Maternal and Child Health Journal

, Volume 6, Issue 3, pp 169–179 | Cite as

Reliability of Birth Certificate Data: A Multi-Hospital Comparison to Medical Records Information

  • David L. DiGiuseppe
  • David C. Aron
  • Lorin Ranbom
  • Dwain L. Harper
  • Gary E. Rosenthal


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 (κ = 0.854–0.969) and “substantial” for several other variables (e.g., tobacco use (κ = 0.766), gestational age (κ = 0.726), prenatal care (κ = 0.671)). However, agreement was only “slight” to “moderate” for most maternal risk factors and comorbidities (κ = 0.085–0.545) and for several complications of pregnancy and/or labor and delivery (κ = 0.285–0.734). Overall agreement was similar in teaching (mean κ = 0.51) and nonteaching (κ = 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.

birth certificate medical record reliability 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bailit JL, Dooley SL, Peaceman AN. Risk adjustment for inter-hospital comparison of primary cesarean rates. Obstet Gynecol 1999;93:1025–30.Google Scholar
  2. 2.
    Keeler EB, Park RE, Bell RM, Gifford DS, Keesey J. Adjusting cesarean delivery rates for case mix. Health Serv Res 1997;32:511–28.Google Scholar
  3. 3.
    Liu LL, Clemens CJ, Shay DK, Davis RL, Novack AH. The safety of newborn early discharge: The Washington state experience. JAMA 1997;278:293–8.Google Scholar
  4. 4.
    Din-Dzietham R, Hertz-Picciotto I. Infant mortality differences between whites and African Americans: The effect of maternal education. Am J Public Health 1998;88:651–6.Google Scholar
  5. 5.
    Schulte JM, Atkinson WL, Suarez L, Pelosi J, Wood R, Haley CE, Rutenberg GW. Use of Texas birth certificate data to predict measles immunization status. South Med J 1996;89:793–7.Google Scholar
  6. 6.
    Murphy NJ, Butler SW, Peterson KM, Heart V, Murphy CM. Tobacco erases 30 years of progress: Preliminary analysis of the effect of tobacco smoking on Alaska Native birth weight. Alaska Med 1996;38:31–3.Google Scholar
  7. 7.
    Piper JM, Mitchel EF Jr., Snowden M, Hall C, Adams M, Taylor P. Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records. Am J Epidemiol 1993;137:758–68.Google Scholar
  8. 8.
    Buescher PA, Taylor KP, Davis MH, Bowling JM. The quality of the new birth certificate data: A validation study in North Carolina. Am J Public Health 1993;3:1163–5.Google Scholar
  9. 9.
    Clark K, Chun-Mei F, Burnett C. Accuracy of birth certificate data regarding the amount, timing, and adequacy of prenatal care using prenatal clinic medical records as referents. Am J Epidemiol 1997;145:68–71.Google Scholar
  10. 10.
    Watkins ML, Edmonds L, McClearn A, Mullins L, Mulinare J, Khoury M. The surveillance of birth defects: The usefulness of the revised US standard birth certifcate. Am J Public Health 1996;86:731–4.Google Scholar
  11. 11.
    Dobie SA, Bladwin LM, Rosenblatt RA, Fordyce MA, Andrilla CH, Hart LG. How well do birth certificates describe the pregnancies they report? The Washington State experience with low-risk pregnancies. Matern Child Health J 1998;2:145–54.Google Scholar
  12. 12.
    Hexter AC, Harris JA, Roeper P, Croen LA, Krueger P, Gant D. Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects. Public Health Rep 1990;105:296–307.Google Scholar
  13. 13.
    Parrish KM, Holt VL, Connell FA, Williams B, LoGerfo JP. Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington state, 1989. Am J Epidemiol 1993;138:119–27.Google Scholar
  14. 14.
    Kirby RS. The quality of data reported on birth certificates. Am J Public Health 1997;87:301.Google Scholar
  15. 15.
    Rosenthal GE, Harper DL. Cleveland Health Quality Choice: Amodel for community-based outcomes assessment. Jt Comm J Qual Improv 1994;20:425–44.Google Scholar
  16. 16.
    Aron DC, Harper DL, Shepardson LB, Rosenthal GE. Impact of risk-adjusting cesarean delivery rates when reporting hospital performance. JAMA 1998;279:1968–72.Google Scholar
  17. 17.
    Aron DC, Gordon HS, DiGiuseppe DL, Harper DL, Rosenthal GE. Variations in risk-adjusted cesarean delivery rates according to race and health insurance. Med Care 2000;38:35–44.Google Scholar
  18. 18.
    Report grades Cleveland hospitals. Cleveland Plain Dealer 1993;April 29:1.Google Scholar
  19. 19.
    Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: The essentials. Baltimore, MD: Williams & Wilkins, 1988:47–8.Google Scholar
  20. 20.
    Last JM. Adictionary of epidemiology. New York: Oxford University Press, 1995:154.Google Scholar
  21. 21.
    Kramer MS, Feinstein AR. Clinical biostatistics: LIV. The biostatistics of concordance. Clin Pharmacol Ther 1981;29:111–23.Google Scholar
  22. 22.
    Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74.Google Scholar
  23. 23.
    Levy PS, Lemeshow S. Sampling for health professionals. Belmont, CA: Lifetime Learning Publications, 1980:110.Google Scholar
  24. 24.
    Starr P, Starr S. Reinventing vital statistics: The impact of changes in information technology, welfare policy, and health care. Public Health Rep 1995;110:534–44.Google Scholar
  25. 25.
    Green DC, Moore JM, Adams MM, Berg CJ, Wilcox LS, McCarthy BJ. Are we underestimating rates of vaginal birth after previous cesarean birth? The validity of delivery methods from birth certificates. Am J Epidemiol 1998;147:581–6.Google Scholar
  26. 26.
    Finkelstein BS, Harper DL, Rosenthal GE. Patient assessments of hospital maternity care: A useful tool for consumers? Health Serv Res 1999;34:623–40.Google Scholar
  27. 27.
    Koroukian SM, Trisel B, Rimm AA. Estimating the proportion of unnecessary cesarean sections in Ohio using birth certificate data. J Clin Epidemiol 1998;51:1327–34.Google Scholar
  28. 28.
    DiGiuseppe DL, Aron DC, Payne SMC, Snow RJ, Dierker L, Rosenthal GE. Risk adjusting cesarean delivery rates: A comparison of hospital profiles based on medical record and birth certificate data. Health Serv Res 2001;36:959–77.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • David L. DiGiuseppe
    • 1
  • David C. Aron
    • 2
  • Lorin Ranbom
    • 3
  • Dwain L. Harper
    • 4
  • Gary E. Rosenthal
    • 5
  1. 1.Department of Pediatrics, Child Health InstituteUniversity of WashingtonSeattle
  2. 2.Division of Clinical and Molecular Endocrinology, Department of Medicine and Institute of Health Care ResearchCase Western Reserve University and the Cleveland VA Medical CenterCleveland
  3. 3.Ohio Department of Human ServicesBureau of Medicaid PolicyColumbus
  4. 4.Quality Information Management CorporationCleveland
  5. 5.Program for Interdisciplinary Research in Health Care Organization, Iowa City VA Medical Center and Division of General Internal Medicine, Department of Internal MedicineUniversity of Iowa College of MedicineIowa City Iowa

Personalised recommendations