Title: The Birth Certificate and Medicaid Data Match Project: Initial Findings in Infant Mortality
1The Birth Certificate and Medicaid Data Match
Project Initial Findings in Infant Mortality
- John Oswald, PhD
- Director, Minnesota Center for Health Statistics
- June 7, 2006
- NAPHSIS Annual Meeting
2Background
- The Minnesota IMR in 2002 was 5.3 per 1000 live
births - One of the lowest infant mortality rates in the
nation - The low rate masks great disparities in infant
mortality within the state
3Background
- The Minnesota Department of Human Services (DHS)
and the Minnesota Department of Health (MDH)
entered into a data sharing agreement to link
Minnesota Medicaid data with birth certificate
data - This linking allows for comparisons between the
Medicaid and non-Medicaid populations - 1997-2001 linked data are analyzed for this
presentation
4Background
- The Medicaid population is comprised of both
Medical Assistance and MinnesotaCare enrollees - The non-Medicaid population includes those
covered by private health insurance,
self-insured, or uninsured
5Linkage Methods
- Iterative matching procedure that included
mothers name, mothers date of birth, and
fathers last name. - State of residence of the birth mother was used
rather than state of occurrence of the birth
6Linkage Methods
- overall match rate has been 93.1
- No major differences between Medicaid women who
matched and those who did not except - Hispanic women
- Border communities with North Dakota
7Linkage Methods
- Future methodological issues in data linkage and
probabilistic techniques - Agenda for future research
- Gyllstrom ME, Oswald JW, et al. Linking Birth
Certificates with Medicaid Data to Enhance
Population Health Assessment Methedological
Issues Addressed. Journal of Public Health
Management and Practice, July 2002, 38-44.
8Other Methods
- Race categories are based upon the race of the
mother as reported on the birth certificate and
include White, Black/African American, Asian, and
Native American - Hispanic ethnicity is also based upon ethnicity
of mother as reported on the birth certificate
and includes anyone indicating Hispanic/Latina
descent regardless of race
9Other Methods
- Age of mother is obtained from the birth
certificate - Initiation of prenatal care is also taken from
the birth certificate
10Methods
International Classification of Diseases (ICD 9 10) International Classification of Diseases (ICD 9 10) International Classification of Diseases (ICD 9 10) International Classification of Diseases (ICD 9 10)
Cause of Death ICD-9 ICD-10 ICD-10
Congenital Anomalies 740 - 795 Q00 - Q99 Q00 - Q99
Sudden Infant Death Syndrome (SIDS) 798 R95 R95
Prematurity 765 P07 P07
Unintentional Injury 800 - 949 V01 - X59 V01 - X59
Maternal Complications 761 P01 P01
Placenta or Cord Complications 762 P02 P02
Perinatal Infections 771 P35 - P39 P35 - P39
Respiratory Distress Syndrome 769 P22 P22
Intrauterine Hypoxia and Birth Asphyxia 771 P35 - P39 P35 - P39
Pneumonia / Influenza 487 J10 - J18 J10 - J18
ICD 10 codes were adopted in the U.S. in 1999 ICD 10 codes were adopted in the U.S. in 1999
11Results
Medicaid Births by Maternal Age Minnesota,
1997-2001
Non-Medicaid Births by Maternal Age Minnesota,
1997-2001
12Results
- Minnesota as a whole had an IMR of 5.7 per 1,000
for calendar years 1997-2001 - Medicaid had an IMR of 7.4 per 1,000
- 7.5 per 1,000 for Medical Assistance
- 6.2 per 1,000 for MinnesotaCare
- Non-Medicaid had an IMR of 5.2 per 1,000
13Results
14Results
15Results
16Results
17Discussion
- Whites had significantly lower IMR than all other
race categories, and White non-Medicaid had
significantly lower IMR than White Medicaid - Finding for teenaged mothers supported in results
from other states - Those who receive early prenatal care have lower
infant mortality in both the Medicaid and
non-Medicaid populations
18Discussion
- Unintentional injury deaths accounted for a high
proportion of deaths in the Medicaid population - 1 in 3 was related to co-sleeping with adults
- Inadequate sleeping accommodations
- SIDS also much higher in the Medicaid populations
(25.5 vs. 7.3)
19Limitations
- Small number of events
- Lack of clear definition of Non-Medicaid
population - Inherent challenges of birth and death records
- Unknown enrollment date in Medicaid
20Further Research
- Further investigation into the teen mother
finding - Formal analysis of these data to examine the
interplay of race and Medicaid status - Ideally, a comparison of Medicaid and those with
private insurance