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Arialdi M. Miniño, MPHNational Center for Health Statistics

Presented at the 134th Annual Meeting & Exposition of the American Public Health Association

Continuing Education Institutes

November 4, 2006Boston, MA

National Vital Statistics System - MortalityNational Vital Statistics System - Mortality

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Staff – Mortality Statistics BranchStaff – 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

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National Vital Statistics System 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)

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• 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

National Vital Statistics System, cont.National Vital Statistics System, cont.

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U.S. Standard Certificate of Death, first third U.S. Standard Certificate of Death, first third

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U.S. Standard Certificate of Death, mid third U.S. Standard Certificate of Death, mid third

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U.S. Standard Certificate of Death, last third U.S. Standard Certificate of Death, last third

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• 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)

Sample of Major Users of National Mortality DataSample of Major Users of National Mortality Data

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• 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

Sample of Major Users of National Mortality DataSample of Major Users of National Mortality Data

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• 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

Two Data Series for MortalityTwo Data Series for Mortality

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List of Variables and Locations on FileList of Variables and Locations on File

General Tape Locations

The Decedent Tape Locations

Record Type 19 Month of Death 55-56 Resident status 20 Sex 59 Place of death and decedent’s status 75 Race 60-63 Day of week of death 83 Age 64-74 Date of data receipt 110-114 Marital status 77 Data year 115-118 State of birth 78-79 Manner of death 139 Hispanic origin 80-81,82 Activity code 140 Education 52-53, 54 Place of injury 141

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List of Variables and Locations on File, cont.List of Variables and Locations on File, cont.

Residence Tape Locations

Occurrence Tape Locations

State 31-32,43 Reporting Area 3 Expanded State 44-45 State 21-22,28 County 33-35 Expanded State 29-30 County Population size 50 County 23-25 City 36-38 County Population size 49 City Population size 39 Region 26 Met/Nonmet county 40 Division 27 Region 41 FIPS State 119-120 Division 42 FIPS County 121-123 PMSA/MSA 46-48 PMSA/MSA Population size 51 FIPS State 124-125 FIPS County 126-128 FIPS Place 97-101 FIPS PMSA/MSA 129-132 FIPS CMSA 134-135

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List of Variables and Locations on File, cont.List of Variables and Locations on File, cont.

Underlying Cause of Death

Tape Locations

Tape Locations

ICD-10 code 142-145 Entity-Axis conditions 358 cause recode 146-148 Number of… 160-161 113 cause recode 151-153 Each condition 162-301 130 cause recode 154-156 39 cause recode 157-158 Number of… 338-339 Place of injury 141 Each condition 341-440 Injury at work 136

Multiple Causes of Death

Record-Axis conditions

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States Using New (Revised 2003) Standard Certificate for 2004 Data YearStates Using New (Revised 2003) Standard Certificate for 2004 Data Year

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.

New StandardBalance of States & Registration Offices

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NCHS Reports Using NVSS Mortality DataNCHS Reports Using NVSS Mortality Data

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NCHS Reports Using NVSS Mortality DataNCHS Reports Using NVSS Mortality Data

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NCHS Reports Using NVSS Mortality DataNCHS Reports Using NVSS Mortality Data

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NCHS Reports Using NVSS Mortality DataNCHS Reports Using NVSS Mortality Data

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NCHS Reports Using NVSS Mortality DataNCHS Reports Using NVSS Mortality Data

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Other Reports Using NVSS Mortality DataOther Reports Using NVSS Mortality Data

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Other Reports Using NVSS Mortality DataOther Reports Using NVSS Mortality Data

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Other Reports Using NVSS Mortality DataOther Reports Using NVSS Mortality Data

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Trend Data Using Multiple Years’ Mortality DataTrend Data Using Multiple Years’ Mortality Data

Age-adjusted Death Rates for HIV Disease: United States, 1987-2003

0

5

10

15

20

25

30

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

De

ath

s p

er

10

0,0

00

sta

nd

ard

po

pu

lati

on

both sexes

male

female

ICD-10 codesB20-B24

ICD-9 codes *042-*044

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Issues Affecting Interpretation, Analysis & Handling of NVSS Mortality DataIssues 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 decedentCheckboxes for specific causes of deathAvailability 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

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Trend Discontinuities Across ICD Revisions in the U.S.Trend Discontinuities Across ICD Revisions in the U.S.

Source: National Vital Statistics SystemYear

0

5

10

15

20

25

30

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ICD-6 ICD-7 ICDA-8 ICD-9

Age-adjusted death rates for Nephritis, nephrosis & nephrotic syndrome: United States, 1950-2002

Age

-ad

just

ed D

eath

Rat

e p

er 1

00,0

00 U

.S. S

tan

dar

d P

opu

lati

on

ICD-10

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Analysis of Time Series Across RevisionsAnalysis of Time Series Across Revisions

Source: National Vital Statistics SystemYear

7

8

9

10

11

12

13

14

15

Age

-ad

just

ed D

eath

Rat

e p

er 1

00,0

00 U

.S. S

tan

dar

d P

opu

lati

on

R2=.7372APC=3.9%

ln(rate)=a+b1(year)

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Analysis of Time Series Across RevisionsAnalysis of Time Series Across Revisions

Source: National Vital Statistics SystemYear

7

8

9

10

11

12

13

14

15

Age

-ad

just

ed D

eath

Rat

e p

er 1

00,0

00 U

.S. S

tan

dar

d P

opu

lati

on

R2=.9898APC=0.8%

ln(rate)=a+b1(year)+b2

1=ICD-100=ICD-9

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Access to Public Use Data and Relevant DocumentationAccess to Public Use Data and Relevant Documentation