NAPHSIS 75 Years

1
NAPHSIS 75 Years

• Highlights from the History of Vital Statistics
  Reporting

2
Massachusetts Public Health Milestones

• 1721 First smallpox inoculation
• 1842 First registration law (births, deaths, and
  marriages) was enacted
• 1869 Law enacted creating State Board of Health
• 1873 First venereal disease clinic in the nation
  started in Boston
• 1891 Food and Drug Laboratory established- first
  of its kind
• 1927 First state-supported cancer clinics opened
• 1962 Mandatory PKU (phenylketonuria) screening
  required in
  newborns
• 1971 First to require childhood lead poisoning
  prevention
• 1985 First health hazard warnings on smokeless
  tobacco products
• 1992 First mandatory reporting surveillance
  of work-related injuries and occupational
  illness of persons under age 18
• 2000 Childrens and Families Protection Act

3
MA Infant Mortality Rate 1842 to 2006
APC 2 -3.85
1902
APC 1 0.48
APC 3 0.86
1953
1964
APC 4 -3.91
4
1858

• 150 Years Ago

5
1858 - History

• Edwin T. Holmes installs 1st electric burglar
  alarm (Boston, Massachusetts)
• Pencil with attached eraser patented by Hyman L.
  Lipman
• Abraham Lincoln says "A house divided against
  itself cannot stand"
• Fee 1st charged to see a baseball game (50 cents
  ) (New York beats Brooklyn 22-18)

6
1858

• Queen Victoria and President Buchanan exchange
  messages over the first transatlantic cable

7
1858

• Guillaume-Benjamin-Amand Duchenne documented the
  case of a 9-year-old boy who was losing the
  ability to walk due to a muscle-wasting disease.
• Demonstration of the contagious nature of
  puerperal fever (childbed fever) (Ignaz
  Semmelweis)

8
1858

• Charles Darwin publishes the Origin of the
  Species by Means of Natural Selection in 1859

9
Highlights From the 17th Annual MA vital
statistics report - 1858

• There were 84 pages of text, followed by 11
  tables for 1858 and
• 9 tables for 1852 to 1858
• The birth tables included Plurality Births
  (684, 2 339 sets of twins 2 sets of triplets)
  and Illegitimate Births (293, 75 or 26 at the
  state almshouses)
• Persons Married by Conjugal Conditions, i.e.,
  Bachelors to Maids (8,108), Bachelors to
  Widows (451), Widowers to Maids(1,207),
  Widowers to Widows (613) seasons the largest
  number of marriages are associated with the
  festivities of our annual Thanksgiving holidays,
  which occur in the month of November
• The year 1858 was one of comparative immunity
  from excessive death
• Statistics were compared with those of England,
  e.g., mean duration of life for Massachusetts
  40 years, for England in 1841, 41 years.

10
MA Vital Statistics - 1858
Population 1,191,568
11
1908

• (100 Years Ago)

12
1908

• Henry Ford mass produces the Model T.
• British suffragettes begin a campaign for female
  suffrage.
• Bureau of Investigation, forerunner of the FBI,
  is founded.
• Grand Canyon National Monument is designated
  (becomes a National Park in February 1919).

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VITAL STATISTICS IN SOME MUNICIPAL REPORTS.
CRESSY L. WILBUR, M. D.Chief Statistician,
Bureau of the Census, Washington, D. C.
There were 109 cities of this size (50,000), out
of which number the annual reports of eighty-six
were available for either 1910, 1911, or 1912. In
these eighty-six reports there were about 6,395
pages devoted to matters of public health, of
which 1,782 pages, or 27 per cent, consisted of
tables or discussions of vital statistics. The
fact that over one fourth of the permanent
printed records of the activity of the municipal
health departments of the country consists of
vital statistics would seem to indicate that
great care should be taken to make such records
accurate, precise, and thoroughly comparable with
those of other cities, of the states, and of the
nation. Yet it is extremely difficult, in a very
large proportion of cases, to obtain exact
information in regard to some of the most
elementary facts, such, for example, as the total
number of births (living births, exclusive of
stillbirths), the total number of deaths (again
exclusive of stillbirths but inclusive of all
other deaths of children born alive that occurred
in the area under consideration), or the causes
of death (properly compiled in accordance with
the International List, and hence comparable with
the statistics of other offices).
great care should be taken to make such records
accurate, precise, and thoroughly comparable with
those of other cities, of the states, and of the
nation.
Yet it is extremely difficult to obtain exact
information in regard the total number of
births (living births, exclusive of stillbirths),
the total number of deaths (again exclusive of
stillbirths but inclusive of all other deaths of
children born alive that occurred in the area
under consideration), or the causes of death
(properly compiled in accordance with the
International List, and hence comparable with the
statistics of other offices)
Read before the Joint Session of the Sections
of Municipal Health Officers and Vital
Statistics, American Public Health Association,
Colorado Springs, September, 1913. Am J Public
Health, 1914 Feb 01, 120-574
14
VITAL STATISTICS IN SOME MUNICIPAL REPORTS.
Cressy, 1914, Continued
At the outset one is met by the difficulty that a
considerable proportion (nearly one fifth) of the
eighty-six reports examined are for years other
than the calendar year. This makes the
compilations practically worthless for many
purposes of comparison. The total number of
deaths for the same group of sixty-seven
cities (326,884) also slightly exceeded the
number compiled by the census for the same cities
and years (326,505). The difference, only 379
deaths, may not fully represent deaths not
returned because the figures for certain city
reports include stillbirths. Some of the offices
attempting to make use of the International List
of Causes of Death , either in its original or
revised editions, have seen fit to modify it,
sometimes even adding new divisions or groups, so
that the purpose of uniformity and comparability
is entirely or largely defeated..
reports are for other than the calendar year..
This makes the compilations practically
worthless for many purposes of comparison.
The number of deathsMay not fully represent
deaths because the figures for certain city
reports include stillbirths.
Some of the offices have seen fit to modify the
International List of Deaths, sometimes even
adding new divisions or groups, so that the
purpose of uniformity and comparability is
entirely or largely defeated
15
POPULARIZING VITAL STATISTICSC. ST. CLAIR DRAKE,
M. D.,Director, Illinois State Department of
Public Health, Springfield, Illinois.
Fitting dry-as-dust vital statistics to the
psychology of the people is one of the most
important problems in modem popular health
education. For the benefit of brother health
officers Dr. Drake gives a few leaves out of his
own experience in impressing fundamental
statistical truths on a public that demands
interesting presentation together with pictures
and variety and novelty. It has long been
recognized that the average citizen, rich or
poor, can appreciate the value of dollars and
cents more clearly than that of human life or
human efficiency and, on this account, a common
method of popularization of vital statistics has
come to be the expression of human wastage in
terms of money.
It has long been recognized that the average
citizen, rich or poor, can appreciate the value
of dollars and cents more clearly than that of
human life
Read before Section on Vital Statistics,
American Public Health Association, at New
Orleans, La.,October 29, 1919. 1920 Feb 01, Am J
Public Health, 112-574.
16
Some years ago, when it seemed particularly
desirable to impress upon the people of Chicago
the unnecessary wastage due to communicable
diseases and when mere words, however expressive,
seemed to arouse little attention, we employed
the plan of measuring the cost of these diseases
to the several city wards in silver dollars and
illustrated the cost by pictures showing these
piles of dollars as compared in height with the
Masonic Temple, then the highest and best known
building in the city. When it was shown that
diphtheria, scarlet fever and measles, for a
period of six months, had cost one city ward a
stack of silver dollars over nine times as high
as the twenty-story Masonic Temple, there was
general surprise and very extensive discussion,
the important thing was that a much larger
percentage of the Chicago population was
thinking of the value of health more
definitelythan it had been formerly.
POPULARIZING VITAL STATISTICS, DRAKE, Continued
When it was shown that diphtheria, scarlet fever
and measles, for a period of six months, had
cost one city ward a stack of silver dollars
over nine times as high as the twenty-story
Masonic Temple, there was general surprise and
very extensive discussion, the important thing
was that a much larger percentage of the Chicago
population was thinking of the value of health
more definitelythan it had been formerly.
17
Highlights from the 67th Annual MA Vital
Statistics Report - 1908

• Used the 1st (1900) Revision of the International
  Classification of Causes of Death
• Number of tables was reduced from the 90s and
  tables with no practical utility were
  eliminated
• Omitted tables that depended on the decennial
  census
• Statistics on illegitimate births were omitted
  because they would be practically a violation of
  the law
• The statistics of the births is less accurate
  than those of marriage and births

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MA Vital Statistics - 1908
Population 3,129,128
19
1908 Nativity of Mothers1
1Public Document 1, 1908, Secretary of
Commonwealth of Massachusetts, accessed from
http//www.books.google.com.
20
Non-U.S. Born Mothers Massachusetts 1990-2006
5.2 APC
1.4 APC
Statistically Significant (p .05) APC
Annual Percentage Change
21
1933

• (75 Years Ago)

22
1933

• The Lone Ranger debuts on radio.
• American President Herbert Hoover is succeeded by
  Franklin D. Roosevelt
• Great Depression The U.S. Congress begins its
  first 100 days of enacting New Deal legislation.
• The first Major League Baseball All-Star Game is
  played at Comiskey Park in Chicago.

23
Statistics and the Health OfficerGEORGE B. L.
ARNER, PH.D.,U. S. Bureau of the Census,
Washington, D. C.
IT is not my purpose to review the rise and
progress of preventive medicine. It is enough to
say that with the concentration of population in
the new industrial cities there came the
beginning of sanitation. Then in the last half of
the 19th century came the brilliant discoveries
of Pasteur, Koch, and a host of other scientists,
which now form the basis of the efficient work of
the modern health officer. The record of these
triumphs of sanitation and preventive medicine is
the subject matter of vital statistics. Vital
statistics are inseparable from preventive
medicine just as accounting is inseparable from
modern business. Without vital statistics the
health officer, the modern public health
administrator, would be working in the dark. He
would have no means of measuring the degree of
his success or failure The health officer does
not need to be a vital statistician, any more
than a business man needs to be an accountant,
but he should be able to understand vital
statistics and to use them effectively in his
daily work. He should know the uses and the
limitations of every device used in vital
statistics, although he may depend upon his
statistician to compute even the crude death rate
and the infant mortality rate.
Vital statistics are inseparable from preventive
medicine just a accounting is inseparable from
modern business.
The health officer does not need to be a vital
statistician, any more than a business man needs
to be an accountant, but he should be able to
understand vital statistics and to use them
effectively in his daily work.
Read before Health Officers Section, American
Public Health Association at Sixty-first Annual
Meeting in Washington, D.C., October 24, 1932.
Am J Public Health, 23, 28-34.
24
Statistics and the Health Officer, ARNER,
Continued
Statistics, like the Holy Scriptures, are usually
accepted on faith, and they lend themselves
readily to the spreading of false doctrine. The
devil can quote Scripture, and the booster, the
propagandist, the high pressure salesman, and the
unscrupulous advertiser can prove anything by
statistics Vital statistics, as well as
economic statistics, lend themselves readily to
the use of the professional booster and to the
health officer whose chief interest is his own
self-glorification The health officer should
understand and correctly interpret the findings
of the statistician. For example, the crude death
rate is frequently misused by those who do not
understand its shortcomings. The crude death rate
is easy to compute and readily understood, and is
very useful within proper limits, but beyond
those limits it may be grossly misleading. For
comparisons between cities or between any two
areas of different social composition, it is
often improperly used. In order to make an
honest comparison of death rates between one
community and another, the death rate must be
adjusted for residence and corrected for age. The
adjustment of death rates for residence, as well
as the adjustment of birth rates by residence of
the mother, can only be made if the information
as to residence is accurately stated on the death
and birth certificates.
The crude death rate is easy to compute and
readily understood, and is very useful within
proper limits, but beyond those limits it may be
grossly misleading.
In order to make an honest comparison of death
rates between one community and another, the
death rate must be adjusted for residence and
corrected for age
25
1933

• In 1932, the Public Health Service, working with
  the Tuskegee Institute, began a study to record
  the natural history of syphilis in hopes of
  justifying treatment programs for blacks. It was
  called the "Tuskegee Study of Untreated Syphilis
  in the Negro Male."

26
Names of NAPHSIS

• 1933 American Association of State Registration
  Executives
• 1938 American Association of State and Provincial
  Registration Executives
• 1939 American Association of Registration
  Executives (AARE)
• 1958 American Association for Vital Records and
  Public Health Statistics (AAVRPHS)
• 1980 Association for Vital Records and Health
  Statistics (AVRHS)
• 1995 Association for Public Health Statistics and
  Information Systems (APHSIS)
• 1996 National Association for Public Health
  Statistics and Information Systems (NAPHSIS)

27
Highlights from the From 92nd Annual MA Vital
Statistics Report-1933

• Death registration often gives the first
  intimation of pestilential disease, permitting
  health officers to attack epidemics in their
  incipiency.
• Used 4th (1929) Revision of the International
  List of Causes of Disease
• Heart Disease was the leading cause of death in
  1933.
• No accurate data are available for death rate
  per number of automobilesas the Department of
  Public Works show the number of machines
  registered, and thus contain duplications, since
  one machine may be registered more than once in a
  calendar year.
• The birth rate (14.7 live births per 1,000
  population) was the lowest ever recorded in MA,
  and the IMR was the lowest on record

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Highlights from the From 92nd Annual MA Vital
Statistics Report-1933 (cont.)

• Marriages may be performed by a minister of
  the gospela rabbi of the Israelitish faithby a
  justice of the peaceamong Friends or Quakersno
  person shall solemnize a marriageunless he can
  read and write in the English language
• The practical purposes of marriage records are
  As evidence to establish dower and curtesy rights
  of husband and wife.for pension purposes and to
  prove legitimacy of children
• The average number of years libellants were
  married at the time of application of divorcewas
  10.4 years in 1933
• Divorce table statistics were by cause of
  divorce Desertion, Cruel and abusive treatment,
  Adultery, Intoxication, Non-support, Impotency,
  and Imprisonment. Cruel and abusive treatment was
  the leading cause.

29
MA Vital Statistics - 1933
Population 4,318,137
30
1958

• 50 Years Ago

31
1958

• The Soviet Union launches Sputnik 3.
• Ted Williams oldest player in history to win
  batting crown (.328) at age 40.
• American League wins All-Star Game 4-3 in
  Baltimore (on my birthday)
• President Dwight D. Eisenhower signs the Alaska
  Statehood Act into United States law.
• Instant noodles go on sale for the first time.
• A CDC team traveled overseas, for the first time,
  to Southeast Asia to respond to an epidemic of
  cholera and smallpox

32
VITAL STATISTICS -THEIR PAST AND FUTURECarl L.
Erhardt, M.P.A., M.S. (Hyg.), F.A.P.H.A..
New ways of tabulating vital statistics are
constantly adding to their usefulness. More
detailed data are made available for small areas
and the term "small areas" includes, in addition
to census tracts or other traditional segments of
a city, hospital service areas and individual
hospitals. Greater emphasis is being placed on
birth statistics with reduction of infant
mortality to a resistant plateau we have
recognized that more information is needed about
the course of the pregnancy and delivery. As a
result, such facts as period of gestation, weight
at birth, complications of pregnancy, and
operative interventions are ascertained on the
birth certificate for each delivery in most
states and in some areas even more factors are
investigated.
New ways of tabulating vital statistics are
constantly adding to their usefulness. More
detailed data are made available for small areas
and the term "small areas" includes, in addition
to census tracts or other traditional segments
of a city, hospital service areas and individual
hospitals.
This paper was presented before a Joint Session
of the Association for Vital Records and Public
Health Statistics and the Statistics Section of
the American Public Health Association at the
Eighty-Sixth Annual Meeting in St. Louis,
Mo., October 27, 1958. Am J Public Health, 49
192-196.
33
VITAL STATISTICS -THEIR PAST AND FUTURECarl L.
Erhardt, M.P.A., M.S. (Hyg.), F.A.P.H.A..
The relative stabilization of infant mortality
has also stimulated more intensive investigation
of prenatal mortality a number of states now
require reporting of all terminated pregnancies,
regardless of period of gestation, in efforts to
get better indications of the full extent of
pregnancy wastage and to encourage further
exploration of its causes Administrative control
of programs is demanding more extensive use of
statistics. But here the statistician must urge
extreme caution on the administrator lest the
tail wag the dog. Collection of data for
administrative purposes can become so detailed
that the expense of its collection is
unwarranted. Gaines phrased the idea succinctly
when he said, "Be sure the juice is worth the
squeeze." An even greater danger, however, is
that the detail becomes so marked that no one any
longer bothers to look at the material. The
effort then becomes a complete waste, for we not
alone squeeze more juice than is needed, but do
not even drink any of it. .
the statistician must urge extreme caution on
the administrator lest the tail wag the dog.
Collection of data for administrative purposes
can become so detailed that the expense of its
collection is unwarranted. Gaines phrased the
idea succinctly when he said, "Be sure the juice
is worth the squeeze." An even greater danger,
however, is that the detail becomes so marked
that no one any longer bothers to look at the
material. The effort then becomes a complete
waste, for we not alone squeeze more juice than
is needed, but do not even drink any of it.
34
Highlights from the 117th MA Vital Statistics -
1958

• the steadily declining rate in infant
  mortalityis largely due to constantly improving
  methods of infant feeding and the continued
  developments in community and home sanitation...
• Causes of death were from the International
  Classification of Diseases, 7th Revision, 1955.
• Tx of Infants Eyes after birth Chapter 46,
  Acts of 1943 requires attending physician to
  recordthe use of a prophylactic remedy with
  which he has treated the eyes of a child
• Married persons are now referred to as Brides
  and Grooms
• Divorces on the grounds of desertion have
  decreased 28.5 per cent in the last twenty-five
  years

35
MA Vital Statistics - 1958
Population 4,946,055
36
1983

• (25 Years Ago)

37
1983

• 1983 First gene is mapped
• CDC established a Violence Epidemiology Branch to
  apply public health prevention strategies to
  child abuse, homicide, and suicide.
• McDonald's introduces the McNugget

38
Highlights from the 142nd MA Vital Statistics -
1983

• Uses ICD-9 International classification of
  Diseases (WHO)
• 2,000 copies of the report are distributed to
  federal, state, and local agencies
• Although there appears to be a growing interest
  in home births, such births accounted for only
  439 births registered in 1983.
• The rank order of the ten leading causes of
  deaths changed slightly in 1983 with pneumonia
  and influenza in 4th place and accidents in 5th.
• Heart disease (39.1) and cancer (23.8) are
  slightly higher that the U.S. percentages.

39
MA Vital Statistics - 1983
Population 5,750,015
40
2008

• The 75th Anniversary

41
Highlights from MA Birth and Death Statistics -
2006

• While the number of white non-Hispanic births
  remained stable, there were significant increases
  in the numbers of Hispanic (6.3). Black
  Non-Hispanic (6.1), and Asian (4.1) births
• Gestational diabetes mellitus (GDM) is an
  emerging issue associated with an increased risk
  of developing overt diabetes
• In 2006, the Cesarean section delivery rate rose
  to an all time high of 33.4 of all deliveries.
• The age-adjusted death ratefell to a record low
  of 717.6 deaths per 100,000 population.
• The International Classifications of Disease,
  Revision 10 (ICD-10) is used in the Deaths
  Report.
• In 2006, cancer was the leading cause of death
  in Massachusetts, surpassing heart disease for
  the first time
• There was a 23 increase in the number of
  poisoning deaths among Massachusetts residents.

42
MA Vital Statistics - 2006
Population 6,437,193
43
MA Vital Statistics in 25 Year Intervals from
1858
44
MA Cause of Death Rates in 25 Year Intervals
from 1858
45
Summary

• Ascertainment
• Interpretation
• Presentation
• Influence by programs on data collection
• Framing vital stats human economic terms
• Some basic demographics in MA havent changed in
  100 years

46
Causes of Death Massachusetts 1842-2006