1. MAKING VITAL STATISTICS MORE VITAL SUPPLEMENT: THE NEW DEATH CERTIFICATE The Last Word Centers for Disease Control and Prevention National Center for Health Statistics Division of Vital Statistics Mortality Statistics Branch

2. Development of the Revised Death Certificate 11 th Revision The U.S. Standard Certificate of Death had 10 revisions during the 20th century. The last revision, still in use, was in 1989. – The revision process began with a consensus from the States that a revision was needed. – In 1998, the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) assembled an expert panel to evaluate the current certificate and recommend changes.

3. Development of the Revised Death Certificate The Panel to Evaluate the U.S. Standard Certificates and Report Parent Group was composed of: – State vital registration and statistics executives - Patricia W. Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; Lorne A. Phillips, KS; Steven Schwartz, NYC. – Researchers and representatives of data providers and user organizations - (e.g., CAP, NAME, NFDA, AHA, and AMA).

4. Development of the Revised Death Certificate -- cont. In a series of meetings over 16 months, the Panel reviewed literature, suggestions, and recommendations and heard outside testimony from other experts and private citizens. – The revision was viewed as a opportunity to improve the data collection process. – Recommendations were made as to: Content Content Format Format Instructions Instructions – The Panel made its final recommendations in 1999. – NCHS was mandated to test the new documents.

5. Guides to Completing Death Certificate To assist the funeral director completing demographic and legal items, the funeral director’s handbook has been revised. To assist physicians, medical examiners, and coroners completing cause of death, the physicians’ and medical examiners’ and coroners’ handbooks have been revised. To assist physicians, medical examiners, and coroners completing cause of death, the physicians’ and medical examiners’ and coroners’ handbooks have been revised.

6. Detailed Specification for Electronic Systems Because an increasing number of deaths are expected to be registered electronically, for the first time, detailed specifications for each data item on the electronic death certificate have been developed. The specifications include: – Suggested electronic screens – Response categories – Drop-down menus – Edits – Help screens – Ability to edit and query at data entry; resolution of data issues at the source

7. Proposed New Death Certificate: Modified Items – Decedent’s race, captures multiple race identification – Decedent’s education, captures highest degree attained – Decedent’s marital status distinguishes “Married” from “Married, but separated” – Place of death includes hospice facility

8. Proposed New Death Certificate: Important New Items – If female, pregnancy status at time of death that will help identify maternal and pregnancy- related deaths – If transportation injury, decedent’s role with respect to vehicles – Did tobacco use contribute to death? – Separate instructions for funeral director and person completing medical portion

9. Summary The quality of death certificate data will be improved as a result of: – Expanded instructions in the death certificate packet – Revised handbooks – Detailed specifications for the electronic system and the ability to edit and query as data are entered

10. Public Health Implications – Cause-of-death trends – Leading causes of death – Life expectancy – Socio-economic differentials – Demographic differentials More accurate and comprehensive reporting on the death certificate will enhance our ability to analyze and track crucial indicators of health, including demographic characteristics and causes of death. Number of deaths Age-adjusted death rate