1. Oregon Veteran Combat Status: Collection, Quality, and Analysis
Vivian Siu, MPH, MURP
Mortality Research Analyst
Center for Health Statistics
Oregon Public Health Division

3. Overview Oregon 2011 HB3611 Data collection and initial outreach
Data quality and assurance
Data analysis
Future Plans

4. 2011 Oregon’s HB 3611
If a decedent’s death was caused by suicide, the person who submits the death certificate to the county registrar or to the Center for Health Statistics, or as otherwise directed by the State Registrar of the Center for Health Statistics, shall make reasonable efforts to ascertain and shall notify the center through the electronic death certificate system:
Whether the decedent was a veteran; and
If the decedent was a veteran, whether the decedent served in combat and, if so, where the decedent served.

5. Data Collection – Oregon Center for Health Statistics
Added two questions in death certificate
Collect responses for ALL death records
Timing: demographic information and manner of death
Useful in comparing the occurrence among groups
Only appear in Electronic death system, not paper records.
Require submitting supplemental forms if paper filing.

6. Veteran Status Question
Death Certificate include question on veteran status.
Ever in US Armed Forces?
U.S. Standard Certificate of Death

7. New Questions on OVERS (Oregon’s EDRS)

8. Initial Outreach Measures
Letter about law change
Four death newsletters – updates
Instructional materials
Worksheets
Reference Lists
Supplemental Forms
Instructional documents and video
Newsletter: August 2011, March 2012, August 2012, March 2013

9. Data Assurance and Control – Data Quality
Early monitoring
High percent of Unknown/Missing information
Time point
Percent Veteran’s Combat Status Unknown or Missing
Early Feb, 2012
52.0%
First Quarter
40.1%
Second Quarter
36.7%
Third Quarter
34.9%
End of 2012
34.4%

10. Data Assurance and Control - Data Quality
2012 Veteran Status and Combat Status Data by Unknown and Missing Responses
2012 Response
Veteran Status (% Total, n=15725)
Combat Status (% Veterans, n=8740)
Unknown
0.8%
33.8%
Missing information
N/A
0.6%

11. Each data point is a funeral home

12. Data Assurance and Control – Comparative Table
Comparative table- funeral listing and performance over time

13. Data Assurance and Control – Suicide Focused Editing
Identify individual record with missing or unknown information if manner of death was suicide.
Registration Manager’s outreach:
Funeral homes
Individual cases

14. Registration Manager follow-up
Why so many unknown/missing data?
Questions not asked
True unknown
Individual calls for suicides cases
148 veteran suicide deaths
32 unknown combat status after follow up
about 1/3 are actual unknowns
2/3 have to amend the death certificate
Funeral home tone and attitude improved over time
More cooperative

15. Data Analysis - Analytic Sample
Analysis based on 2012 death data
Population 18 years or older
Male population
Oregon residence and occurrence

16. Data Analysis- Death by Veteran Status, 2012

17. Data Analysis- Veteran Deaths by Combat Status, 2012

18. Combat Status and Suicide Deaths

19. Combat Status and Unintentional Injury Deaths

20. Combat Status and Homicide Deaths

21. Combat Status and Percent Suicide Deaths Related to Firearm

22. Combat Veterans by Combat Zone
Percent Combat Vet. Deaths by…
World War II
(n=1582)
Korea
(n=589)
Vietnam and Cold War Era Conflicts
(n=666)
Persian Gulf/ Afghanistan
(n=42)
Other or Unknown
(n=141)
Natural Causes
96.0%
95.9%
94.0%
50.0%
93.6%
External Causes
4.0%
4.1%
6.0%
6.4%

23. Caution when analyzing or interpreting data
Sex
-- More male veterans than female veterans
Age
-- Age-adjustment
Distribution of age
-- Larger numbers of veterans in older age groups
Cause of death
-- Varies by age groups

24. Analysis Plan
Multiple years data for more detailed summary in CHS annual report
Confidentiality
Improve confidence in statistical analysis
Analyzed by the Injury Prevention Program
Work with Oregon Department of Veterans’ Affairs

25. What can be done on Quality Assurance
Continue follow-up of suicide deaths among veterans
Future newsletters
Regular automated reporting
Prioritize resources- general vs. suicide deaths
Goal setting
Letters to specific funeral homes that did not improve over time.

26. Each data point is a funeral home

27. Cycle of collection, quality and analysis

28. Special Thank You
Lisa Millet, Manager, Injury Prevention Section, Center for Prevention & Health Promotion
Xun Shen, Epidemiologist, Injury Prevention Section, Center for Prevention & Health Promotion
Jennifer Woodward, Oregon State Registrar, Center for Health Statistics, Center for Health Practice
Joyce Grant-Worley, Manager, Statistics Unit, Center for Health Statistics, Center for Health Practice

29. Contact
Vivian Siu, MPH, MURP (971) JoAnn Jackson, MBA Registration Manager and VSCP liaison (971)