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Jeffrey B. Gould, MD, MPH, Gilberto Chavez, MD, MPH, Amy R. Marks, BA and Hao Liu, MA

Jeffrey B. Gould is with the School of Public Health, University of California, Berkeley. Gilberto Chavez is with the Maternal and Child Health Branch, California Department of Health Services. Amy R. Marks is, and at the time of the study Hao Liu was, with the School of Public Health, University of California, Berkeley.

Correspondence: Requests for reprints should be sent to Jeffrey B. Gould, MD, MPH, University of California, School of Public Health, 309 Earl Warren Hall, #7360, Berkeley, CA 94720-7360 (e-mail: jgould{at}uclink4.berkeley.edu).

Objectives. This study assessed the relationship between incomplete birth certificates and infant mortality.

Methods. Birth certificates from California (n = 538 945) were assessed in regard to underreporting of 13 predictors of perinatal outcomes and mortality.

Results. Of the birth certificates studied, 7.25% were incomplete. Underreporting was most common in the case of women at high risk for poor perinatal outcomes and infants dying within the first day. Increasing numbers of unreported items were shown to be associated with corresponding increases in neonatal and postneonatal mortality rates.

Conclusions. Incomplete birth certificates provide an important marker for identifying high-risk women and vulnerable infants. Because data "cleaning" will result in the removal of mothers and infants at highest risk, birth certificate analyses should include incomplete records.

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