1. 1 Arialdi M. Miniño, MPH National Center for Health Statistics Presented at the 134th Annual Meeting & Exposition of the American Public Health Association Continuing Education Institutes November 4, 2006 Boston, MA National Vital Statistics System - Mortality

2. 2 Staff – Mortality Statistics Branch Robert N. Anderson (chief) Elizabeth Arias Melonie P. Heron Donna L. Hoyert Kenneth D. Kochanek Hsiang Kung Arialdi M. Miniño Sherry L. Murphy Chester Scott Jiaquan Xu

3. 3 National Vital Statistics System Registration of births and deaths is not a Federal activity – responsibility lies with the States Currently, there are 57 registration areas 50 States District of Columbia New York City 5 Territories (Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas)

4. 4 Vital Statistics Cooperative Program (VSCP) Includes all 57 registration areas Standardization of data collection and data processing Comparability among States Compilation of national vital statistics data sets National Vital Statistics System, cont.

5. 5 U.S. Standard Certificate of Death, first third

6. 6 U.S. Standard Certificate of Death, mid third

7. 7 U.S. Standard Certificate of Death, last third

8. 8 Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) National Center for Injury Prevention and Control (NCIPC) National Center for Infectious Diseases (NCID) Office of the Surgeon General Bureau of the Census Social Security Administration (SSA) National Institutes of Health (NIH) National Cancer Institute (NCI) National Institute on Aging (NIA) National Institute on Drug Abuse (NIDA) National Highway Traffic Safety Administration (NHTSA) Substance Abuse and Mental Health Services Administration (SAMHSA) Sample of Major Users of National Mortality Data

9. 9 Other Non-Government Organizations and Firms: World Health Organization (WHO) Pan American Health Organization (PAHO) American Cancer Society American Heart Association American College of Surgeons National Bureau of Economic Research (NBER) Max Planck Institute for Demographic Research North American Association of Central Cancer Registries (NAACCR) Population Reference Bureau State and Local Departments of Health Various Marketing, Investment, Insurance, Pharmaceutical, Healthcare and Law Firms March of Dimes Sample of Major Users of National Mortality Data

10. 10 Preliminary Data Consists of large proportion of deaths occurring in calendar year Data are weighted up to independent counts Data files not released to public Final Data Tied to release of public use file Two Data Series for Mortality

11. 11 List of Variables and Locations on File

12. 12 List of Variables and Locations on File, cont.

13. 13 List of Variables and Locations on File, cont.

14. 14 States Using New (Revised 2003) Standard Certificate for 2004 Data Year California Idaho Michigan Montana New Hampshire New Jersey New York (city) New York (state) Oklahoma South Dakota Washington Wyoming Most still use old (1989) Standard Certificate Some combine old certificate with certain items reported as per new standard certificate  Hawaii, Maine, Minnesota and Wisconsin provide multi-race data.  Minnesota provides multi- Hispanic data.  Massachusetts, Missouri and Texas provide FIPS geo. codes. New Standard Balance of States & Registration Offices

15. 15 NCHS Reports Using NVSS Mortality Data

16. 16 NCHS Reports Using NVSS Mortality Data

17. 17 NCHS Reports Using NVSS Mortality Data

18. 18 NCHS Reports Using NVSS Mortality Data

19. 19 NCHS Reports Using NVSS Mortality Data

20. 20 Other Reports Using NVSS Mortality Data

21. 21 Other Reports Using NVSS Mortality Data

22. 22 Other Reports Using NVSS Mortality Data

23. 23 Trend Data Using Multiple Years’ Mortality Data

24. 24 Issues Affecting Interpretation, Analysis & Handling of NVSS Mortality Data Changes to data items due to variability of certificate (change of revision, or interstate)  Multiple race selection for decedent  Checkboxes for specific causes of death  Availability of specific items on certificate Periodic revision of the system for International Classification of Diseases (ICD)  Last revision change occurred between 1998-1999 for U.S.  Affects the way that causes of death and medical entities are coded, classified and selected

25. 25 Trend Discontinuities Across ICD Revisions in the U.S. Source: National Vital Statistics System Year ICD-6 ICD-7 ICDA-8 ICD-9 Age-adjusted death rates for Nephritis, nephrosis & nephrotic syndrome: United States, 1950-2002 Age-adjusted Death Rate per 100,000 U.S. Standard Population ICD-10

26. 26 Analysis of Time Series Across Revisions Source: National Vital Statistics System Year Age-adjusted Death Rate per 100,000 U.S. Standard Population R 2 =.7372 APC=3.9% ln(rate)=a+b 1 (year)

27. 27 Analysis of Time Series Across Revisions Source: National Vital Statistics System Year Age-adjusted Death Rate per 100,000 U.S. Standard Population R 2 =.9898 APC=0.8% ln(rate)=a+b 1 (year)+b 2 1=ICD-10 0=ICD-9

28. 28 Access to Public Use Data and Relevant Documentation