-twin before 22 weeks was rarely reported.

CONCLUSIONS

Reinforcement of data collection was associated with a decrease of missing information. The residual missing data rate was very low. The stillbirth rate was also improved but the early loss of a co-twin before 22 weeks seems to remain underreported.

The use of birth certificate data to reconstruct and validate self-reported birth address in a study of breast cancer and environment

PURPOSE

We conducted a study comparing the location of addresses recorded on birth certificates with self-reported birth addresses provided by adults who were participants in the Western New York Exposure and Breast Cancer (WEB) Study. We also evaluated whether birth certificate residence data may be used to reconstruct missing self-reported birth residence information.

METHODS

Subjects were selected from WEB study participants born in Western New York State between 1920 and 1964 for whom we were able to obtain a New York State birth certificate. Addresses were geocoded and mean distance and SD between self-reported and certificate addresses were calculated.

RESULTS

Our findings indicate good agreement between self-reported and birth certificate addresses (77% are within 0.25 mile difference), and no difference in recall for cases compared with controls.

CONCLUSIONS

This study provides evidence that self-reported and birth certificate-based addresses may be used together to achieve increased accuracy of historical records in early life when place of birth is used as a proxy for early life environment in relation to the development of breast cancer or other chronic diseases.

Sensitivity of birth certificate reports of birth defects in Atlanta, 1995-2005: effects of maternal, infant, and hospital characteristics

OBJECTIVES

We assessed variations in the sensitivity of birth defect diagnoses derived from birth certificate data by maternal, infant, and hospital characteristics.

METHODS

We compared birth certificate data for 1995-2005 births in Atlanta with data from the Metropolitan Atlanta Congenital Defects Program (MACDP). We calculated the sensitivity of birth certificates for reporting defects often discernable at birth (e.g., anencephaly, spina bifida, cleft lip, clubfoot, Down syndrome, and rectal atresia or stenosis). We used multivariable logistic regression models to examine associations with sociodemographic and hospital factors.

RESULTS

The overall sensitivity of birth certificates was 23% and ranged from 7% for rectal atresia/stenosis to 69% for anencephaly. Non-Hispanic black maternal race/ethnicity, less than a high school education, and preterm birth were independently associated with a lower probability of a birth defect diagnosis being reported on a birth certificate. Sensitivity also was lower for hospitals with > 1,000 births per year.

CONCLUSIONS

The underreporting of birth defects on birth certificates is influenced by sociodemographic and hospital characteristics. Interpretation of birth defects prevalence estimates derived from birth certificate reports should take these issues into account.

Avaliação de preditores do óbito neonatal em uma série histórica de nascidos vivos no Nordeste brasileiro

OBJETIVOS: avaliar tendência dos preditores do óbito neonatal entre os nascidos vivos e qualidade do preenchimento do Sistema de Informações para Nascidos Vivos (Sinasc) institucional. MÉTODOS: série histórica do Sinasc do Instituto de Medicina Integral Prof. Fernando Figueira (1995-2006) em Recife, Pernambuco, Brasil. Foram avaliadas: completitude de preenchimento das variáveis e tendência dos indicadores de risco para mortalidade infantil (baixo peso ao nascer; anóxia; prematuridade; cesariana; ausência de pré-natal; mãe adolescente; analfabetismo e nenhum filho nascido vivo e morto). Significância estatística para teste t de Student foi de 5% em um modelo de regressão linear. RESULTADOS: 58.689 nascidos vivos com contínuo incremento a partir de 2002; baixo peso ao nascer, 22,8%; Apgar <7 1º minuto 15,3%; prematuros 22,4%; parto cesáreo 38,2%; mães adolescentes 27,2%; analfabetas 2,7% e 89% sem filho nascido morto. Prevaleceu 1% de variáveis ignoradas. Tendência de aumento (p<0,05): Apgar no 1º minuto, baixo peso ao nascer, prematuridade e parto cesáreo; tendência de declínio(p<0,05): nenhuma consulta de pré-natal, mães adolescentes, analfabetismo e nenhum filho nascido morto. CONCLUSÕES: valores progressivos dos preditores do óbito infantil sugerem problemas na qualidade do pré-natal. Predomínio de 1% de informação ignorada, excelente qualidade de preenchimento do Sinasc institucional. Avaliação rotineira dos nascimentos promove agilidade da informação e intervenções oportunas na prevenção dos óbitos neonatais no nível local.

Challenges and priorities for surveillance of stillbirths: a report on two workshops

Stillbirths, those with and without birth defects, are an important public health topic. The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention conducted two workshops during April and July 2005. Both workshops explored the challenges of conducting surveillance of stillbirths. Workshop participants considered an approach that added the surveillance of stillbirths, those with and without birth defects, as part of existing population-based birth defects surveillance programs in Iowa and Atlanta. The workshops addressed three key aspects for expanding birth defects programs to conduct active, population-based surveillance on stillbirths: (1) case identification and ascertainment, (2) data collection, and (3) data use and project evaluation. Participants included experts in pediatrics, obstetrics, epidemiology, maternal-fetal medicine, perinatology and pediatric pathology, midwifery, as well as practicing clinicians and pathologists. Expanding existing birth defects surveillance programs to include information of stillbirths could potentially enhance the data available on fetal death reports and also could benefit such programs by improving the ascertainment of birth defects.

JC, Gama SGND, Cunha CBD, Theme Filha MM. Confiabilidade das informações das declarações de nascido vivo com registro de defeitos congênitos no Município do Rio de Janeiro, Brasil, 2004

Avaliou-se a confiabilidade das informações sobre defeitos congênitos contidas nas declarações de nascido vivo do Sistema de Informações sobre Nascidos Vivos (SINASC) no Município do Rio de Janeiro, Brasil, no ano de 2004 comparando-as com os prontuários hospitalares destas crianças e de suas mães na internação para o parto. Após a seleção de 24 maternidades do SUS, os tipos de defeitos congênitos constantes nos prontuários foram transcritos em formulários de coleta próprios, codificados com base na CID-10 e comparados com os arquivos do SINASC. Verificou-se uma maior freqüência de defeitos congênitos dos sistemas osteomuscular e nervoso central e percentual de concordância acima de 50% nos aparelhos digestivo, urinário e osteomuscular, órgãos genitais e de anomalias cromossômicas. O kappa ajustado pela prevalência variou conforme as análises para 2 ou 3 dígitos da CID-10, com melhores resultados nos aparelhos osteomuscular, genito-urinário, digestivo e as anomalias cromossômicas e os piores nos sistemas nervoso central e cárdio-circulatório, malformações congênitas da face, olhos pescoço e orelhas e fendas lábio-palatinas. Os resultados encontrados são insatisfatórios e apontam para a necessidade de qualificação do pessoal envolvido no preenchimento das declarações assim como a padronização da codificação dos defeitos congênitos.

Accuracy of birth certificate data by risk factors and outcomes: analysis of data from New Jersey

OBJECTIVE

The purpose of this study was to determine the extent to which the accuracy of birth certificate data varies by risk factors and birth outcomes.

STUDY DESIGN

We reanalyzed data from a validation study of birth certificate data in New Jersey, focusing on subgroups of mothers according to marital status, age, race, ethnicity, English-language proficiency, prenatal care, transfer status, birthweight, and gestational age.

RESULTS

Underreporting of birth certificate data elements varies by maternal characteristics (particularly English-language proficiency), transfer status, and birth outcomes.

CONCLUSION

It is important to consider subgroup variations in data quality when birth certificate data are used for research. Additional studies are needed to explore the sources of variation in data quality and to assess the quality for additional subgroups, across subgroups in other states, in low-risk populations, and of new data items that were introduced in the 2003 revision of the US Standard Certificate of Live Birth.

Risk factors for antepartum and intrapartum stillbirth: a population-based study

To examine disparities in risk factors for stillbirths and its occurrence in the antepartum versus intrapartum periods. A population-based, cross-sectional study using data on women that delivered singleton births between 20 and 43 weeks in Missouri (1989-1997) was conducted (n = 626,883). Hazard ratios and 95% confidence intervals were derived from regression models and population attributable fractions were estimated to examine the impact of risk factors on stillbirth. Among African Americans, risks of antepartum and intrapartum stillbirth were 5.6 and 1.1 per 1,000 singleton births, respectively; risks among whites were 3.4 and 0.5 per 1,000 births, respectively. Maternal age > or = 35 years, lack of prenatal care, prepregnancy body mass index (BMI) > or = 30 kg/m2, and prior preterm or small-for-gestational age birth were significantly associated with increased risk for antepartum stillbirth among whites, but not African Americans. BMI < or = 18.5 kg/m2 was associated with antepartum and intrapartum stillbirth among African Americans, but not whites. The presence of any congenital anomaly, abruption, and cord complications were associated with antepartum stillbirth in both races. Premature rupture of membranes was associated with intrapartum stillbirth among whites and African Americans, but intrapartum fever was associated with intrapartum stillbirth among African Americans. These risk factors were implicated in 54.9% and 19.7% of antepartum and intrapartum stillbirths, respectively, among African American women, and in a respective 46.6% and 11.9% among white women. Considerable heterogeneity in risk factors between antepartum and intrapartum stillbirths is evident. Knowledge on timing of stillbirth specific risk factors may help clinicians in decreasing antepartum and intrapartum stillbirth risks through monitoring and timely intervention.

Back to the future? A critical commentary on the 2003 U.S. National standard certificate of live birth

Vital statistics documents for the United States have been revised approximately decennially throughout the past century. In this commentary we review the contents of the 2003 revision of the national standard certificate of live birth, focusing on changes from the certificates in use nationally since 1989, and identifying strengths and weaknesses of key data elements. Additional federal-state partnership funding is imperative to support the transition to the new standard certificates, and to ensure a focus on data quality at the state and national levels.

The reliability and validity of birth certificates

OBJECTIVES

To summarize the reliability and validity of birth certificate variables and encourage nurses to spearhead data improvement.

DATA SOURCES

A Medline key word search of reliability and validity of birth certificate, and a reference review of more than 60 articles were done.

STUDY SELECTION

Twenty-four primary research studies of U.S. birth certificates that involved validity or reliability assessment.

DATA EXTRACTION

Studies were reviewed, critiqued, and organized as either a reliability or a validity study and then grouped by birth certificate variable.

DATA SYNTHESIS

The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery.

CONCLUSIONS

Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented.

Risk factors for neonatal morbidity and mortality among "healthy," late preterm newborns

Research about neonatal outcomes among late preterm infants (34 weeks through 36 6/7 weeks of gestation) is limited. Understanding which late preterm infants are at risk for neonatal morbidity or mortality is necessary to improve health outcomes and reduce hospital costs. We conducted a population-based cohort study of "healthy," singleton late preterm infants vaginally delivered in Massachusetts hospitals to Massachusetts residents between 1998 and 2002. We compared the incidence of neonatal morbidity (postdelivery inpatient readmissions, observational stays, or mortality) between "healthy," late preterm infants with and without infant, obstetric, and sociodemographic factors by calculating risk ratios adjusted for confounding. Of the 9552 late preterm, "healthy" infants, 4.8% had an inpatient readmission and 1.3% had an observational stay. Infants with neonatal morbidity were more likely to be firstborn, be breastfed at discharge, have labor and delivery complications, be a recipient of a public payer source at delivery, or have an Asian/Pacific Islander mother. Non-Hispanic blacks had a decreased risk for neonatal morbidity compared to other racial/ethnic groups. Knowledge of risk factors for neonatal morbidity among "healthy" late preterm infants can be used to identify infants needing closer monitoring and earlier follow-up after hospital discharge.

Early discharge among late preterm and term newborns and risk of neonatal morbidity

Understanding how late preterm infants (34-36 completed weeks' gestation) are affected by discharge policies created for term infants (37-41 completed weeks' gestation) is essential for preventing postdischarge neonatal morbidity among late preterm infants. We analyzed linked birth certificate and hospital discharge data for Massachusetts between 1998 and 2002 to evaluate the risk of neonatal morbidity (defined as hospital readmission, observational stay, or both) between all vaginally delivered, live-born singleton late preterm and term infants. All infants were born at a Massachusetts hospital to a state resident and were discharged home early (<2-night hospital stay). We calculated crude and adjusted risk ratios using a modified Poisson regression and compared the timing and principal discharge diagnoses for those neonates who needed hospital readmission. Of the 1004 late preterm and 24,320 term infants in our study, 4.3% and 2.7% of infants, respectively, were either readmitted or had an observational stay. Late preterm infants were 1.5 times more likely to require hospital-related care and 1.8 times more likely to be readmitted than term infants. Among infants who were breastfed, late preterm infants were 1.8 times more likely than term infants to require hospital-related care and 2.2 times more likely to be readmitted. In contrast, no differences were found between late preterm and term infants who were not breastfed. Jaundice and infection accounted for the majority of readmissions. Our findings suggest that late preterm infants discharged early experience significantly more neonatal morbidity than term infants discharged early; however, this may be true only for breastfed infants. Evidence-based recommendations for appropriate discharge timing and postdischarge follow-up for these late preterm infants are needed to prevent neonatal morbidity.

Validity of hospital discharge data for identifying infants with cardiac defects

OBJECTIVE

To examine validity of the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes in discharge data for identifying infants with cardiac defects according to surveillance guidelines.

STUDY DESIGN

Retrospective medical record review of infants born in 2001 at one hospital in Minneapolis, Minnesota. Infants were identified using ICD-9-CM codes from hospital discharge data, and keywords in medical records.

RESULTS

Of 2,697 children, ICD-9-CM codes identified 66 infants coded with cardiac defects; physician review confirmed 24 had cardiac defects. Only 35 of 85 (41.2%) ICD-9-CM codes accurately reflected the cardiac defect diagnoses. Additional case finding located four infants with five cardiac defects. Sensitivity of ICD-9-CM codes for identifying these infants was 0.857, predictive value positive was 0.364.

CONCLUSIONS

ICD-9-CM codes from hospital discharge data identified most infants with cardiac defects, but many were false positives. ICD-9-CM codes were inaccurate for specific cardiac defects.

Completeness of state administrative databases for surveillance of congenital heart disease

BACKGROUND

Tracking birth prevalence of cardiac defects is essential to determining time and space clusters, and identifying potential associated factors. Resource limitations on state birth defects surveillance programs sometimes require that databases already available be used for ascertaining such defects. This study evaluated the data quality of state administrative databases for ascertaining congenital heart defects (CHD) and specific diagnoses of CHD.

METHODS

Children's Hospital of Wisconsin (CHW) medical records for infants born 1997-1999 and treated for CHD (n = 373) were abstracted and each case assigned CHD diagnoses based on definitive diagnostic reports (echocardiograms, catheterizations, surgical or autopsy reports). These data were linked to state birth and death records, and birth and postnatal (< 1 year of age) hospital discharge summaries at the Wisconsin Bureau of Health Information (WBHI). Presence of any code/checkbox indicating CHD (generic CHD) and exact matches to abstracted diagnoses were evaluated.

RESULTS

Fifty-eight percent of cases with generic CHD were identified by state databases. Postnatal hospital discharge summaries identified 48%, birth hospital discharge summaries 27%, birth certificates 9% and death records 4% of these cases. Exact matches were found for 52% of 633 specific diagnoses. Postnatal hospital discharge summaries provided most matches.

CONCLUSION

State databases identified 60% of generic CHD and exactly matched about half of specific CHD diagnoses. The postnatal hospital discharge summaries performed best in both in identifying generic CHD and matching specific CHD diagnoses. Vital records had limited value in ascertaining CHD.

Maternal fish consumption and infant birth size and gestation: New York State Angler Cohort Study

BACKGROUND

The scientific literature poses a perplexing dilemma for pregnant women with respect to the consumption of fish from natural bodies of water. On one hand, fish is a good source of protein, low in fat and a rich source of other nutrients all of which have presumably beneficial effects on developing embryos and fetuses. On the other hand, consumption of fish contaminated with environmental toxicants such as polychlorinated biphenyls (PCBs) has been associated with decrements in gestation and birth size.

METHODS

2,716 infants born between 1986-1991 to participants of the New York State Angler Cohort Study were studied with respect to duration of maternal consumption of contaminated fish from Lake Ontario and its tributaries and gestation and birth size. Hospital delivery records (maternal and newborn) were obtained for 92% of infants for the ascertainment of gestation (weeks), birth size (weight, length, chest, and head circumference) and other known determinants of fetal growth (i.e., maternal parity, history of placental infarction, uterine bleeding, pregnancy loss or cigarette smoking and infant's race, sex and presence of birth defect). Duration of maternal fish consumption prior to the index infant's birth was categorized as: none; 1-2, 3-7, 8+ years, while birth weight (in grams), birth length (in centimeters), and head and chest circumference (in centimeters) were left as continuous variables in multiple linear regression models. Birth size percentiles, ponderal indices and head to chest circumference ratios were computed to further assess proportionality and birth size in relation to gestational age.

RESULTS

Analysis of variance failed to identify significant mean differences in gestation or any measure of birth size in relation to duration of maternal lifetime fish consumption. Multiple linear regressions identified gestational age, male sex, number of daily cigarettes, parity and placental infarction, as significant determinants of birth size.

CONCLUSIONS

The results support the absence of an adverse relation between Lake Ontario fish consumption and reduced birth size as measured by weight, length and head circumference. Biological determinants and maternal cigarette smoking during pregnancy remain important determinants of birth size.

Reliability of birth certificate data: a multi-hospital comparison to medical records information

OBJECTIVE

To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals.

METHODS

We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993-95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36 common data elements, and the sensitivity, specificity, and positive and negative predictive values of birth certificate data, using medical record data as a "gold standard."

RESULTS

Sensitivity and positive predictive value varied widely (9-100% and 2-100%, respectively), as did agreement, which was "almost perfect" for measures of prior obstetrical history, delivery type, and infant Apgar score (K = 0.854-0.969) and "substantial" for several other variables (e.g., tobacco use (K = 0.766), gestational age (K = 0.726), prenatal care (K = 0.671)). However, agreement was only "slight" to "moderate" for most maternal risk factors and comorbidities (K = 0.085-0.545) and for several complications of pregnancy and/or labor and delivery (K = 0.285-0.734). Overall agreement was similar in teaching (mean K = 0.51) and nonteaching (K = 0.52) hospitals. Although agreement in teaching and nonteaching hospitals varied for some variables, no systematic differences were seen across types of variables.

CONCLUSIONS

Our findings indicate that the reliability of birth certificate data vary for specific elements. Researchers and health policymakers need to be cognizant of the potential limitations of specific data elements.

Validation of birth certificate data. A study of women in New Jersey's HealthStart program

PURPOSE

This study assesses the accuracy of 1989-1992 birth certificate data from New Jersey for a group of high-risk women.

METHODS

Birth records were linked to data on women who participated in HealthStart, a program of enriched prenatal care for pregnant women on Medicaid. Concordance was assessed for all variables common to the two data sets.

RESULTS

The birth records had accurate reporting of birth-weight, demographic characteristics, and most methods of delivery. Prenatal care use was over-reported, and alcohol, tobacco, transfer status, medical risk factors, obstetric procedures, as well as complications of labor and delivery were underreported.

CONCLUSIONS

While many variables are reported very accurately on birth certificates, other measures must be used cautiously. Analyses using birth certificate data, particularly those focusing on high-risk women, need to take the low levels of sensitivity for many risk factors into consideration.

Variations in risk-adjusted cesarean delivery rates according to race and health insurance

OBJECTIVE

To assess the association between race and insurance and Cesarean delivery rates after adjusting for clinical risk factors that increase the likelihood of cesarean delivery.

DESIGN

Retrospective cohort study in 21 hospitals in northeast Ohio.

SUBJECTS

25,697 women without prior cesarean deliveries admitted for labor and delivery January 1993 through June 1995.

METHODS

Demographic and clinical data were abstracted from patients' medical records. The risk of cesarean delivery was adjusted for 39 maternal and neonatal risk factors that were included in a previously developed risk-adjustment model using nested logistic regression analysis.

MAIN OUTCOME MEASURES

Odds ratios for cesarean delivery in nonwhite patients relative to whites and for patients with government insurance or who were uninsured relative to patients with commercial insurance.

RESULTS

The overall rate of cesarean delivery was similar in white and nonwhite patients (15.8% and 16.1%, respectively), but rates varied (P < 0.001) according to insurance (17.0%, 14.2%, 10.7% in patients with commercial insurance, government insurance, and without insurance, respectively). However, after adjusting for clinical factors, the adjusted odds ratio (OR) of cesarean delivery was higher in nonwhite patients (OR = 1.34; 95% CI: 1.14-1.57; P < 0.001), but similar for patients with government insurance (OR = 1.01; 95% CI: 0.90-1.14; P = 0.84) and lower for uninsured patients (OR = 0.65; 95% CI, 0.41, 1.03; P = 0.067), albeit not statistically significant. In analyses stratified according to quintiles of predicted risk of cesarean delivery, racial differences were largely limited to patients in the lower risk quintiles. However, differences in odds ratios for uninsured patients were seen across the risk quintiles, although odds ratios were not statistically significant.

CONCLUSION

After adjusting for clinical factors, race and insurance status may independently influence the use of cesarean delivery. The higher rates in nonwhites and lower rates in the uninsured may reflect differences in patient preferences or expectations, differences in physician practice, or unmeasured risk factors. The lower odds of cesarean delivery in uninsured women, particularly women at high risk, may raise the issue of underutilization of services and warrants further study.