Vital Statistics Institute for Implementation Science In population health at cuNY CUNY Graduate School of Public Health and Health Policy June 2016 Disclaimer: The information in this slide set was assembled by the The Institute for Implementation Science in Population Health at CUNY to inform the work of the NYC DSRIP HIV projects. The content of these slides is based on publicly available information as of June 2016. For detailed Vital Statistics inquiries, see the resources and contact information slides.

OUTLINE Background Content How to use the data Limitations Resources

Background

BACKGROUND (2) What are Vital Statistics? The Bureau of Vital Statistics of the NYC Department of Health and Mental Hygiene (DOHMH) collect annual data on all live births and deaths recorded in the city of New York. Vital statistics provide data on premature mortality, life expectancy, infant mortality and leading causes of death, and can be used to provide a measure of AIDS mortality. Mortality data (death data) are derived from death certificates, which contain demographic information and the underlying cause of death, as defined by the International Classification of Diseases (ICD-10)

BACKGROUND (3) Population and geography New York City: Bronx, Brooklyn, Manhattan, Queens, Staten Island All recorded deaths in NYC: 2014: 53,034 2013: 53,409 2012: 52,455 Deaths due to HIV in NYC: 2014: 523 2013: 579 2012: 609

BACKGROUND (4) Timeframe of available data Accessibility of data 1984 – present AIDS first listed as a cause of death in the 1984 NYC Vital Statistics Summary NYC DOHMH holds all records dating back to 1949. Death records prior to 1949 found in the Municipal Archives of the NYC Dept. of Records. Accessibility of data Annual summary reports publicly available on NYC DOHMH website Counts, percentages and rates not found on the publicly available Annual Summaries or the web-based EpiQuery module may be made available from DOHMH by request

CONTENT What’s in vital statistics data set? HIV-related indicators Selected underlying cause of death (as defined by the ICD-10) Demographic variables for each death reported: Sex, race/ethnicity, age group, most current address HIV-related indicators All codes from the block B20-B24 of the ICD-10 signify HIV as underlying cause of death B20: HIV disease resulting in infectious and parasitic diseases B24: Unspecified HIV disease

HOW TO USE THE DATA Examples of how data has been used in the past Trends of age-specific death rates by sex (2004-2013) City of New York, Summary of Vital Statistics, 2013

HOW TO USE THE DATA (2) - Age-adjusted HIV death rates by race/ethnicity (2004-2013) City of New York, Summary of Vital Statistics, 2013

HOW TO USE THE DATA (3) - Age-adjusted HIV death rates by borough of residence, 2014 NYC DOHMH EpiQuery System

HOW TO USE THE DATA (3) - HIV deaths by borough of residence (2000-2014) NYC DOHMH EpiQuery System

HOW TO USE THE DATA (4) Age-adjusted death rates among persons with HIV in NYC, 2000-2013 Match between vital statistics and HIV surveillance data to compare all-cause deaths with HIV-related among PLWHA

HOW TO USE THE DATA (5) Potential use of vital statistics to further DSRIP PPS work Examine trends in HIV death rates by geographic area (borough/UHF neighborhood) or by demographic subgroup Compare vital statistics (HIV as leading cause of death) to HIV Surveillance data on all deaths among persons who were living with HIV Analysis of vital statistics data with HIV surveillance may point to some common diseases that seemed unrelated to HIV infection but in fact PLWHA have a higher risk of death from those conditions (e.g. liver and kidney disease) Whiteside, et al., 2015

LIMITATIONS What to keep in mind: Misclassification of cause of death on death certificates Increasing proportion of deaths of PLWHA attributable to causes not considered HIV related HIV deaths caused by a variety of factors Statistics on multiple causes of death can provide a more comprehensive and ultimately insightful view of mortality patterns than single underlying cause-of-death statistics.

STRENGTHS Aggregate data is publically accessible and free Citywide aggregate data can be stratified by geographic level (borough, UHF) as well as demographic subgroup Available historical data allows for trend analysis Routinely matched with NYC HIV surveillance registry data (NYC HARS)

RESOURCES Publications and reports Summary of Vital Statistics 2014, City of New York Summary of Vital Statistics, historical annual reports Kim JH., et al. (2013) All-cause mortality in hospitalized HIV-infected patients at an acute tertiary care hospital with a comprehensive outpatient HIV care program in New York City in the era of highly active antiretroviral therapy (HAART). Infection, (2):545-51. Lim S., et al., (2015). All-Cause, Drug-Related, and HIV-Related Mortality Risk by Trajectories of Jail Incarceration and Homelessness Among Adults in New York City American Journal of Epidemiology, 181: 261-270. National (not NYC specific) Whiteside YO., et al. (2015). Comparison of Rates of Death Having any Death-Certificate Mention of Heart, Kidney, or Liver Disease Among Persons Diagnosed with HIV Infection with those in the General US Population, 2009-2011. Open AIDS Journal, 9, 14-22. Ingle SM., et al. (2014). Impact of Risk Factors for Specific Causes of Death in the First and Subsequent Years of Antiretroviral Therapy Among HIV-Infected Patients. Clinical Infectious Diseases,  59(2), 287–297. Guides/guidelines and general information Summary of Vital Statistics http://www1.nyc.gov/site/doh/data/data-sets/vital-statistics-data.page http://www1.nyc.gov/site/doh/data/vital-statistics/vital-statistics-summary.page EpiQuery Mortality Module https://a816-healthpsi.nyc.gov/epiquery/VS/index.html General info – National Vital Statistics System, MMWWR http://www.cdc.gov/mmwr/preview/mmwrhtml/00001356.htm

CONTACT INFORMATION Office of Vital Records, Bureau of Vital Statistics Email: vsdata@health.nyc.gov Phone: 212-639-9675

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