1. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Education Reporting and Classification on Death Certificates in the United States Brian L. Rostron, Ph.D. National Center for Health Statistics John L. Boies, Ph.D. US Census Bureau Elizabeth Arias, Ph.D. National Center for Health Statistics

2. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Background Studies show large disparities in mortality by educational attainment Persons with lower education generally have higher levels of mortality Mortality differentials by educational attainment vary by sex, race and ethnicity Differences are greater for men than women and for African American than White persons

3. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Background The death certificate is a prime source of information about the relationship between education and mortality As a result, we first need to explore the accuracy of education information on death certificates How does reporting on death certificate compare with reporting on population Census and Surveys? Why is comparison important? Death rates are prime mortality measure and are estimated using two distinct data systems Death certificate & Census/Survey Population Estimates

4. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Distinct Reporting Methods Numerator of rate Death Certificate= Educational attainment is recorded by funeral director as per family member report or, often, as result of his/her observation of decedent. Denominator of rate Census or Survey= Educational attainment is self-reported or reported by family/household member while individual is still alive.

5. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Distinct Classification Systems Death Certificate= Year-based classification of educational attainment & Degree-based classification. 1989 Standard Death Certificate Revision Year – Based 2003 Standard Death Certificate Revision Degree –Based Current Population Survey = Degree-based classification. Since 1992 Degree - Based

6. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Evaluation of Education Reporting on Death Certificate The National Longitudinal Mortality Study Current Population Surveys (CPS) & 1980 Census Data linked, using the NDI, to NCHS Mortality Data 25 Annual March CPS (1973, 1979-1998) and 1980 US Census sub-sample (~2.3 million records) CPS: National Sample of Households (60,000-80,000), Non-Institutionalized Population, 96% Response Rate Deaths Occurring between 1979-1998 (~253,000) For this study: Sample of Decedents in NLMS who responded to 1992 – 1998 CPS Surveys, and who were age 25 and older at time of Survey Total Sample Size of 10,570 after removal of States that did not include Education item on Death Certificate

7. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Evaluation of Education Reporting on Death Certificate Record-level agreement between CPS and death certificates of individual decedents: Percent of respondents in a CPS self-identified Educational attainment who are correctly identified on the death certificate Classification Ratios: Ratios of CPS Educational Attainment counts to death certificate counts for sample of identified decedents

8. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Classification Ratios Less than HS Graduate = CPS: Less than HS Graduate / DC: Less than 4 yrs of HS completed HS Graduate = CPS: HS Graduate / DC: 4 yrs of HS completed Some College = CPS: Some College, no degree / DC: 1-3 yrs of college Bachelor’s degree = CPS: Bachelor’s degree / DC: 4 yrs of college Graduate degree = CPS: Graduate degree / DC: More than 4 yrs of college

9. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Adjustment Process Classification Ratio 1989 Unrevised States 2003 Revised States Classification Ratio Inexact Adjustment

10. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Record-Level Percent Agreement (Sensitivity) CPS Education Level Death Certificate Education Level 0-3 Years HS 4 Years HS 1-3 Years College 4 Years College 5+ Years College % Un- known Less than HS Grad 661910013 High School Grad 106991010 Some College 328499210 Bachelor's Degree 151160149 Graduate Degree 12216709

11. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Record-Level Percent Agreement (Sensitivity) by Age at Death CPS Education Level Death Certificate Education Level 25-4445-6465 and over 0-3 Ye ars HS 4 Ye ars HS 1-3 Ye ars Col leg e 4 Ye ars Col leg e 5+ Ye ars Col leg e 0- 3 Ye ar s H S 4 Ye ars HS 1-3 Ye ars Col leg e 4 Ye ars Col leg e 5+ Ye ars Col leg e 0-3 Ye ars HS 4 Ye ars HS 1-3 Ye ars Col leg e 4 Ye ars Col leg e 5+ Ye ars Col leg e Less than HS Grad 612120165221006619 10 HS Grad 87391097210101168920 Some College 118567132750913294692 Bachelor’s degree 011070111612621016115815 Graduate degree 000127212215711321769

12. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Record-Level Percent Agreement (Sensitivity) by Hispanic Origin CPS Education Level Death Certificate Education Level HispanicNon-Hispanic < 4 Years HS 4 Years HS > 4 Years HS < 4 Years HS 4 Years HS > 4 Years HS Less than HS Grad 6113366201 HS Grad 14487107011 More than HS Grad 2226221871

13. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Record-Level Percent Agreement (Sensitivity) by Race CPS Education Level Death Certificate Education Level WhiteBlackAIANAPI < 4 Year s HS 4 Yea rs HS > 4 Year s HS < 4 Year s HS 4 Year s HS > 4 Year s HS < 4 Year s HS 4 Year s HS > 4 Year s HS < 4 Year s HS 4 Year s HS > 4 Year s HS Less than HS Grad 67202611826713174190 HS Grad 107010166012558766922 More than HS Grad 2187122363011800987

14. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Classification Ratios by Sex

15. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Life expectancy for males age 25, Unrevised States

16. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Life expectancy for males age 25, Revised States

17. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Life expectancy for females age 25, Unrevised States

18. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Life expectancy for females age 25, Revised States

19. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Summary Findings validate concerns about the validity of mortality measures by education level from unadjusted death certificate data. Identified specific patterns of differential education reporting on death certificate. *common for those not completing HS to have them classified as HS graduates on death certificate *black and Hispanic high school grads in CPS were more likely to than white and non-Hispanic high school grads to have their educational attainment underreported on death certificate. API high school grads in CPS were more likely have their education over reported on death certificate.

20. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Summary Findings also support general pattern of mortality differentials by educational attainment observed in other studies: *life expectancy in the US consistently increases with greater education and differences in life expectancy by education are greater for men than women. Finally, study also highlights the complications produced by the use of different classification systems for educational attainment in the data sources.