1. National Mortality Data Set Kenneth D. Kochanek Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics Data Users Conference July 12-14, 2004

2. Presentation Outline National Vital Statistics System National Vital Statistics System Nature of the System – Decentralized Nature of the System – Decentralized Role of the States Role of the States Role of NCHS Role of NCHS Role of the World Health Organization (WHO) Role of the World Health Organization (WHO) Mortality Data Mortality Data Underlying Cause-of-Death Data Underlying Cause-of-Death Data Advantages of Underlying Cause-of-Death DataAdvantages of Underlying Cause-of-Death Data Limitations of Underlying Cause-of-Death DataLimitations of Underlying Cause-of-Death Data Multiple Cause-of-Death Data Multiple Cause-of-Death Data Entity Axis ApplicationsEntity Axis Applications Record Axis ApplicationsRecord Axis Applications Electronic Death Certificate Electronic Death Certificate Data Dissemination Data Dissemination

3. Nature of the National Vital Statistics System The National Vital Statistics System is decentralized The National Vital Statistics System is decentralized There are no laws at the national level requiring the collection of vital statistics data There are no laws at the national level requiring the collection of vital statistics data Statistics that are produced by NCHS are based on information obtained from certificates filed in the States where events occur Statistics that are produced by NCHS are based on information obtained from certificates filed in the States where events occur Cooperation between NCHS and the States is governed by contracts of agreement Cooperation between NCHS and the States is governed by contracts of agreement SOURCE: CDC/NCHS

4. Role of States State laws govern filing of certificates and reports State laws govern filing of certificates and reports States produce their own certificates and reports States produce their own certificates and reports States code the information States code the information Vital Statistics Cooperative Program (VSCP) Vital Statistics Cooperative Program (VSCP) Availability of certificates and reports Availability of certificates and reports SOURCE: CDC/NCHS

5. Role of NCHS To compile and publish national and sub-national vital statistics To compile and publish national and sub-national vital statistics To promote coherence and uniformity of the data collected through the VSCP To promote coherence and uniformity of the data collected through the VSCP SOURCE: CDC/NCHS

6. Promote Data Quality Model law Model law Handbooks Handbooks Training and instruction manuals Training and instruction manuals Various publications Various publications Standard certificates and reports Standard certificates and reports Quality control Quality control SOURCE: CDC/NCHS

8. Mortality Data Mortality statistics are based on information from the approximately 2.3 million death certificates filed each year in the 50 States and the District of Columbia Mortality statistics are based on information from the approximately 2.3 million death certificates filed each year in the 50 States and the District of Columbia The Death Certificate serves two very different purposes The Death Certificate serves two very different purposes

9. Death Certificate A legal document regarding the facts and circumstances of a death A legal document regarding the facts and circumstances of a death A statistical resource providing information on characteristics of the decedent A statistical resource providing information on characteristics of the decedent SOURCE: CDC/NCHS

12. Role of World Health Organization Promoting standardization of mortality statistics through the International Classification of Diseases (ICD) Promoting standardization of mortality statistics through the International Classification of Diseases (ICD) Compiling international mortality statistics Compiling international mortality statistics SOURCE: CDC/NCHS

13. Role of ICD Provides standard definitions Provides standard definitions Prescribes the format for cause-of-death information on the death certificate Prescribes the format for cause-of-death information on the death certificate Describes how death certificate should be completed Describes how death certificate should be completed Provides rules for selecting the underlying cause of death Provides rules for selecting the underlying cause of death SOURCE: CDC/NCHS

14. Underlying Cause of Death “The disease or injury which initiated the chain of morbid events leading directly to death, or “The disease or injury which initiated the chain of morbid events leading directly to death, or The circumstances of the accident or violence that produced the fatal injury.” The circumstances of the accident or violence that produced the fatal injury.” SOURCE: CDC/NCHS

15. Computer Software ACME: Automated Classification of Medical Entities ACME: Automated Classification of Medical Entities TRANSAX: Translation of Axes TRANSAX: Translation of Axes MICAR: Mortality Medical Indexing, Classification and Retrieval MICAR: Mortality Medical Indexing, Classification and Retrieval SuperMICAR SuperMICAR SOURCE: CDC/NCHS

16. Advantages of Underlying Cause of Death Simple and one dimensional Simple and one dimensional Conceptually easy to understand Conceptually easy to understand Well-accepted measure of mortality Well-accepted measure of mortality Useful to public health officials Useful to public health officials SOURCE: CDC/NCHS

17. Limitations of Underlying Cause of Death Only one disease selected Only one disease selected Arbitrary selection Arbitrary selection Excludes information Excludes information Certifier mistakes Certifier mistakes Only as good as the information on the death certificate Only as good as the information on the death certificate SOURCE: CDC/NCHS

18. Multiple Cause of Death Portrays the number of deaths in which a given condition is a significant factor contributing to death, if reported Portrays the number of deaths in which a given condition is a significant factor contributing to death, if reported Portrays the Interaction of diseases Portrays the Interaction of diseases Contains two fields: Contains two fields: Record Axis Record Axis Entity Axis Entity Axis SOURCE: CDC/NCHS

19. Entity Axis Applications Relationships among conditions Relationships among conditions Accuracy of certification reporting Accuracy of certification reporting Testing traditional assumptions of underlying cause selection Testing traditional assumptions of underlying cause selection SOURCE: CDC/NCHS

20. Record Axis Applications Classifiable in manner like the underlying cause of death Classifiable in manner like the underlying cause of death Best representation of ICD codes Best representation of ICD codes SOURCE: CDC/NCHS

21. Electronic Death Certificate (EDC) Certifier and funeral director data entry in electronic form, including Certifier and funeral director data entry in electronic form, including prompts prompts tutorials tutorials querying for incomplete or uninformative terms querying for incomplete or uninformative terms querying for implausible cause of death sequences querying for implausible cause of death sequences SOURCE: CDC/NCHS

22. Data Dissemination Preliminary Report Preliminary Report Final Report Final Report Monthly National Vital Statistics Reports Monthly National Vital Statistics Reports Special reports Special reports Public use micro data – CD-ROM Public use micro data – CD-ROM Confidentiality Confidentiality SOURCE: CDC/NCHS

23. CD-ROM’s Mortality Public Use Data Sets Mortality Public Use Data Sets ASCII Dump CD-ROM’s 1968-2001 ASCII Dump CD-ROM’s 1968-2001 SETS CD-ROM’s 1991-98 SETS CD-ROM’s 1991-98 Compressed Mortality File (CMF) Compressed Mortality File (CMF)

27. Mortality Data from the National Vital Statistics System website: http://www.cdc.gov/nchs/about/ major/dvs/mortdata.htm http://www.cdc.gov/nchs/about/ major/dvs/ http://www.cdc.gov/nchs/about/ major/dvs/