1. Patricia W. Potrzebowski, Ph.D. Executive Director National Association for Public Health Statistics and Information Systems January 25, 2012 Vital Statistics 101

2. Types of Vital Events Live Births Deaths Fetal Deaths Induced Terminations of Pregnancy Marriages Divorces/Annulments

3. Responsibility for Registering Vital Events State (not federal) jurisdiction 50 states + DC + NYC + 5 territories = 57 Jurisdiction where event occurs NOT residence of decedent or mother

4. How are vital statistics prepared? Data collected from new parents, hospitals, birthing centers, midwives, physicians, nursing homes, funeral homes, coroners/medical examiners, next-of-kin Reported to local/state health departments Records reviewed, edited, processed, registered Causes of death coded according to international standards (ICD-10) Data files prepared

5. Vital Statistics Cooperative Program (VSCP) 57 jurisdictions (NAPHSIS members) Collect and report data using U.S. standard certificates Make state and local level data available Federal government (NCHS) Compiles data Issues data files (individual case records, de-identified) Prepares/publishes analytical/statistical reports

6. Roles of Vital Statistics Civil registration system

7. Civil Registration System Serve as the permanent legal record of the fact of birth, death, marriage or divorce Birth certificate Proof of date of birth, age, parentage, birthplace, citizenship Used for school entrance, voter registration, driver’s license, marriage license, passport, social security benefits Death certificate Proof of date of death, date and place of interment, cause and circumstances of death Used to obtain insurance benefits and pensions; transfer of property

8. Roles of Vital Statistics Civil registration system Public health data system

9. Public Health Uses of Vital Statistics Data Identifying public health problems Identifying patterns in fertility and mortality Monitoring trends in health and health care Monitoring risk factors leading to poor outcomes Planning and evaluating public health programs

10. Critical Public Health Data Source Certificate revisions allow data items to remain relevant Complete reporting Mandatory (not a sample or survey) Consistent data among jurisdictions Until recently

11. Administrative Uses Population estimates and projections Enumeration at birth - SSN School enrollment estimates Maintenance of administrative data sets Voter registration SSA

12. Roles of Vital Statistics Civil registration system Public health data system National security system

13. National Security System Intelligence Reform and Terrorism Act of 2004 Minimum standards Certification of birth certificates and use of security paper Proof and verification of identity as a condition of issuance of a birth certificate Processing of birth certificate applications to prevent fraud Birth/death matching to mark birth records of deceased persons To date Regulations several years overdue No funds appropriated

14. Recent Improvements to Vital Statistics Evolving to meet new needs Electronic Verification of Vital Events (EVVE) State and Territorial Exchange of Vital Events (STEVE) Electronic birth and death systems Improve timeliness, efficiency and data quality Will reduce need for corrections

15. Roles of Vital Statistics Civil registration system Public health data system National security system Public health surveillance system

16. Public Health Surveillance System Allows for monitoring of trends as data are collected Allows states and the federal government to identify problems in real time Allows for the collection of additional data items

17. Expanded use of data needs to begin at the state level States collect data from the source States have identifiers States have access to other data sets for linkage States can incorporate EHR into medical portion of birth records

18. Past Effects of Underfunding Elimination of Abortion reporting system Marriage and divorce statistics program Occupation and industry coding of death records Delay in adoption of 2003 certificate revisions Reduced timeliness of data Negative impacts on data quality

19. Ongoing Effects of Underfunding Scarce resources What do states do first (or at all)? Civil registration most critical at the state level and other functions may suffer

20. What is our vision? Reengineered data collection systems based on the national model that would allow for: Immediate electronic transfer to state vital records offices Immediate transfer to other health dept. programs Timely transfer of out of state data Timely sharing of data with federal partners Collection of timely, complete, accurate data Linkage with other data sets Continued evolution from a ‘public health data system’ to a ‘surveillance system’ Use of vital records as an effective tool for protecting national security

21. For more information Please contact: Trish Potrzebowski ppotrzebowski@naphsis.org 301-563-6001 Or go to www.naphsis.orgwww.naphsis.org