Linked birth cohort files for perinatal health research: California as a model for methodology and implementation

Danielsen, Beate; Carmichael, Suzan L.; Jb, Gould; Hc, Lee

doi:10.1016/j.annepidem.2022.12.014

Cited by 10 publications

(6 citation statements)

References 44 publications

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“…Maternal hospital discharge data are linked to birth certificates via a modified version of a previously published algorithm that provides valid linkage for more than 98% of records. 9…”

Section: Methodsmentioning

confidence: 99%

“…Maternal hospital discharge data are linked to birth certificates via a modified version of a previously published algorithm that provides valid linkage for more than 98% of records. 9 Our study population was pregnant individuals who underwent delivery hospitalization in California from 2016 to 2020. The inclusion criteria included patients who underwent labor and who were classified as patients who had a vaginal delivery (spontaneous or instrumental) or a cesarean delivery after a trial of labor (hereafter referred to as an intrapartum cesarean delivery).…”

Section: Setting and Participantsmentioning

confidence: 99%

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Variation in Hospital Neuraxial Labor Analgesia Rates in California

Parameshwar,

Guo,

Bentley

et al. 2024

Anesthesiology

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Background Neuraxial analgesia provides effective pain relief during labor. However, it is unclear whether neuraxial analgesia prevalence differs across US hospitals. Our aim was to assess hospital variation in neuraxial analgesia prevalence in California. Methods A retrospective cross-sectional study analyzed birthing patients who underwent labor in 200 California hospitals from 2016 to 2020. The primary exposure was the delivery hospital. The outcomes were hospital neuraxial analgesia prevalence and between-hospital variability, before and after adjustment for patient and hospital factors. Median odds ratio and intraclass correlation coefficients (ICC) quantified between-hospital variability. The median odds ratio estimated the odds of a patient receiving neuraxial analgesia when moving between hospitals. The ICC quantified the proportion of the total variance in neuraxial analgesia use due to variation between hospitals. Results Among 1,510,750 patients who underwent labor, 1,040, 483 (68.9%) received neuraxial analgesia. Both unadjusted and adjusted hospital prevalence exhibited a skewed distribution characterized by a long-left tail. The unadjusted and adjusted prevalence at the 1 st percentile were 5.4% and 6.0%; 5 th percentile were 21.0% and 21.2%; 50 th percentile were 70.6% and 70.7%; 95 th percentile were 75.8% and 76.6%; and 99 th percentile were 75.9% and 78.6%. The adjusted median odds ratio (2.3; 95% CI, 2.1 – 2.5) indicated a substantially increased odds of a patient receiving neuraxial analgesia if they moved from a hospital with a lower to higher odds of neuraxial analgesia. The hospital explained only a moderate portion of the overall variability in neuraxial analgesia (ICC=19.1%; 95% CI, 18.8 – 20.5%). Conclusions A long left tail in the distribution and wide variation exist in the neuraxial analgesia prevalence across California hospitals, not explained by patient and hospital factors. Addressing the low prevalence among hospitals in the left tail requires exploration of the interplay between patient preferences, staffing availability, and care providers’ attitudes towards neuraxial analgesia.

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“…Maternal hospital discharge data are linked to birth certificates via a modified version of a previously published algorithm that provides valid linkage for more than 98% of records. 9…”

Section: Methodsmentioning

confidence: 99%

Section: Setting and Participantsmentioning

confidence: 99%

Variation in Hospital Neuraxial Labor Analgesia Rates in California

Parameshwar,

Guo,

Bentley

et al. 2024

Anesthesiology

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“…Live birth and fetal death certificate data were previously linked to obstetric and neonatal discharge data from birth hospitalizations using probabilistic linkage techniques. 13 This study was part of a larger, ongoing project to build a repository of state-level data sets of linked vital statistics and hospitalization discharge data. At the time of analysis, data from five states (California, Michigan, Oregon, Pennsylvania, and South Carolina) were available.…”

Section: Methodsmentioning

confidence: 99%

Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications

Leonard,

Formanowski,

Phibbs

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate whether there are individual- and population-level associations between chronic hypertension and pregnancy complications, and to assess differences across seven racial–ethnic groups. METHODS: This population-based study used linked vital statistics and hospitalization discharge data from all live and stillbirths in California (2008–2018), Michigan (2008–2020), Oregon (2008–2020), Pennsylvania (2008–2014), and South Carolina (2008–2020). We used multivariable log-binomial regression models to estimate risk ratios (RRs) and population attributable risk (PAR) percentages with 95% CIs for associations between chronic hypertension and several obstetric and neonatal outcomes, selected based on prior evidence and pathologic pathways. We adjusted models for demographic factors (race and ethnicity, payment method, educational attainment), age, body mass index, obstetric history, delivery year, and state, and conducted analyses stratified across seven racial–ethnic groups. RESULTS: The study included 7,955,713 pregnancies, of which 168,972 (2.1%) were complicated by chronic hypertension. Chronic hypertension was associated with several adverse obstetric and neonatal outcomes, with the largest adjusted PAR percentages observed for preeclampsia with severe features or eclampsia (22.4; 95% CI 22.2–22.6), acute renal failure (13.6; 95% CI 12.6–14.6), and pulmonary edema (10.7; 95% CI 8.9–12.6). Estimated RRs overall were similar across racial–ethnic groups, but PAR percentages varied. The adjusted PAR percentages (95% CI) for severe maternal morbidity—a widely used composite of acute severe events—for people who were American Indian or Alaska Native, Asian, Black, Latino, Native Hawaiian or Other Pacific Islander, White, and Multiracial or Other were 5.0 (1.1–8.8), 3.7 (3.0–4.3), 9.0 (8.2–9.8), 3.9 (3.6–4.3), 11.6 (6.4–16.5), 3.2 (2.9–3.5), and 5.5 (4.2–6.9), respectively. CONCLUSION: Chronic hypertension accounts for a substantial fraction of obstetric and neonatal morbidity and contributes to higher complication rates, particularly for people who are Black or Native Hawaiian or Other Pacific Islander.

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“…Vital statistics records were linked to hospital discharge records from California Department of Health Care Access and Information, resulting in over 95% successful linkage for live births and 85% for stillbirths. 29 We limited the analysis to successfully linked records and included only the first birth for multifetal gestations to avoid duplicates, leaving an analytic sample of 10,580,096 births.…”

Section: Methodsmentioning

confidence: 99%

Trends and Disparities in Severe Maternal Morbidity Indicator Categories during Childbirth Hospitalization in California from 1997 to 2017

El Ayadi,

Lyndon,

Kan

et al. 2023

Am J Perinatol

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Objective Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization. Study Design We analyzed California birth cohort data on all live and stillbirths ≥20 weeks gestation from 1997-2017 (n=10,580,096) using the Centers for Disease Control and Prevention’s SMM index. Cases were categorized into seven non-mutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression. Results SMM occurred in 1.16% of births and non-transfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over three-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717% and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, US-born Hispanic, and non-US-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial. Conclusion Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities and potential needs for intervention.

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Linked birth cohort files for perinatal health research: California as a model for methodology and implementation

Cited by 10 publications

References 44 publications

Variation in Hospital Neuraxial Labor Analgesia Rates in California

Variation in Hospital Neuraxial Labor Analgesia Rates in California

Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications

Trends and Disparities in Severe Maternal Morbidity Indicator Categories during Childbirth Hospitalization in California from 1997 to 2017

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