1. Vital Statistics Processing in the United States U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Presented to the FSCPE/P by Stephanie Ventura and Jim Weed Division of Vital Statistics October 5, 2004

2. National Vital Statistics System 57 reporting jurisdictions (States + NYC, DC, VI, PR, Guam, AS, NMI) Decentralized system US historical development: States retain rights not ceded to Federal govt. Nothing on vital event registration in the US Constitution Responsibility based in state law Responsibility with provider of services

3. Federal Role Defined by the Public Health Service Act – Sec 306 (h) (1) Annual collection of data from the records of births, deaths, marriages, and divorces Satisfactory data in necessary detail and form Encourage States to collect detailed data on ethnic and racial populations Each State or registration area shall be paid by the Secretary the Federal share of its reasonable costs

4. National Vital Statistics System Individual Record Data: Births Deaths Fetal Deaths Counts: Marriages Divorces

5. e-Birth Registration Process Hospital authority (medical records office) completes entire Electronic Birth Certificate using mother and facility worksheets Hospital files the certificate with local registrar or State office, per State law State office reviews, queries, and codes information and transmits electronically to NCHS NCHS edits and prepares master file Final file closes when all jurisdictions say they have closed their statistical files for the year.

6. Death Registration Process Hospital (or ME/coroner) initiates paper certificate and gives to funeral director Funeral director obtains personal facts about decedent, completes certificate, and obtains cause of death from attending physician as needed FD files certificate with local office or State office, per State law; obtains burial permit Local office may hold records for fixed period (e.g. 2 months) to provide copies to family members State office receives certificate and codes/keys demographic and medical information State office transmits demographic and medical data electronically to NCHS for editing and possible additional coding of medical data.

7. Types of Data Dissemination: National Vital Statistics Reports

8. Provisional Data Most timely data release of counts and rates Short “fact sheet” released monthly on the Internet in the NVSR series Includes counts only of births, deaths, infant deaths, marriages & divorces Estimates based on counts of certificates received during a one- month period, regardless of month of occurrence

9. Preliminary Data Detail for basic variables and preview of data in final report; data track well with final report Based on substantial sample of records – 98% of all births for 2002; 97% of demographic- deaths and 92% of medical-deaths for 2002 Sample of all records received and processed by cut-off date – 3 months after end of data year 2002 for births, 7 months for deaths Births published 6-8 months after end of year; 14-15 months for deaths

10. Final Data Annual reports – based on all US births and deaths in a given year Discussion and detailed data on almost all items in the data sets Final public use files available with release of final data reports Births released 12 months after end of data year 2002, deaths about 21 months after end of data year 2001

11. Data Transmission & Coding All jurisdictions except Guam code their birth record data and transmit to NCHS electronically (internet to CDC Secure Data Network) All jurisdictions except Guam code/key demographic data on death certificates and transmit to NCHS Most jurisdictions (except IL, WV, VI, AS, MP, Guam) key medical death data with SuperMICAR; some process underlying cause with NCHS’ mortality software ACME/ MICAR/ SuperMICAR. NCHS codes medical data on records rejected by the mortality software for 33 jurisdictions (less than 15% of records are rejects) NCHS receives 500-700 data file transmissions from the jurisdictions each month.

12. Data Processing and Closure Optimal goal is to close all files by end of April However, in practice, final files are held open until all jurisdictions say they have closed their statistical files and those files have been sent to NCHS If a jurisdiction sends more records, they will be added to NCHS’ national file if it has not yet been closed Many jurisdictions may close their files before NCHS closes its national file Jurisdiction and NCHS files should be equal, but jurisdiction count of events may exceed number of records in statistical file if records come in to registration office after the jurisdiction closes its file

13. Occurrence vs. Residence Almost all NCHS vital statistics are tabulated by place of residence of mother or decedent (PUF data indicate both residence and occurrence information) Interstate transfer of records designed to give each jurisdiction the events of residents for that jurisdiction, but this may be incomplete Some State laws limit or prevent interstate transfer due to confidentiality concerns A State’s tabulation of residence deaths or births may thus be less than the NCHS count of that State’s residence deaths or births

14. Future for Vital Statistics Revised Birth Certificate Revised Death Certificate

15. Revised Birth Certificate More detail on cigarette smoking Method of delivery More maternal weight gain info Infertility treatment WIC Infections during pregnancy Maternal morbidity Breast feeding Payment for delivery Congenital anomalies New worksheets developed and tested – to encourage data collection from the most appropriate sources

16. Revised Death Certificate Decedent’s marital status distinguishes “Married” from “Married, but separated” Place of death includes hospice If female, pregnancy status at time of death to identify maternal and pregnancy-related deaths If transportation injury, decedent’s status with respect to vehicles Did tobacco use contribute to death? Separate instructions for funeral director and person completing medical portion

17. New Data on Race and Educational Attainment for Births and Deaths Data on race and ethnicity conforming to 2000 Census data collection Data on education conforming to 2000 Census data collection 22. MOTHER’S RACE (Check one or more races to indicate what the mother considers herself to be) □ White □ Black or African American □ American Indian or Alaska Native (Name of the enrolled or principal tribe) __________ □ Asian Indian □ Chinese □ Filipino □ Japanese □ Korean □ Vietnamese □ Other Asian (Specify) _________________________ □ Native Hawaiian □ Guamanian or Chamorro □ Samoan □ Other Pacific Islander (Specify) _________________ □ Other (Specify) ______________________________ 22. MOTHER’S RACE (Check one or more races to indicate what the mother considers herself to be) □ White □ Black or African American □ American Indian or Alaska Native (Name of the enrolled or principal tribe) __________ □ Asian Indian □ Chinese □ Filipino □ Japanese □ Korean □ Vietnamese □ Other Asian (Specify) _________________________ □ Native Hawaiian □ Guamanian or Chamorro □ Samoan □ Other Pacific Islander (Specify) _________________ □ Other (Specify) ______________________________ 51. DECEDENT’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of death) □ 8th grade or less □ 9th – 12th grade; no diploma □ High school graduate or GED completed □ Some college credit, but no degree □ Associate degree (e.g., AA, AS) □ Bachelor’s degree (e.g., BA, AB, BS) □ Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA) □ Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD) 51. DECEDENT’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of death) □ 8th grade or less □ 9th – 12th grade; no diploma □ High school graduate or GED completed □ Some college credit, but no degree □ Associate degree (e.g., AA, AS) □ Bachelor’s degree (e.g., BA, AB, BS) □ Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA) □ Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

18. Where are we Now? Births registered electronically for well over a decade, but States are using individually developed legacy systems not adaptable for the revised certificates. Death registration has never been electronic. Need to get hospitals, physicians, and funeral directors to use electronic systems and update their technology. In sum, implementing new certificates requires States to re-engineer their data collection systems for birth and deaths.

19. Challenges in Creating National Data Sets for Births and Deaths Tracking who’s doing what, when Implementation schedules Some will implement entire standard certificate Some will implement partial certificate Some will implement multiple race only Some will implement mid-year Putting together a National data set Comparability between jurisdictions Comparability over time MAJOR IMPACT ON DATA TIMELINESS

20. Implementation of the revised race/ethnicity standard …  14 jurisdictions have revised birth certificates to collect multiple race data; 10 have the new race format.  18 jurisdictions have revised death certificates to collect multiple race data; 13 have the new race format. NCHS codes and edits race information and transmits the edited codes back to the States for their own use.

21. The Compatibility Problem… Race data are not compatible between States. Race data are not compatible between vital records and data collected in the 2000 census or produced for post-censal estimates. OMB recognized the problem of incompatibility between data systems and allowed agencies to employ a “bridge period.” Provide consistent numerators and denominators for transition period, before all data are available in the new format. To get national rates, we must bridge numerator data as an interim measure until all States collect multiple-race vital statistics.

22. Summary: Current Issues in Vital Statistics: Resource limitations Major initiatives to improve data quality and timeliness Re-engineering data collection systems Challenges in creating national data sets Web site: http://www.cdc.gov/nchs/nvss.htm