A New Model Law for Vital Statistics National Center for Health Statistics Division of Vital Statistics

Model law revision Model State Vital Statistics Act and Regulations: Provides detailed guidance to States that are considering revision of their own State vital statistics laws and regulations. Promotes uniformity among states in definitions, registration practices, disclosure and issuance procedures, and in the many other functions that comprise a state system of vital statistics. Initially established in 1907, has been revised in 1941, 1959, 1977,

Why update? Security Electronic environment Assisted reproduction Confidentiality and disclosure Establishing new records of live birth Same-sex marriage COOP (Continuity of Operations Planning)

Model law revision work group Chairperson Alvin T. Onaka, Ph.D., Hawaii Department of Health Members Catherine Molchan Donald, Alabama Department of Public Health Karen R. Hampton, J.D., Oregon Department of Human Services Ronald Hyman, Colorado Department of Public Health and Environment Wilfredo Lopez, J.D., General Counsel Emeritus, New York City Department of Health and Mental Hygiene Patricia W. Potrzebowski, Ph.D., Formerly, Pennsylvania Department of Health; Executive Director, NAPHSIS Steven Schwartz, Ph.D., New York City Department of Health and Mental Hygiene Linette T. Scott, M.D., M.P.H., California Department of Public Health

Model law revision work group Centers for Disease Control and Prevention National Center for Health Statistics, Division of Vital Statistics, Registration Methods Staff Judy M. Barnes Julia L. Kowaleski George C. Tolson Dewey LaRochelle Centers for Disease Control and Prevention Deborah Tress, J.D. Office of General Counsel

Functional focus areas Registration Issuance Preservation Dissemination Security Authorities Fees Penalties  Cathy Molchan Donald  Karen Hampton  Ron Hyman  Trish Potrzebowski  Linette Scott  Alvin Onaka  Steve Schwartz  Wilfredo Lopez The Model Act and Regulations were divided by functional focus areas with a Work Group member assigned as lead for each area

Objectives Implementation of revised Model Law and Regulations in jurisdictions Improved uniformity of process Use as a resource to support justifications for actions in the jurisdictions regarding the vital records system

Legislative research Assisted reproductive technology Adoption laws Electronic records and signatures Aspect of breach of confidentiality Same-sex parentage

Accomplishments Surveys of NAPHSIS Membership developed by the Workgroup Model Law Survey – 32 states responded Issuance Survey – 35 states responded Other Surveys of NAPHSIS Membership used by the Workgroup: Fees Charged Fee Retention Levying Fines Verification Charges

Accomplishments Solicitation of Comments on NCHS web site Received feedback from NAPHSIS Members National Archives and Records Administration CSTE Subcommittee on Tribal Epidemiology US Department of Justice, Witness Security Division Vermont Notary Public West VA Funeral Directors Association American College of Nurse Midwives National Funeral Directors Association Lambda Legal ACLU LGBT Rights Project National Center for Lesbian Rights Gay and Lesbian Advocates and Defenders Others

Accomplishments 2009/2010 NAPHSIS/VSCP Joint Meetings Presentations Roundtables Town Hall Workgroup Meetings began in 2009 April, July, September, November 2009 January, April, July, September, November 2010 March, May 2011

Accomplishments October/November 2010 Workgroup Webinars Total of 8 December 23, 2010 – Draft Model Law sent to NAPHSIS Membership

Accomplishments January Webinars with NAPHSIS–Purpose Provided background on development process for Draft Model Law & Regulations Provided overview of changes Answered clarifying questions Comments on draft were due from NAPHSIS Members February 11, 2011

Statistical Uses of Vital Records Data

Identifying and measuring public health problems Planning and evaluating programs at local, State, national, and international levels Providing baseline data for city, county, state, and U.S. comparisons Statistical uses of the data

Uses of natality data Population composition and growth Estimate size of population and project increases and decreases Influence on economic and social institutions (schools, labor market, commercial uses)

Life expectancy Teenage birth rates Births to unmarried mothers Uses of natality data

Adverse birth outcomes Low birth weight babies Racial differentials Multiple births Uses of natality data

Natality data used to: Determine need for birthing centers and hospitals Target prenatal care to certain populations Develop educational programs Add warning labels to certain products

Infant mortality Teenage suicide Deaths due to violence Motor vehicle mortality Maternal mortality Uses of mortality data

Mortality data used for: Allocation of health facilities Epidemiological research Discovery of emerging problems

Latest available NCHS data Final Birth–2008 Preliminary Birth–2009 Final Death–2008 Preliminary Death-2009

NOTE: Prior to 1933, data are for death-registration States only. Deaths per 100,000 standard population 2008 Life expectancy and age-adjusted death rates: U.S., Life expectancy Age-adjusted death rates

NOTES: Beginning with 1959, trend lines are based on registered live births; trend lines for are based on live births adjusted for underregistration. SOURCE: CDC/NCHS, National Vital Statistics System Live births and fertility rates: United States, Number Rate

Fertility rates by race and Hispanic origin: United States, 1920– Hispanic Black White, total Non-Hispanic White Asian/PI NOTE: Data for black women for years prior to 1960 are for women of all races other than white. In 1960, 92% of "all other" births were to black women. Data for 2006 are preliminary Births per 1,000 women aged in specified group (plotted on a log scale) 2006 American Indian

Number of births Birth rate Percent Number of births, birth rate, and percent of births to unmarried women Births per 1,000 unmarried women Births in 1000’s SOURCE: National Vital Statistics System, National Center for Health Statistics, CDC.

Percent of births to unmarried women, US, selected years, 1980–2008 SOURCE: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention Percent

Birth rate for unmarried women, selected years, 1980–2008 SOURCE: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention Rates per 1,000 unmarried women aged 15–44

Triplet/+ birth rates Triplet/+ birth rates NOTE: Triplet/+ births are births in triplet and higher order multiple deliveries. SOURCE: CDC/NCHS, National Vital Statistics System.

Cesarean delivery by race and Hispanic origin of mother SOURCE: CDC/NCHS, National Vital Statistics System. Percent Hispanic Non-Hispanic black Non-Hispanic white

Per 100 births NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. Race and Hispanic origin Non-Hispanic black HispanicAmerican Indian or Alaska Native Asian or Pacific Islander Non-Hispanic white Cesarean delivery rates by race and Hispanic origin of mother 0

Twin birth rates by age of mother: United States, 1990, 2000, and 2008 Twin birth rates by age of mother: United States, 1990, 2000, and 2008 Per 1,000 NOTE: The twin birth rate is per 1,000 live births. The birth rate for women for 1990 is not shown because of the small number of births. Years of age –1920–2425–2930–3435–3940–4445–

Birth rates for teenagers years SOURCE: National Vital Statistics System, National Center for Health Statistics, CDC Rates per 1,000 women aged years

MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC Teenage birth rates for year olds by State, 2009 Significantly higher than the U.S. 10 highest Not significantly different from U.S. Significantly lower than U.S. 10 lowest

NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System years years years 2009 Birth rate for teenagers by age Rate per 1,000 women in specified age

* Non-Hispanic SOURCE: CDC/NCHS, National Vital Statistics System. Teen birth rates by race and Hispanic origin, final 1991, 2005, 2007, and 2009

Number of births and birth rate for teenagers years SOURCE: CDC/NCHS, National Vital Statistics System. Number of births Birth rate NOTE : Data for 2009 are preliminary.

Birth rates for teenagers years by race and Hispanic origin * Non-Hispanic NOTE : Data for 2009 are preliminary. SOURCE : CDC/NCHS, National Vital Statistics System

MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC Change in birth rate for women aged years by State, 2007 and 2009 Decreased significantly Ten largest significant decreases No significant difference Increased significantly NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. U.S. teen birth rate for ages was 22.1 per 1,000 in 2007 and 20.1 in 2009

MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC Change in birth rate for women aged years by State, 2007 and 2009 Decreased significantly Ten largest significant decreases No significant difference NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. U.S. teen birth rate for ages was 73.9 per 1,000 in 2007 and 66.2 in 2009

Preterm and low birthweight rates Preterm Low birthweight 0

Note: Data prior to 1933 contain death-registration States only. Heart disease Influenza & Pneumonia Age-adjusted death rates for heart disease and influenza and pneumonia

Leading causes for U.S Influenza & Pneumonia Tuberculosis Diarrhea Heart disease Stroke 2008 Heart disease Cancer Stroke Chronic lower respiratory diseases Accidents (unintentional injuries) NOTE: Prior to 1933, data are for death-registration States only.

Deaths per 100,000 standard population 1- Diseases of heart 2- Malignant neoplasms 3- Cerebro- vascular diseases 4- Chronic lower respiratory diseases 5- Accidents (unintentional injuries) Trends in leading causes of death, United States,

years years 1-4 years 5-9 years Childhood death rates by age at death Deaths per 100,000 population SOURCE: CDC/NCHS: National Vital Statistics System,

Maternal mortality rates, NOTE: Prior to 1933, data are for birth-registration States only. 2007

Infant Neonatal Postneonatal NOTES: Death registration area complete for Infant, neonatal, and postneonatal mortality rates

Vital Statistics Core of our health data system Base for public health, social science, economic planning and program development Monitor key indicators of health world-wide and at the local, state and national level Track progress to goals Identify disparities Alert to emerging problems

Need for complete and accurate information Every certificate is important!