Improved Ascertainment of Pregnancy-Associated Suicides and Homicides in North Carolina.

INTRODUCTION: Injuries, including those resulting from violence, are a leading cause of death during pregnancy and the postpartum period. North Carolina, along with other states, has implemented surveillance systems to improve reporting of maternal deaths, but their ability to capture violent deaths is unknown. The purpose of this study was to quantify the improvement in ascertainment of pregnancy-associated suicides and homicides by linking data from the North Carolina Violent Death Reporting System (NC-VDRS) to traditional maternal mortality surveillance files. METHODS: Enhanced case ascertainment was used to identify suicides and homicides that occurred during or up to 1 year after pregnancy from 2005 to 2011 in North Carolina. NC-VDRS data were linked to traditional maternal mortality surveillance files (i.e., death certificates with any mention of pregnancy or matched to a live birth or fetal death record and hospital discharge records for women who died in the hospital with a pregnancy-related diagnosis). Mortality ratios were calculated by case ascertainment method. Analyses were conducted in 2015. RESULTS: A total of 29 suicides and 55 homicides were identified among pregnant and postpartum women through enhanced case ascertainment as compared with 20 and 34, respectively, from traditional case ascertainment. Linkage to NC-VDRS captured 55.6% more pregnancy-associated violent deaths than traditional surveillance alone, resulting in higher mortality ratios for suicide (2.3 vs 3.3 deaths per 100,000 live births) and homicide (3.9 vs 6.2 deaths per 100,000 live births). CONCLUSIONS: Linking traditional maternal mortality files to NC-VDRS provided a notable improvement in ascertainment of pregnancy-associated violent deaths.

Discrepancies between published data on racial classification and self-reported race: evidence from the 2002 North Carolina live birth records.

OBJECTIVES: We compared data on race as reported by the mother on North Carolina birth certificates with data on race in officially reported statistics. We also determined to what extent differences in the classification of race affect measures of racial disparity in maternal and child health indicators. METHODS: We examined how data on race are collected, coded, and tabulated in North Carolina via live birth certificates, death certificates, the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey, and the Central Cancer Registry case records. We showed how the data on race collected through North Carolina birth and death certificates are translated into 10 fixed racial categories designated by the National Center for Health Statistics (NCHS) for use in official vital statistics. We compared race as reported by the mother on birth certificates to racial tabulations used in the official published birth statistics. We also examined to what extent differences in the determination of race affect measures of racial disparity in maternal and child health indicators. RESULTS: Out of nearly 118,000 live births in North Carolina in 2002, mothers reported more than 600 different versions of race on birth certificates. These entries were collapsed into the 10 standard racial categories outlined in federal coding rules. Approximately two-thirds of mothers of Hispanic ethnicity report their race with a label that can be categorized as "Other" race, but nearly all of these births are re-coded to "white" for the official birth statistics. Measures of racial disparity vary depending on whether self-reported or officially coded race is used. CONCLUSIONS: This study shows that, given the opportunity to report their own race, North Carolinians describe their race using a wide variety of terms and concepts. In contrast, health statistics are usually reported using a few standardized racial categories defined by federal policy. The NCHS rules for coding race should be reexamined. As the ethnic and racial diversity of the United States continues to increase, these rules will become increasingly antiquated.