National Mortality Data SetNational Mortality Data Set

Kenneth D. KochanekKenneth D. KochanekMortality Statistics BranchMortality Statistics BranchDivision of Vital StatisticsDivision of Vital Statistics

National Center for Health StatisticsNational Center for Health Statistics

Data Users ConferenceData Users ConferenceJuly 12-14, 2004July 12-14, 2004

Presentation OutlinePresentation Outline

• National Vital Statistics SystemNational Vital Statistics System

• Nature of the System – DecentralizedNature of the System – Decentralized

• Role of the StatesRole of the States

• Role of NCHSRole of NCHS

• Role of the World Health Organization (WHO)Role of the World Health Organization (WHO)

• Mortality DataMortality Data

• Underlying Cause-of-Death DataUnderlying Cause-of-Death Data• Advantages of Underlying Cause-of-Death DataAdvantages of Underlying Cause-of-Death Data• Limitations of Underlying Cause-of-Death DataLimitations of Underlying Cause-of-Death Data

• Multiple Cause-of-Death DataMultiple Cause-of-Death Data• Entity Axis ApplicationsEntity Axis Applications• Record Axis ApplicationsRecord Axis Applications

• Electronic Death CertificateElectronic Death Certificate

• Data DisseminationData Dissemination

Nature of the National Vital Statistics Nature of the National Vital Statistics System System

• The National Vital Statistics System is decentralizedThe National Vital Statistics System is decentralized

• There are no laws at the national level requiring the collection There are no laws at the national level requiring the collection of vital statistics dataof vital statistics data

• Statistics that are produced by NCHS are based on Statistics that are produced by NCHS are based on information obtained from certificates filed in the States information obtained from certificates filed in the States where events occur where events occur

• Cooperation between NCHS and the States is governed by Cooperation between NCHS and the States is governed by contracts of agreementcontracts of agreement

SOURCE: CDC/NCHS

Role of States Role of States

• State laws govern filing of certificates and reportsState laws govern filing of certificates and reports

• States produce their own certificates and reportsStates produce their own certificates and reports

• States code the informationStates code the information

• Vital Statistics Cooperative Program (VSCP)Vital Statistics Cooperative Program (VSCP)

• Availability of certificates and reportsAvailability of certificates and reports

SOURCE: CDC/NCHS

Role of NCHS Role of NCHS

• To compile and publish national and To compile and publish national and sub-national vital statisticssub-national vital statistics

• To promote coherence and uniformity of To promote coherence and uniformity of the data collected through the VSCPthe data collected through the VSCP

SOURCE: CDC/NCHS

Promote Data Quality Promote Data Quality

• Model lawModel law

• HandbooksHandbooks

• Training and instruction manualsTraining and instruction manuals

• Various publicationsVarious publications

• Standard certificates and reportsStandard certificates and reports

• Quality controlQuality control

SOURCE: CDC/NCHS

Mortality DataMortality Data

• Mortality statistics are based on information Mortality statistics are based on information from the approximately 2.3 million death from the approximately 2.3 million death certificates filed each year in the 50 States and certificates filed each year in the 50 States and the District of Columbiathe District of Columbia

• The Death Certificate serves two very The Death Certificate serves two very different purposesdifferent purposes

Death CertificateDeath Certificate

• A legal document regarding the facts A legal document regarding the facts and circumstances of a deathand circumstances of a death

• A statistical resource providing A statistical resource providing information on characteristics of the information on characteristics of the decedentdecedent

SOURCE: CDC/NCHS

Role of World Health OrganizationRole of World Health Organization

• Promoting standardization of mortality Promoting standardization of mortality statistics through the International statistics through the International Classification of Diseases (ICD)Classification of Diseases (ICD)

• Compiling international mortality Compiling international mortality statisticsstatistics

SOURCE: CDC/NCHS

Role of ICDRole of ICD

• Provides standard definitionsProvides standard definitions

• Prescribes the format for cause-of-death Prescribes the format for cause-of-death information on the death certificateinformation on the death certificate

• Describes how death certificate should be Describes how death certificate should be completedcompleted

• Provides rules for selecting the underlying Provides rules for selecting the underlying cause of deathcause of death

SOURCE: CDC/NCHS

Underlying Cause of DeathUnderlying Cause of Death

• ““The disease or injury which initiated The disease or injury which initiated the chain of morbid events leading the chain of morbid events leading directly to death, ordirectly to death, or

• The circumstances of the accident or The circumstances of the accident or violence that produced the fatal injury.”violence that produced the fatal injury.”

SOURCE: CDC/NCHS

Computer SoftwareComputer Software

• ACME: Automated Classification of ACME: Automated Classification of Medical EntitiesMedical Entities

• TRANSAX: Translation of AxesTRANSAX: Translation of Axes

• MICAR: Mortality Medical Indexing, MICAR: Mortality Medical Indexing, Classification and RetrievalClassification and Retrieval

• SuperMICARSuperMICAR

SOURCE: CDC/NCHS

Advantages of Underlying Cause of Death Advantages of Underlying Cause of Death

• Simple and one dimensionalSimple and one dimensional

• Conceptually easy to understandConceptually easy to understand

• Well-accepted measure of mortalityWell-accepted measure of mortality

• Useful to public health officialsUseful to public health officials

SOURCE: CDC/NCHS

Limitations of Underlying Cause of Death Limitations of Underlying Cause of Death

• Only one disease selectedOnly one disease selected

• Arbitrary selectionArbitrary selection

• Excludes informationExcludes information

• Certifier mistakesCertifier mistakes

• Only as good as the information on Only as good as the information on the death certificatethe death certificate

SOURCE: CDC/NCHS

Multiple Cause of DeathMultiple Cause of Death

• Portrays the number of deaths in which Portrays the number of deaths in which a given condition is a significant factor a given condition is a significant factor contributing to death, if reportedcontributing to death, if reported

• Portrays the Interaction of diseasesPortrays the Interaction of diseases

• Contains two fields:Contains two fields:

• Record AxisRecord Axis

• Entity AxisEntity Axis

SOURCE: CDC/NCHS

Entity Axis ApplicationsEntity Axis Applications

• Relationships among conditionsRelationships among conditions

• Accuracy of certification reportingAccuracy of certification reporting

• Testing traditional assumptions of Testing traditional assumptions of underlying cause selectionunderlying cause selection

SOURCE: CDC/NCHS

Record Axis ApplicationsRecord Axis Applications

• Classifiable in manner like the Classifiable in manner like the underlying cause of deathunderlying cause of death

• Best representation of ICD codesBest representation of ICD codes

SOURCE: CDC/NCHS

Electronic Death Certificate (EDC)Electronic Death Certificate (EDC)

• Certifier and funeral director data entry Certifier and funeral director data entry in electronic form, includingin electronic form, including

• promptsprompts

• tutorialstutorials

• querying for incomplete or querying for incomplete or uninformative termsuninformative terms

• querying for implausible cause of querying for implausible cause of death sequencesdeath sequences

SOURCE: CDC/NCHS

Data DisseminationData Dissemination

• Preliminary ReportPreliminary Report

• Final ReportFinal Report

• Monthly National Vital Statistics ReportsMonthly National Vital Statistics Reports

• Special reportsSpecial reports

• Public use micro data – CD-ROMPublic use micro data – CD-ROM

• ConfidentialityConfidentiality

SOURCE: CDC/NCHS

CD-ROM’sCD-ROM’s

• Mortality Public Use Data SetsMortality Public Use Data Sets

• ASCII Dump CD-ROM’s 1968-2001ASCII Dump CD-ROM’s 1968-2001

• SETS CD-ROM’s 1991-98SETS CD-ROM’s 1991-98

• Compressed Mortality File (CMF)Compressed Mortality File (CMF)

Mortality Data from the National Vital Mortality Data from the National Vital Statistics System website:Statistics System website:

http://www.cdc.gov/nchs/about/major/dvs/mortdata.htmmortdata.htm