State-specific disparities in maternal and perinatal morbidity
Project Number: 5R40 MC 07540-03 (R40 MC 05471) Project Date: 09/01/2005 Grantee: Research Triangle Institute Department/Center: Statistics and Epidemiology
Final Report
Pending
Principal Investigator
Melissa M. Adams Ph.D., Senior Research Epidemiologist II, Research Triangle Institute Statistics and Epidemiology, Koger Center Oxford Bldg, Suite 119 2951 Flowers Road South Atlanta, GA 30341-5533 madams@rti.org
Abstract
Scant data are available about maternal and perinatal morbidity. Such data are needed to shed light on racial and ethnic disparities in maternal, fetal and infant mortality within a state as well as disparities among states. These data answer the question of whether a racial disparity in mortality is due to a higher morbidity rate in one group, a higher case-fatality rate in that group, or both.
Numerous studies have shown that perinatal morbidity is under-reported on birth and fetal death certificates. In contrast, hospital discharge summaries provide reasonably accurate ascertainment of many perinatal morbidities. However, they lack information about important demographic and obstetric covariates, such as ethnicity, race, and parity. These covariates are reported on birth certificates. Linkage of hospital discharge summaries with birth certificates remedies the limitations of either source. Additionally, researchers using hospital chart abstraction as their "gold standard" have shown that, for an individual mother or child, joint consideration of birth certificates and hospital discharge summaries provides more complete and accurate morbidity ascertainment than using either source alone.
In this project we will work with the nine states (CA, FL, GA, MA, MI, MO, NJ, SC, and WA) that have linked hospital discharge summaries with birth certificates and other vital records for 2000 and 2001. Our over-arching goal is to identify interventions that hold the promise of reducing disparities in maternal, fetal, and infant mortality through examining perinatal morbidity. Our objectives are: 1) to use linked birth certificate-hospital discharge data to describe the contribution of differences in morbidity and case-fatality rates to disparities within and among states from maternal, fetal, and infant mortality; 2) to prepare written reports of the results and consult with participating states on interpretation of the findings, particularly with regard to programmatic interventions; and 3) to disseminate the findings. Within each state, we will compare perinatal morbidity and case-fatality rates among groups defined by race and ethnicity. For each racial/ethnic group, we will also compare morbidity and case-fatality rates among states. These comparisons allow an individual state to see how it performs relative to other states. This project directly supports two strategic issues of the Maternal and Child Health Bureau, HRSA: 1) eliminating health disparities for MCH populations and 2) (supporting) systems and services to assure the quality of care for MCH populations.
