# Bridging the Data Divide in Nevada: A Repeated Cross-Sectional Study of Birth Certificate and Medicaid Billing Discrepancies in Gestational Substance Exposure

## TL;DR

This study finds significant discrepancies in reporting gestational substance exposure between birth certificates and Medicaid data in Nevada, highlighting the need for better data integration to improve early detection and equity.

## Contribution

The study introduces a novel analysis of gestational substance exposure reporting discrepancies using Medicaid and birth certificate data in Nevada.

## Key findings

- The discordance rate in GES reporting was 95.09 per 1000 live births.
- Higher discordance was observed among White non-Hispanic mothers and those in rural or low-income areas.
- Hospital-level factors also contributed to variation in reporting discrepancies.

## Abstract

Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births in Nevada from 2022 to 2024. Methods: A statewide, hospital-clustered, cross-sectional analysis was conducted using linked Medicaid billing and birth record data. Discordance was defined as GES identified in one source but not the other. Incidence per 1000 live births was stratified by demographic characteristics. Multilevel logistic regression assessed patient- and hospital-level predictors, with random hospital intercepts. Results: Among 50,394 live births, the discordance rate was 95.09 per 1000 (95% Confidence Interval: 92.5–97.7). Substantial disparities were observed by race/ethnicity, socioeconomic status, and geography, with higher discordance among White non-Hispanic mothers, those residing in rural or frontier counties, and individuals with lower educational attainment or living in lower-income areas. Modest but meaningful variation was also observed across hospitals, including differences by hospital size and teaching or research status. Conclusions: Findings highlight substantial discordance in GES reporting and underscore the limitations of single-source surveillance. Findings also have clear policy relevance, indicating that improved cross-system data integration would strengthen statewide surveillance, enhance early detection, and support more equitable resource allocation and intervention strategies.