1. A State’s Experience

2. Original Project
Oklahoma Death Certificate Linkage to IHS database
Findings
Before Recode: 19,257 [4.2% of total deaths]
After Recode: 28,491 [6.2% of total deaths]
Change: Increase of 48.0%
Higher frequency among older populations
Highest percent increase among younger pop’l [5- 14 (89%) and (66%)]
Almost 50% increase in the number of disparities among rankable causes of death
As a results partnerships with chronic disease service area and specifically cancer registry activities

3. Results Quantified the problem
OK2SHARE integration of linked data in death and cancer modules
Inclusion of linked data in reports
Continued linkages, thanks to Melissa Jim, NDI…
Education for other PH programs and PH partners

4. Direct Linkage with Tribal Health Data
Choctaw Nation Health Services Death Linkage Project
What was their patient population was dying from
Resource Patient Management System (RPMS) data limited
Cause of Death field missing many times
Indian Health Service linked data sometimes not readily available to tribal health organizations.
Still often hard to identify the major causes of mortality at the Service Unit Level

5. Benefits
The information can be used to improve data quality and reveal real mortality data at the service unit level.
This data will assist health planners in developing future direction for the CNHSA.
The development of a trust relationship on health data sharing
Ultimately work at sharing hospital / health services data with the OSDH to improve the state-wide health information data.

6. Methods
Developed MOU
Update Choctaw Nation’s files with death data
The state did not update any of our information using this data
Choctaw Nation Health Services exported identifiers from RPMS
OSDH linked (deterministic, statistical/probabilistic)
Returned updated file
Choctaw Nation Health Services analyzed their data

7. Results of NDI IHS Linkage

8. Oklahoma Resident Deaths by Bridged Race Categories before and after IHS Linkage 1999-2009

9. Percent of Oklahoma Resident Deaths by Bridged Race Category after IHS Linkage 1999-2009

10. Oklahoma Resident Deaths by Race Categories before and after IHS Linkage 2004-2009

11. Percent of Oklahoma Resident Deaths by Race after IHS Linkage 2004-2009

12. General Findings
On average 750 additional AIAN descendants annually
After implementing multiple race on death certs in 2004 average went to 584
Across all ages (0 to 104)
94.6% were originally coded as White only and 3.88% as Black only
99% Non-Hispanic
Gender Males (51.1%) Females (48.9%)
By county, the percent of newly identified AIAN ranged from 0 to 64% with an average 15%

13. Oklahoma Age-Adjusted Mortality Rates by Race and IHS Linked Race 1999-2009

14. Top 10 Underlying Causes of Death (OK 2004-2009)
Bridged Race AIAN
Diseases of heart
Malignant neoplasms
Accidents (unintentional injuries)
Diabetes mellitus
Chronic lower respiratory diseases
Cerebrovascular diseases
Chronic liver disease and cirrhosis
Nephritis, nephrotic syndrome and nephrosis
Influenza and pneumonia
Intentional self-harm (suicide)
Newly Identified AIAN
Diseases of heart
Malignant neoplasms
Accidents (unintentional injuries)
Chronic lower respiratory diseases (up 1)
Cerebrovascular diseases (up 1)
Diabetes mellitus (down 2)
Intentional self-harm (suicide) (up 3)
Alzheimer's disease (up 5)
Influenza and pneumonia (up 1)
Chronic liver disease and cirrhosis (down 3)

15. 10 Leading Underlying Causes of Death AIAN Bridged Race
Oklahoma AAMR
(per 100k)
AAMR Bridged Race (per 100k)
AAMR
IHS Linked (per 100k)
Diseases of heart
257.7
248.7
334.5
Malignant neoplasms
194.7
189.9
258.8
Accidents (unintentional injuries)
57.5
68.2
92.6
Diabetes mellitus
30.1
65.1
75.9
Chronic lower respiratory diseases
61.9 49
69.4
Cerebrovascular diseases 56
49.2
65.5
Chronic liver disease and cirrhosis
11.5
26.9
31.5
Nephritis, nephrotic syndrome and nephrosis
16.1
24.8
29.9
Influenza and pneumonia
23.3
23.6
29.7
Intentional self-harm (suicide)
14.9 12
17.5

16. Considerations Create/join NAPHSIS workgroups / user groups
Encourage ongoing support for NDI IHS linkage (State’s waive fee?)
EVVE?
Each Jurisdiction’s laws are different
Joint effort to develop model language
Modify state legislation to allow data sharing
Create/join NAPHSIS workgroups / user groups

17. By Partnering Bring understanding regarding cultural considerations
Bring understanding around complexities of the various health (or political) systems
Assist with educating facilities and partners on the importance & use of vital records (Linked data)
Develop of best practices or templates

18. Opportunities Create/join NAPHSIS workgroups / user groups
State/Jurisdictional and National level
Investigation of disparities
Develop of best practices or templates
Bring understanding regarding cultural considerations
Bring understanding around complexities of the various health (or political) systems
Assist with educating facilities and partners on the importance & use of vital records
Data quality
Timeliness

19. NAPHSIS
Formally organized in 1933 to represent the State Registrars in all 57 vital records jurisdictions (50 states, 5 territories, DC, NYC)
Name changed in 1958 to include support of public health statistics functions in addition to vital records/civil registration
In 1996 became the National Association for Public Health Statistics and Information Systems

20. NAHSIS
Vision: An accurate, timely, and secure record of all vital events in the nation
Our Mission: NAPHSIS provides national leadership for both vital records and related information systems in order to establish and protect individual identity and improve population health.

21. Jurisdictional Diversity
TOTAL – BIRTHS (57) Open 8 Closed 44 Closed w / limited access (old records) 1 Unknown 4 TOTAL – DEATHS (57) Open 13 Closed 30 Closed w / limited access (old records) 10 Unknown 4