National Mortality Data Set Kenneth D Kochanek Mortality

National Mortality Data Set Kenneth D. Kochanek Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics Data Users Conference July 12 -14, 2004

Presentation Outline • • • National Vital Statistics System Nature of the System – Decentralized Role of the States Role of NCHS Role of the World Health Organization (WHO) Mortality Data • • Multiple Cause-of-Death Data • Entity Axis Applications • Record Axis Applications • • Underlying Cause-of-Death Data • Advantages of Underlying Cause-of-Death Data • Limitations of Underlying Cause-of-Death Data Electronic Death Certificate Data Dissemination

Nature of the National Vital Statistics System • • The National Vital Statistics System is decentralized • Statistics that are produced by NCHS are based on information obtained from certificates filed in the States where events occur • Cooperation between NCHS and the States is governed by contracts of agreement There are no laws at the national level requiring the collection of vital statistics data SOURCE: CDC/NCHS

Role of States • • • State laws govern filing of certificates and reports States produce their own certificates and reports States code the information Vital Statistics Cooperative Program (VSCP) Availability of certificates and reports SOURCE: CDC/NCHS

Role of NCHS • To compile and publish national and subnational vital statistics • To promote coherence and uniformity of the data collected through the VSCP SOURCE: CDC/NCHS

Promote Data Quality • Model law • Handbooks • Training and instruction manuals • Various publications • Standard certificates and reports • Quality control SOURCE: CDC/NCHS

Mortality Data • Mortality statistics are based on information from the approximately 2. 3 million death certificates filed each year in the 50 States and the District of Columbia • The Death Certificate serves two very different purposes

Death Certificate • A legal document regarding the facts and circumstances of a death • A statistical resource providing information on characteristics of the decedent SOURCE: CDC/NCHS

Role of World Health Organization • Promoting standardization of mortality statistics through the International Classification of Diseases (ICD) • Compiling international mortality statistics SOURCE: CDC/NCHS

Role of ICD • Provides standard definitions • Prescribes the format for cause-of-death information on the death certificate • Describes how death certificate should be completed • Provides rules for selecting the underlying cause of death SOURCE: CDC/NCHS

Underlying Cause of Death • “The disease or injury which initiated the chain of morbid events leading directly to death, or • The circumstances of the accident or violence that produced the fatal injury. ” SOURCE: CDC/NCHS

Computer Software • ACME: Automated Classification of Medical Entities • TRANSAX: Translation of Axes • MICAR: Mortality Medical Indexing, Classification and Retrieval • Super. MICAR SOURCE: CDC/NCHS

Advantages of Underlying Cause of Death • Simple and one dimensional • Conceptually easy to understand • Well-accepted measure of mortality • Useful to public health officials SOURCE: CDC/NCHS

Limitations of Underlying Cause of Death • Only one disease selected • Arbitrary selection • Excludes information • Certifier mistakes • Only as good as the information on the death certificate SOURCE: CDC/NCHS

Multiple Cause of Death • Portrays the number of deaths in which a given condition is a significant factor contributing to death, if reported • Portrays the Interaction of diseases • Contains two fields: • Record Axis • Entity Axis SOURCE: CDC/NCHS

Entity Axis Applications • Relationships among conditions • Accuracy of certification reporting • Testing traditional assumptions of underlying cause selection SOURCE: CDC/NCHS

Record Axis Applications • Classifiable in manner like the underlying cause of death • Best representation of ICD codes SOURCE: CDC/NCHS

Electronic Death Certificate (EDC) • Certifier and funeral director data entry in electronic form, including • prompts • tutorials • querying for incomplete or uninformative terms • querying for implausible cause of death sequences SOURCE: CDC/NCHS

Data Dissemination • • • Preliminary Report Final Report Monthly National Vital Statistics Reports Special reports Public use micro data – CD-ROM Confidentiality SOURCE: CDC/NCHS

CD-ROM’s • Mortality Public Use Data Sets • ASCII Dump CD-ROM’s 1968 -2001 • SETS CD-ROM’s 1991 -98 • Compressed Mortality File (CMF)

Mortality Data from the National Vital Statistics System website: http: //www. cdc. gov/nchs/about/ major/dvs/mortdata. htm