Arialdi M' Minio, MPH

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

• 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

5
U.S. Standard Certificate of Death, first third
6
U.S. Standard Certificate of Death, mid third
7
U.S. Standard Certificate of Death, last third
8
Sample of Major Users of National Mortality Data

• 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)

9
Sample of Major Users of National Mortality Data

• 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

10
Two Data Series for Mortality

• 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

11
List of Variables and Locations on File
12
List of Variables and Locations on File, cont.
13
List of Variables and Locations on File, cont.
14
States Using New (Revised 2003) Standard
Certificate for 2004 Data Year
Balance of States Registration Offices
New Standard

• 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.

15
NCHS Reports Using NVSS Mortality Data
16
NCHS Reports Using NVSS Mortality Data
17
NCHS Reports Using NVSS Mortality Data
18
NCHS Reports Using NVSS Mortality Data
19
NCHS Reports Using NVSS Mortality Data
20
Other Reports Using NVSS Mortality Data
21
Other Reports Using NVSS Mortality Data
22
Other Reports Using NVSS Mortality Data
23
Trend Data Using Multiple Years Mortality Data
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
Trend Discontinuities Across ICD Revisions in the
U.S.
26
Analysis of Time Series Across Revisions
ln(rate)ab1(year)
R2.7372 APC3.9
Age-adjusted Death Rate per 100,000 U.S.
Standard Population
Year
Source National Vital Statistics System
27
Analysis of Time Series Across Revisions
1ICD-10
ln(rate)ab1(year)b2
0ICD-9
R2.9898 APC0.8
Age-adjusted Death Rate per 100,000 U.S.
Standard Population
Year
Source National Vital Statistics System
28
Access to Public Use Data and Relevant
Documentation