1. National Mortality Surveillance: Building a Foundation Paul D. Sutton, Ph.D. Mortality Surveillance Team Lead NAPHSIS/NCHS Joint Meeting Phoenix, Arizona June 2-6, 2013 National Center for Health Statistics Division of Vital Statistics

2. Mortality Surveillance The ongoing systematic monitoring and analysis of mortality data and the dissemination of information that leads to actions to address data quality and public health concerns.

3. VALIDATION OF RARE VACCINE- PREVENTABLE CAUSES OF DEATH

4. Vaccine-Preventable Diseases [underlying and multiple cause-of-death unless otherwise specified] ICDDescriptionAge limitations A08.0Rotaviral enteritis (Rotavirus)<5 years A36Diphtheriaany A37Whooping cough (Pertussis)<5 years A80Acute poliomyelitis (Polio)any B01Varicella<50 years Varicella [underlying cause only]50 years and older B05Measlesany B06Rubellaany B26Mumpsany P35.0Congenital rubella syndromeany

5. NCIRDs Investigation and Validation  CDC/National Center for Immunization and Respiratory Diseases (NCIRD) working with the state epidemiologist and/or immunization program investigates.  If NCIRD verifies the COD  NCHS marks the cause as confirmed.  If NCIRD cannot verify the COD  NCHS notifies the state vital records office and attempts to coordinate an update/correction.  Pending the receipt of an update/correction NCHS changes the COD to R99 (Other ill-defined and unspecified causes of mortality)

6. First Year (2012) Achievements  Over 40 deaths with a rare vaccine-preventable cause of death (underlying or multiple-cause) were identified and have/or will be validated using the new process  Jurisdiction participation  Formal approval from 20 jurisdictions  Approval pending for 6 additional jurisdictions  Results of validation  Data quality 10 Validated, 3 Corrected, and 7 Not Validated  Public health surveillance Identified previously unknown cases Helped complete surveillance record (i.e. case resulted in death)

7. INFLUENZA MORTALITY SURVEILLANCE

8. Influenza Surveillance in the United States  Find out when and where influenza activity is occurring  Track influenza-related illness  Determine what influenza viruses are circulating  Detect changes in influenza viruses  Measure the impact influenza is having on hospitalizations and deaths in the United States

9. 122 Cities Mortality Reporting System: Reporting Guidance and Case Definitions  Report all deaths registered during the week of the report that occurred in the city  Case definitions DefinitionExclusions Death due to Influenza Influenza listed anywhere on the death certificate (Part I or Part II) Mentions of: Haemophilus influenzae Parainfluenzae virus Death due to Pneumonia Pneumonia listed anywhere on the death certificate (Part I or Part II) Aspiration pneumonia Pneumonitis Pneumococcal meningitis If both pneumonia and influenza are listed, count as influenza.

11. Current 122 Cities Influenza Mortality Surveillance System  Incomplete reporting  About 25% of all deaths  Increasingly difficult to get reports from some cities  Inconsistent reporting  Not all jurisdictions follow the case definitions (e.g. some only report underlying cause of death)  Certificate review automated or semi-automated in some jurisdictions, manual review in other jurisdictions.  Deaths reported by week the death was registered  Lag between date of death and registration is unknown and varies from place to place  Deaths reported only by place the death occurred  Place of death not necessarily the same as place of residence

12. Future Vital Statistics based Influenza Mortality Surveillance  Improvements  Reported by date of death  Automated and consistent process for certificate review based on coded cause of death information  True national representation  Deaths available by place of occurrence and residence  Potential new capabilities  More focused regional, state, or local surveillance may be possible  Ability to switch from weekly to daily reporting in a pandemic

13. Projects  Parallel surveillance for 2013-14 influenza season  Real-time comparison of vital statistics and 122 city based influenza mortality surveillance  Reporting lag evaluation  Difference between date of death and the date NCHS receives the cause of death  Compute new baselines  Seasonal baseline  Epidemic threshold -- 1.645 standard deviations above the seasonal baseline

14. Vital Statistics based Pneumonia and Influenza Mortality Surveillance, for 122 Cities

15. Vital Statistics based Pneumonia and Influenza Mortality Surveillance, for the United States

16. Reporting Lag and the Importance of Timeliness  Just over 40% of the way through 2013 Percent of Expected Annual Deaths Received Number of Jurisdictions 40+2 35-3915 30-3411 25-296 20-244 15-193 10-142 5-93 0-56

17. MORTALITY SURVEILLANCE USER/WORKGROUP

18. Charge Mission Advance the use of vital statistics for public health surveillance at the local, state, and national level by identifying practical guidance for the vital statistics and surveillance communities on how to create and operate a vital statistics based public health surveillance system.

19. National Mortality Surveillance: Building a Foundation For more information please contact Paul D. Sutton 3311 Toledo Road, Hyattsville, MD 20782 Telephone: (301) 458-4433 E-mail: PSutton@cdc.gov The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Health Statistics Division of Vital Statistics