section 7- technical appendix- page 1 · nchs from copies of the original cert}flcates the...

SECTION 7- TECHNICAL APPENDIX- PAGE 1

SOURCES OF DATA

Death and fetal-death statistics

Mortality statistics for 1986 are, = for* previotu yearsexcept 1972, based oninfom@on from -Ofdtiorxwsingintbe UnE8d Sta=Fd-dedh xMM=for-’yyear are based on all repats of fetal death received by theNational Center for Heafth Statistics (NCHS).

‘fIre death-registration system and the fetal-death re-porting sy~temof the Lhuted States ●ncompass the 50 States.the District of Columbia New York Cih (which is inde-pendent of New York State for the purpose of death regwtration). Puerto Rico. the Virgin Islands. Guam, AmericanSamoa and the Tmst Territon of the Pacific Islands. In thestatistical tabulations of this pubhcation, United Wstes re-fers only to the aggregate of the so States (including NewYork City) and the D]stnct of Columbia Tabulations forGuam. Puerto Rico. and the Virgin Islands are shown sep-arately in tlus volume. NOdata have ever been included forAnencan Samoa or the Tmst Ternto~ of the Paciilc Islands.

llse Virgin Islands was admitted to the ““registrationarea” for deaths in 1924. Puerto Rico. in 193?. and Guam.m 197fJ Tabulations of death statistics for Puerto Rico andthe Virgin Mands were regular]} shown in the annual iol-urnes of Vital Stotisti-m cfthe L’nitecf States from the year oftheir admission through 1971 except for the years 1967through J965. and tabulations for Guam were included for1970 and 1971 Death statistics for Puerto RJco.the VuginIslands. and Guam were not includtd in the 1972 volumebut have been included in section 8 of the volumes for●ach of the years 1973-76 and in section 9 beginning with1979. Information for 1972 for these three areas W* pub-hshed in the respective annual vital statistics reports of theDepartment of Health of the Commonwealth of Puerto Rico.the Department of Health of the Virgin Islands. and theDepartment of Pubhc Health and Social Services of theGo, ●mment of Guam.

Procedures used by XCHS to collect death statisticshave changed over the years Before 1971, tabulations ofdeaths and fetal deaths were based solely on informationobtained b! NCHS from copies of the original cert}flcatesThe information from these cupies was ●dited, coded. andtabulated. For 1960-70. all mottahv inforrrmtlon taken fromthese records was transferred by NCHS to magnetic tapefor computer processing.

Beginning with 1971. an increasing number of Stateshave prorlded NCHS with computer tapes of data codedaccording to NCHS specifications and provided to NCHSthrough the Vital Statistics Cooperative Program. The yearin which State-coded demographic data were first trans-mitted on computer tape to NCH S is shown below for ●ach

of the States, New York City, Puerto NCO,and the wetof Columbia all of which now furnish demographic or nors-mednl data on tape.

1971

Floridx

1972

MaineMissouriNew HampshireRhode islandt’erroont

1973

ColoradoMichiganNew York (except

Xew York City}

.1974

I!lmols *IowaKansas%lontanaNebraskaOregonSouth Carohna

1975

Louisianaif qlandNorth CarolinaOklahomaTennesseeVirgm]a\Viscensin

19Y6

AlabamaKentuckyMinnesota!GevadaTexasWest Virginia

1977

AlaskaIdahoMassachusettsXCw York CityC)hioPuerto Rico

1975

IndianaUtah\Va,shingtcm

1979

ConnecticutHdlt aiiMlsslsslpplNew JerseyPennsylvania\Vyommg

1960

Arkansa5Xeu MexicoSouth Dakota

19K2

North Dakota

1965

ArixonaCaliforniaDe]awarcCeorg]aDistrict of

Columbia

For the Virgin Islands and Guam mortality statistics for1986 are based on information obtained directly by

SECTION 7 -TECHNICAL APPENDIX - PAGE 2

NCHS from copies of the original certificates recei\ ed fromthe registration offices

In 1974. States began coding medical (cause-of-death)data on computer tape< .ictordmg to NCHS specifwat)onsThe year in which Stat*coded medical data were fust trans-mitted to NCHS is shown below for the 22 States now fur.nishing such data

1974

IowaMichigan

1975

Louisiana!$ebraskaNorth CarolinaVirginiaWisconsin

1980

ColoradoKansasMassachusettsMississippiNew,HampshirePennsylvaniaSouth C=ohna

1981

Maine

1963

Minnesota .

1964

Ma@andNeu York State (except

New York City) -Vermont

19b6

CaliforniaFloridaTehas

For 1986 and previous years ●xcept 1972. NCHS cixfedthe medical inforrnat]on from copies of the original ce~ifi-cates received from the registration offwes for all deathsOccurnng in those States that were not furnishing NCHSwith medical data coded accorckng to NCHS specifications.For 1981 and 19%?.it wu necess~ to change these pr~cedures because of a backlog m coding and processing thatresufted from personnel and budget~ restrictions To pmduce the mortali~ files on a timely basis with reduced re-sources, NCHS used Stateasded underling causeof-deathinformation supplied by 19 States for so percent of therecords. for the other 50 percent of the records for theseStates as well as for 100 percent of the records for theremairm-yz21 registration areas. NCHS coded the medicalinfomratlon

Mortality statistics for 1972 were based on informationobtained ham a SO-percent sample of d~ath records insteadof from all records as in other years. The sample resultedfrom personnel and budgetq restrictions. Sampling varia-tion assomatcd with the 50-percent sample is describedbelow in the section “’Estimates of ●mors arising from 50-percent sample for 1972.””

Fetal-death data are obtained directly from copies oforiginal reports of fetal deaths received by !SCHS.exceptNew York State (excluding New York City). wh]ch submitted State-coded data m 1986 Fetal-death data are notpublished by NCHS for the Virgin Islands and Guam.

Standard certificates and reports

The US Standard Certificate of Death and the U.S.Standard Repofl of Fetal Death. issued by the Public HealthService, have served for many yesm as the principal meansof attaining uniformity in the content of documents used tocollect information on these ●vents. They have been mod]-fied in each State to the ●xtent required b} the particulwneeds of the State or by special provisions of the State vitalstatistics law. However, the certificates or reports of mostStates confimn closely in content and arrangement to tbeStandards.

The first issue of the U.S. Standard Certificate of Deathappeared in 1900. Since then. it has been revised periodi-cal! b! the national vital statistics agent} through consul-tation u6tJrState heafth officers and regktram Federd ●gen-cies concerned with \ital statistics; national. Sine. and rmurrtymedicaf societies. and others working in such fields as publichealth. social welfare. demography. and insurance This re-vision procedure has assured careful ewshsationof ●ach itemin terms of its cument and future usefulness for legal, medi-cal and heafth, demographic, and research purposes. Newitems have been added when necessary. and old items h.+icbeen modif]ed to ensure better reporting. or in some sawshave been dropped when their usefulness appeared to belimited.

New revisions of the U.S.Standard Certificate of Deathand the U.S. Standard Report of Fetal Death were recom-mended for State use beginning ]anu~ 1.1975. The U.SStandard Certificate of Death and the U.S. Standard Repmtof Fetal Death are shown in figures 7-A and 7-B. The cer-tificate of death shown in figure 7-A is for use by a phy-sician. a medical examiner. or a coroner. Two other formsof the K.S Standard Certificate of Death are aiailahle. theyare similar to the one shown except that the section oncertification is designed for the physicians signature onone. and for the med]cal examiners or coroner”s signatureon the other.

.4mong the changes in the new re~ision were the addi-tions of(1) an item asking “If Hosp or Inst.. Indicate DO.4.OP/Emer. Rrn., Inpatienf” and (2) an item “’\VasDecedentEver in US. Amsed Forces?” The fatter item was previouslyon the certificate but was deleted during 1966 through1977. .4n item on whether autops} findings were consideredfor determining cause of death was dropped.

HISTORY

The first death statistics published b! the Federal cov-●mment concerned ●vents in 1850 and were based on sta-tistics collected during the decennial census of that year.In 1880a national ‘registration area”’was created for deaths.Originally consisting of two States (Massachusetts and NewJemey). the District of Columbia and several large citieshaving ef%cient systems for death registrations. the death-registration wea continued to expand until 1933. when itincluded the entire United States for the first time. Tablesthat show data for death-nigistration States include the Dis-trict of Columbia for all years. registration cities in nonreg-

SECTION 7 – TECHNICAL APPENDIX - PAGE 3

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istration States are not included. For more details on thehiston of the death-registration area see the TechnicalAppendL~in I’itrdStatistics tithe L’rsik’dState&1979, Vokrne11.Mortali~. Part A. Section 7. pages 34 and the section“Histo~ and Organization of the Vital Statistics System.””chapter 1. Vital .Watastics oj the United States, J950, vol-ume L pages 2-19.

Statistics on fetal deaths were first published for thebirth-registration area in 1918, and then eve~ year begin-ning with 1922

CLASSIFICATION OF DATA

The principal vafue of vital statistics data is reahzedthrough the presentation of rates. u+hichare computed by

relating the vital events of a class to the population of asimilarly defined class. Vital statistics and populatmn statis-tics must theretore be cksified according to similarl} de-fined systems and tabulated in comparable groups. Evenwhen the variables common to both, such as geographicarea age. sex and race. have been similarly ckssif)ed andtabulatecL differences between the enutnerat]on method ofobtaining ~pulation data and the re~stration method ofobtaining vital statistics data may result in significant dw-crepancies.

The general rules used in the classificationof geographicand personal items for deaths and fetal deaths for 19b6 areset fotih in two instruction manuals (NCHS. 1966a 1986b)

A discussion of the classification of cefiain importantitems is presented below.

SECTION 7- TECHNICAL APPENDIX - PAGE 4

FIGURE 7-B.

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wn4.163a,. 1/79

Classification by occurrence and residence 1970. the total number of deaths in the United States by

Tabulations for the United States and specified ge~graphic areas in this volume are by place of residence unlessstisted as by place of occurrence. Before 1970. resident mor.tality stattstim for the United States included all deaths oc-curring in the L%ited States, with deaths of ‘“nonresidentsof the United States” assigned to place of death. “’Deaths ofnonresidents of the United States’” refers to deaths thatoccur in the Lbited States of nonresident aliens. nationalsresiding abroad. and residents of Puerto Rco, the VirginIslands, Guam. and other territories of the United States.Beginning with 1970, deaths of nonresidents of the UnitedStates are not included in tables by place of residence.

Tables by place of occumence, on the other hand, in.elude deaths of both residents and nonresidents of theUnited States. Consequently, for each year beginning with

place of occurrence was somewhat greater than the tothby place of residence. For 1986 this difference amountedto 3.023 deaths. Mortality statistics by place of ocmsrrenceare shown in tables 1-10, 1-18, 1-19, 1-28.1-29,3-1, H.8-1. and s-7.

Before 1970, except for 1W and 196S, deaths of non.residents of the United States occuning in the United Stateswere treated as deaths of residents of the exact place ofoccurrence, which in most instances was an urban area In1964 and 1965, deaths of nonresidents of the United Statesoccurring in the United States were allocated = deaths ofresidents of the balance of the county in which they oc-curred.

Residence emor-Results of a 1960 study showed thatthe classification of residence infimnation on the death cer-tificates corresponded closely to the residence cltisification

SECTION 7 -TECHNICAL APPENDIX- PAGE S

of the census records for the decedents whose records werematched (NCHS. 1969).

A comparison of the results of this study of deaths withthose for a previous matched record study of births (Na-tional Vital Statistics Division. 1962) showed that the qualihof residenm data had considerable!improved between 1950and 1960. Both studies found that ●vents in urban areaswere overstated by the NCHS classification in comparisonwith the U.S. Bureau of the Census classification. The msg.nitssde of the dfierence was substantially less for deaths in1960 than it was ksr bk in 1950.

The ~~t ~ -bed to ~ ftern * fn lowto the U.S. Standard CertiRcates of BidI and of Deathasking if residence was inside or outside city limits. TMSnew item aided in properly allocating the residence of per-sons living near cities but outside the corporate limits.

Geographic classification

The rules followed in the classification of geographicareas for deaths and fetal deaths are contained in the twoinstruction manuals r.efemed to previously (NCHS. 1986L1986b).

The geographic codes assigned by the National Centerfor Herdth Statistim during data reduction of source infor-mation on birth, death. and fetaLdeath records are given inanother instmction manual (NCHS, 1985). Beginning with1982 data the geographic cdes were modified to reflectresults nf the 1980 census For 1970-81. codes we basedon results of the 1970 census.

Standard nsctropolitan siatirtical arws-l%e standardmetropolitan statistical areas (SMS.A’S)used in this volumeare those ●stablished by the L’.S.Office of Managementand Budget (1981 a pp 1-20) from final 1950 census pop-ulation counts and used by the U.S. Bureau of the Census,except in the New’England States.

Except in the New England States, an SMSA is a countyor a group of contiguous counties containing a cih of 50JW0inhabitants or more or an urbanized area of 50.000 with atotal metropolitan population of at least 100,000. In addi-tion to the county or counties containing such a city orurbanized area. contiguous counties are included in anS\K4 if according to specified criteria they are essentiallymetropolitan in character and are socisdlyand emmrrsicallyintegrated with the central city or urbanized area (U.S. Of-fice of Management and Budget 1981b. p. 420).

In the New England States the U.S. Office of !tlanag-ment and Budget uses towns and cities rather than coun-tiei as geographic components of ShfSA’s. The NationalCenter for Health Statistics cannot. however, use the SMSAclassification for these States because its data are not codedto identify all towns. Instead. NCHS uses New EnglandCounty Metropolitan Areas (NECMA”S).Mxle up of countyunits. these areas are established by the U.S OffIce of Man-agement and Budget (1975. pp. 89-90: 1981b. p. 420).

Metropohn and nonmcrropdtan arsmties-lndepend-ent cities and counties included in SMSA”Sor in NECMA”S

are included in data for metropolitan counties. all othercounties are classified as nonmetropolitan.

Popsdation-& groups-Vital statistics data for citiesand certain other urban places in 19S6 =e classified ●c-eording to the population enumerated m the 19s0 Censusof Population. Data are ●vailable for individual cities andother urban places of 10,000 or more population. Data forthe remaining areas not separately identified are shown inthe tables under the heading %&me of area” or “balanceof county.”’ For the years 1970-81, classification of areaswas determined by the population enumerated in the 1970Census of Popukion. Beginning with 1982&@ ms resultof changes its the enumerated population between 1970and 1980. some urban places identified in previous re~are no fonger included and ● number of other urban placeshave heen ●dded.

Wars places other .than incorporated cities for whichvital statistics data are shown in this volume include the fol-lowing

●

●

●

Each town in New England New York and Wss-consin and each township in Michigan. New jersey.and Pennsylvania that IA no inmrporated munici.pafity as a subdivision and had ●ither 25.000 inhabitants or more. or a population of 10.000 to 23.(WJand a density of 1,000 persons or more per squaremile.Each tmunty in States other than those indicatedbe that had no incorporated municipali~ withinits boundaq and had a densih of 1.000 persons ormore per square mile. (Arlington CounQ. Vugini4is the only smursty classified as urban under thissule.)Each place in Hawaii with 10.WO or more popula-tion, as there are no incorporated cities in the State

Before 1964, places were classified as ““urban””or ““nsral.”The Technical Appendixes fix earlier years discuss the pmvious classification system.

State or country of birth

Mortality statistics by State or country of birth (table 1-32) became available beginning with 1979. State or countqof birth ofa decedent is assigned to 1 of the SOStates or theDistrict of Columbia. or to Puerto Rico, the Virgin Islands.or Guam-if specified on the death cefificate. The placeof birth is dso tabulated for Canada CubsLMexico, and forthe Remainder of the World. Deaths for which informationon State or cuuntry of birth was ursknm not stat~ or notclassifiable accounted for a small proportion of ail deaths jn1986, about 0.5 percent

Early moriality reports published by the L’.S.Burems ofthe Census mmtained tables showing natitity of parents aswell as natiti~ of decedent. Publication of these tables U*XSdismntinued in 1933. Mortality data showing nativity ofdecedent were again published in annual reports for 1939-41 and for 1950.


Age

The age recorded on the death record is the age at lastbirthda!. \Vlth respect to the computation of death rates,the age classification used h! the U.S.Bureau of the Censusis also based on the age of the person in completed years.

For computation of age-specific and ag~adjusted deathrates, deaths with age not stated are excluded. For life tablecomputation, deaths with age not stated are distributedproportionately.

Race

For vital statistics in the United States in 1986. deathsare classified by race-white. black. Indian. Chinese. Japa-nese, Filipino. Other Asian or Pacific Islander, and Other.Mortsrfity data for Filipino and other Asian or Pacific ls-Iander were shown for the first time in 1979.

‘flse white catego~ includes. in addition to persons re-ported as white, those reported * Mexican. Puerto Rican.Cuban, and afl other Caucasians. The Indian catego~ in-cludes American, A1-kan Canadian. Eskimo. and .41eut. Ifthe racial en~ on the death certificate indicates a mixtureof Hawaiian and any other race. the entn is coded to Ha-waiian. If the race i’sgiven as a mixture of white and anyother race, the entry is coded to the appropriate other race.If a mixture of races other than white is given (except Ha-waiian). the ●ntry is coded to the first race listed. This pmcedure for coding the fwst race hsted has been in use since1969. Before 1969. if the ent~ for race was a mixture ofblack and any other race ●xcept Hawaiian. the entry wascoded to black.

Most of the tables in this volume. however. do not shoivdata for this detailed classification hy race. In about half ofall the tahlei the d~vlsions are white. all other (inchsdmgblack), and black separately h-iother tables by race, w’herethe main purpose is to isolate the major groups. the classifi-cations are simpl! white and all other.

Rote not stated-For 1986 the number of &atfs recordsfor which race was unknown. not stated, or not classifiablewu 4.5s3. or 0.2 percent of the total deaths. Death recordswith race en~ not stated are assigned to a racial designationas follows: If the preceding record is coded white, the codeassignment :s made to white, if the cde is other than white.the xsignment is made to black. Before 1964 afl recordswith race not stated were assigned to white except recordsof residents of Sew jersey for.1962-W

l$esc )ersey, 1962-64-!$ew Jersey omitted the raceitem from its certificates of live bhth. death, and fetal deathin use in the beginning of 1962 The item was restoredduring the latter partof 1962. However. the certificate revision without the race item was used for most of 1962 aswell as 1963. Therefore figures by race for 1962 and 1963exclude New jersey. For 1964, 6.6 percent of the deathrecords in use for residents of New Jersey did not containthe race item.

.4djustments made in vital statistics to take into accountthe omission of the race item in New Jersey for part of thece~ificates filed during 1Wk2through 1964 are describedm the Technical .4ppendix of Vital Statistics of the t“nitedStates for each of those data years.

Hispanic origin

Mortality statistics for the Hispani&origin populationwere pubfished in 1984 for the fimt time They are basedOninfomum“nfdrthoae StAaand tlse Dis&ictof Colusmbia that included items on the death certifmte to identifyHispanic or ethnic m-gin of decedents. Data were obtainedf+omthe District of Columbia and the following 22 StatesArizona. McarwM, Cahfornk Colorado. Georgia HawaiiIflinois, Indiana KXSIsa.s,Maine, MissixsippL NebraskaNevadL New Jersey, New Mexico, New York (includingNew, York City). North Dakota Ohio. Tennessee. Texas,Utah,and Wyoming. Generally, Use reporting States ssseditems similar to one of two basic formats recommended byNCHS. The fit fimnat is open-ended to obtain the specificorigin or descent of the decedent (for example, halian.Mexican, Puerto RJcan, English, and Cuban). The secondformat is directed specifically toward the Hispanic populztion and asks whether the decedent is of Spanish origin. ifso, the specific origin-for example, .Mexican.Puerto Rican.or Cuban-is to be indicated

For 1986, mortafity data in tables 1-33 and 2-16 arebased on deaths to residents of ~ 22 reporting States andthe Disbict of Columbia In tables 1-34,2-19,2-20, and2-21 mortality data for the Hispanic-origin population arebased on deaths to residents of 18 reporting States and theDistrict of Columbia whose data were at least 90 percentcomplete on a place.of-occurrerwe basis and considered tobe sufficiently comparable to be used for analysis.The 18States are as foflow. ~ona Mamas Cafifomiz Colorado.Georgia Hawaii, Illinois. Indiana WSMS. Mississippi !Q-

braska New Jersey, New York (including New York City),North Dakota Ohio, Texas. Utah, and Wyoming. ExcludedFom these tables are data for New Mexico because theformat for the Hispanic item on the New kfexico deathcertificate departs sufficiently from that of other are= toresult in noncompanble data 1ssxddition, in tables I-33and 1-34 for New Mexism, no deaths are shown for thecategon “’not stated origin. Because of the way in whichthe item on the death certificate for New Mexico is wordedit was not possible to detemine whether a blank ●ntry repre-sented a response of “non.Hispanic origin’”or of””unknownorigin.” Acsmrdingly, blank entries were coded to “’rron-HisparricV Data for the other three States-Maine. Nevadaand Tennessee-we excluded from tables 1-34.2-19.2-20, and 2-21 because of the Iwge proportion of deaths (inexcess of 10 percent) occurring in these States for whichHispanic origin was not stated or was unknown.

In 1980, the 18 reporting States and the District of Cct

$ECTION 7= TECHNICAL APPENDIX- PAGE 7

hunbia accounted for about 80 patent of the Hispanic population in the L’nited States. including about 89 percent ofthe Mexican population. 78 percent of the Puerto Ricanpopulation, 34 percent of the Cuban population. and 66percent of the “other Hispanic””population (I.’.S Bureauof the Census. 19s2a). .+ccordmgly. caution should be ex-ercised in generalizing modih patterns from the reportingarea to the Hispanic-origin population (especially Cubans)of the entire United States. For qualifications regardinginfant mortality of the Hsspanic-origin population. see “’in-fant deaths.”

Marital status

.Mortrditystatistics by marital status {table 1-31) werepublished in 1979 fbr the first time since 1961. (pmviousfythey had been published in the annual volumes for theyears 1949-51 and 1959-61.) Several reports as+ing mor-tality by marital status have been published including thespecial study based on 1959+1 data (NCHS, 1970). Ref-●rence to earlier reports is given in the appendis of part Bof the 18s9-61 special study.

Mortafity statistics by marital status are tabulated sep-arately for never married. married. widowed and divorcedCertificates in which the marriage is specified as being an-nulled are classified as never married where marital statusis specified as separated or cinrsmon-law marriage. it is clas-sified as married. Of the 2.049.203 resident deaths 15 yearsof age and over in 19b6, 10,171 certifmates (0.5 percent)had marital status not stated

Place of death and status of decedent

Mortality statistics by place of death were published in1979 for the first time since 1958 (tables 1-28 and 1-29).hr addition. mortality data were also available for the firsttime in 1979 for the status of decedent when death oc-curred in a hospitaf or medical center (table 1-28). Thesedat~ were obtained from the following two items that appear on the U.S. Standard Certificate of Death.

● Item 7c. Hospital or Other Institution-Name (Ifnot in either. give street and number)

. hem id. If Hosp. or Inst Indicate DO.4. OP/Emer.Rm.. Inpatient (Specify)

All of the States and the District of Columbia have item7C(or its equivalent) on the death Certf]cate. For all Statesand the District of Columbia in the Vital Statistics Cooper-ative Program. NCHS accepts the State definition. clwi-fication, or cafes for hospitals, medical centers. or otherinstitutions.

Table 1-28 shows mortafity data for the total of thefollowing 43 States (including New York City) that have

item id or its equivalent on their death certificates:

Alaska NevadaArizona New HampshireArkansas New JerseyColorado Ne\v \lexicoConnecticut New YorkFlorida North CarolinaGeorgia North DakotaHawaii OhioIdaho OregonIuimis Pesrs@wdaIDdiana RltodelalmldIowa StnstisCarolinaKansas South DakotaKentucky TennesseeLouisiana UtahMaine VermontMichigan VirginiaMississippi WashingtonMissouri West VirginiaMontana WisconsinNebraska Wyoming

Effective with data for 1980. the coding of place ofdeath and status of decedent was changed. A new codingcatego~ was added. ‘Dead on arrival-hospital clinic. med-ical center name not given.” Deaths coded to this categoryare tabulated in table 1-28 as “Dead on anivsl” and intable 1-29 as ““Notin hospital or medical center.” Had the]979 cochng categories been used these deaths would hai ebeen tabufated as ““Placeunknown.””

Mortality by month and date of death

Deaths by month have been regularly tabulated andpublished in the atrnual volume for ●ach year beginning withdata year 1900. For 1986. deaths by month are shows intables 1-19.1-20.1-23, 1-30,2-12.2-13,2-14. and 3-9

Date of death was first published for data year 1972. Inaddition. unpublished data for selected causes b} date ofdeath for 1962 are available from NCHS.

NUMbers of deaths by date of death in this volume areshown in table ]-30 for the total number of deaths and forthe number of deaths for the following three causes. forwhich the greatest interest in date of occurrence of deathhas been expressed: Motor vehicle accidents, Suicide. andHomicide and legal intervention.

These data show tbe frequency distribution of deathsfor the selected causes by day of week. They also make itpossible to identify holidays with peak numbers of deathskom specified causes.

Report of mrtopsy

Before 1972, the last year for which ●utopsy data weretabulated war 1%8. Beginning in 19% all registration areas

SECTION 7 –TECHNICAL APPENDIX- PAGE 8

requested information on the death certificate as to whetherautopsies were performed For 1956. autopsies were re.ported on 257.890 death certificates, 12.2 percent of thetOtdl (tdhle 1-27).

hsfonn~tmn w to vlwthrr the autops! finding, Nrreused in deterrmmng the cause of death was tabulated for1972-73 for all but nine registration areas and from 1974-77 for all but ●ight registration areas. The item ““autopsyfindings used was deleted from the 1976 L’.S.StandardCertificate of Death.

For eight of the causeof-death categories shown intable 1-27, autopsies were reportd as per%smed b 50percent or more ofaU deaths (whooping cough; Meningo-mccaf infection. Regnancy with abortive outcome: Othercomplications of pregnancy. childbirth. and the puerperium.Motor vehicle aecldents; Suicide. Homicide and legal inter-vention, and All other ●xternal causes). There were threeother categories for which 40 pereent or more of the deathcertificates reported autopsies Autopsies were reportedfor on]! 7.6 percent of the Major cardiovascular diseases.

Cause of death

Cmse-@death &.rsj%arkm-Since 1949. causeof-deathstatistics hale been based on the underling cause of death.which is defined as “(a) the disease or injun which initiated

the train of events leading directly to death. or (b) the cir-cumstances of the accident or violence which producedthe fatal inju~”’ (\Vorld Health Organization. 1977).

For each death the underlying cause is selected froman array of conditions reported in the medical certificationsection on the death certificate. This section provides afomrat for entering the causes of death in a squential order.These conditions are translated into medical codes throughuse of the classification structure and the selection arsd mod-ification rules contasned in the applicable revision of theJnternationol Cksification of Dimmes (lCD) published bythe World Health Organization (WHO) Selection rulespromde guidance for systematical} identifying the under-lying cause of death. Modification roles are intended toimprove the usefulness of mortality statistics by gsting pref-erence to certain classification categories over others and’or to consolidate two or more conditions on the certificateinto a single classification catego~.

As a statistical datum. the underlying cause of death isa simple. one-dimensional statistic, it is conceptually easyto undemtand and a well-accepted measure of moRafity. Itidentifies the initiating cause of death and is thereksre mostuseful to public heafth officials in developing measures toprevent the start of the chain of events leading to death.The rules for selecting the underlying cause of death areincluded with the ICD as a means of standardizing classifi-cation. which ccmtibutes toward comparability and uniformi-ty in mortafity medical statistics among countries.

Beginning with data year 1979. the cause-of-death sta-tistim published by the National Center for Health Statisticshave been classified according to the Ninth Revision of thehstemationa[ (3aasrfication oj i)iseaaes (IC&9) (World

Heafth Organization. 1977). In addition to specif@sg thatthe Classification be used WHO afso recommends how the -data should be tabulated in order to promote internationalcomparabifih. The recommended system for tabu]atmg datain tht Ninth Revision aflows countries to construct theirowmmofi,Jtt! ~d morbldj~ tabulation ]Isfi ~om the ~bn~of the WHO Basic Tabulation List as long as rubrics fromthe WHO mortality and morbidity lists. respectively. areincluded ‘flsis tabulation system for the Ninth Revision ismore flexible than that of the Eighth Revision in whichspecific lists were remsrrsmended for &dating osortalitywsd morbidity k

The Basic Tabulation Uat (BTL) remmmended underthe Ninth Revision consists of57 two-digit nsbrics that ●ddto the ‘oaf!causes” total. Within ●ach two-digit mbnc. up to9 three-digit rubrics numbered from O to 6 are identifiedbut these do not dd to the total of the two-digit rubric.The two-digit rubrics of the BTL 01 through 46 provide forthe tabulation of nonviolent deaths to ICD categories 001-799 Rubrics relating to chapter 17 (nature-of.injq causes47 through 56) are not used by NCHS for selecting under-lying cause of death, rather, preference is given to rubricsE47 through E56. The 57th tw~digit rubric VOis the Supelementary Classification of Factors Influencing HealthStatus and Contact with Health Senices and is no! apprepriate for the tabulation of mortafity data The \VHO Mor-tality List. a subset of the titles contained in the BTL con-sists of so rubrics which are a minimum for the nationaldisplay of mortali~ data

File lists of causes have been developed for tabulationand publication of mortafity data in this volume: The Each-Cause List List of 262 Selected Causes of Death List of 72Selected Causes of Death, List of 61 Selected Causes ●ofInfant Death. and List of 34 Selected Causes of Death.These lists were designed to be as comparable as possiblewith the !iCHS hsts more recently in use under the E]ghthRe\-ision.However, complete comparability rmssldnot alwaysbe achieved.

The Each-Cause List is made up of each three-digitcategon of the M“HODetailed List to which deaths may bevalidly assigned and most four-digit subcategories, The listi$used for tabulation for the entire United States The pubIished Each-Cause table does not show the four-digit subcategories prmidd for Motor vehicle accidents (E61@E825).however. these subcategories, which identify persons in-jwed are shown in the accident tables of this report (section5). Special fl?h-digit subcategories are afso used m the acci-dent tables to identifi place of accident when deaths fromnontranspofi accidents are shown. These are not shown inthe Each-Cause table.

The List of 262 Selected Causes of Death is constructedkom BTL rubrh 01-46 and E47-E56. Each of the 56 BTLtwo-digit titles can be obtained either directly or by carr-bining titles in the List The drreedigit level of the BTL ismodified more extensively. where more detail was desiredcategories not shown in the three-digit rubrics were addedto the List of 282 Selected Causes of Death Where lessdetail was needed. the three-digit rubrics were combined


Moreover. each Of the so rubrics of the WHO MortalityList can be obtained from the List of 282 Selected Causesof Death.

The List of ?2 selected Causes of Death was constructedb! combinmg titles in the List of 282 Selected Causes ofDeath. It is used in tables published for the United Statesand ●ach State, and for standard metropolitan statisticalareas.

The List of 61 Selected Cinsses of Infant Death showsmore detailed titles for Congenital anomalies and Certainconditions @natirsg in the prrirsatal pesiod than aity otherlist except the Each-Cmue Mt.

‘ilse IJxtof34Sekcted tiof Dsdswm~edby cumbining titles in the List of 72 selected Causes. Atable using this list is published for detailed geographicareas.

Effectoflistrmirkms-TheIntemahonal Lists or adaptations of them, in use in this country since IW, havebeen revised approximately every 10 years so that the dis-ease classification may be consistent with advances in med-ical science and with changes in diagnostic practice. Eachrevision of the International LBtS has prcduced some breakin cornparabifity of causeof-death statistics Caus~f.deathstatistics beginning with 1979 are classified by NCHS mcording to the ICD-9 (World Heafth organization, 1977).For a discussion of each of the classifications used withdeath statistics since 1900. see the Technical Appendix inVatalStatistics oftb Unitedsto~ 1979,VolumeII.Mortal-ity, Part A. section 7. pages 9-14.

A dual coding study was undertaken between the Ninthand the E}ghth Re~islons to measure the ●xtent of discon-tinuity in casss=f-death *CS resulting tiusn inbuhscingthe new Revision. An initial study for the List of 72 SelectedCauses of Death and the List of 10 Selected Causes of InfantDeath has been published (NCHS, 1980). The List of 10Selected Causes of Infant Death is a basic NCHS tabulationlist but is not used in this volume. Comparability studieswere also undertaken bemveen the Eighth and Seventh,Seventh and Sixth. and Sixth and Fifth Revisions. For ad-ditional information atunst these studies again see the 1979Technical Appendix.

Significant coding changes during the Ninth Recision-Since the irnplementat]on of ICD-9 in the United States.effective with mortality data for 1979. several codingchanges have been mtmduced. The more important changeswill be discussed below. In early 1983, a change w= madein the cding of Acquired immunodeficiency syndrome

(AIDS) and Human immunodeficiency virus (HI\3 infec-tion, which affected data from 1981 onward Ako effectivewith data year 19b1 was a coding change for poliomyelitis.For data year 1982. a change was made in the definition ofchild (which afTectsthe classification of deaths to ● numberof categories, including Child battering and other maltreat-ment), and in guidelines for coding deaths to the categosyChild battering and other maktre~tment (ICD No. E967).During the calendar year 1985 detailed instructions formding motor vehicle -“dents indving all-temain vehicks(A~-S) were implemented to ●nsure consistency in coding

these accidents. Detailed discussion of these changes maybe found in the Technical Appendis for previous vohsrnes.

Ming in 1986-The rules and instructions used incoding the 19S6 motiity medical data remained essentiallythe same as those used for the 1985 data Xotable changesinclude classifying ‘“primasy””and ““invasive”tumors, unspe-cified as ‘“malignant-beginning 1986. Previo@, these noplasms had been classified to Neopksrns of unspecified ~tore (ICD-9 No. 239).

Medical cer@csstims-The use of a standard ckssific>tioo list although essentialfoc Statq regfot4 and itster-BatbsmlcoxrS@aosssdoaatsotusureatxktompera&oftbetAulatd figures Ahighdcgree dampmMtyb~~n~ddbtindon~ifdr-d~tideath were reported with equal accuracy and smsnpkteness. The medical certification of cause of death ass bemadeonfybyaquaMi4 perxomususliy [email protected] examiner, or a coroner. Therefore. the refinabilityandaccuracy of caus~f-death statistics are. to a krge extent.governed by the ability of the certifier to make the properdiagnosis and by the care with which he or she reads thisinfomsation on the death certificate.

A number ofatudies have been undertakenonthe#ity of medical certification on the death cetiiflcate. In gess-er~ these have been for relatively small samples and forlimited geographic areas. A bibliography, prepared byNCHS (1982), covering 128 references over ● period of 23years indicates that no defirsitive conclusions have beenreached ●bout the quafity of medical certification on thedeath certificate. NO country has ● well-defined programfor systematically assessing the quality of medical certifica-tions reported on death certificat~ or fbr mezsuring theerror effects on the IeveLsand trends of caus~f-death sta-tistics.

One index of the quality of reporting causes of death isthe proportion of death certificates coded to the Ninth Re-vision Chapter XII Symptoms, signs, and ill-defined condi-tions (ICD-9 Nos. 780-799). Akhough there are cases forwhich it is not possible to determine the cause of death.this propofiion indicates the cwe and consideration givento the certification by the medical certifier. It may also beused as a rough measure of the specificity of the medicaldiagnoses made by the cefifier in various areas. hs 1986,1.5 percent of all reported deaths in the United States wereassigned to W-defined or unknown causes. However. thispercentage vtied among the States from 0.3 percentto4.0 percent.

Autcnnated ae?ection~USSd+ing cause of death-bgirming with data year 1968, NCHS began using a computersystem for assigning the underlying cause of.death It hasbeen used every year since to select the underlying causeof death. The system is called “Automated Ckasiflcation 04Medical Entities” (ACME).

The ACME systemapphs the same rssks h seketingthe underlying cause as applied manually by a noaokgisLhowever, ursder this systesm the computer consistentlyapplies the same criteri% thus eliminating interceder varia-tion in this step of the process.


‘Ilse ACME computer program requires the coding ofall conditions shown on the medical certification. Thesecodes are matched automatically against decision tables thatconsistently select the underlying cause of death for eachrecord according to the international rules. The decisiontables provide the comprehensive relationships betweenthe smnditions classified by ICD when sppl}ing the rules ofselection and rrwMcation.

fie decision tables were developed by NCHS ataffonthe basis of their ●xperience in coding underlying causes ofdeath under the earlier ntxnod coding system and as a r~asdtofpdodic~t WWtiorKkhblesue~s$pdatedbrektaddhimdm~on the rektionshfp among srsedlcd conditions Fsu 1966,the content of these tables was identical to that in the 1985txbles Coding pmcdsres for selecting the underlying causeof death by the ACME computer ~ as Well as theACMEdecision tables, are documented in NCHS instrtsc-tion mxnuds (NCHS. 1986c, 1986d 1986e).

tissse-ojdeath rorsking-Cause-of-death ranking (ex-cept for infants) is based on the List of 72 selected Causesof wA, Causeof-death Acing for infesstx is based onthe List of 61 Sekcted Causes of Infant Death. ‘f& grouptitks Major cardiovascular diseases and Symptoms. signsand ill-defused conditions are not ranked from the List of72 Selected Causes, and Certain conditions originating inthe perinatd period and $mptom signs, and W-definedmndi&ms are not ranked fiorssthe List of61 Selec+edCausesoflnfasst Death. In additi~ category titks that begin withthe words “Other” or “’A]]other” are not ranked to deter-mine the Ieadmg causes of death. M’hen one of the titlesthat represents ● subtotal is ranked (such as Tuberculosis),its aanponent pasts (in this case, Tuberculosis of respiratory

“ s@em and Other tuberculosis) are not ranked

Materssd deaths

Maternal deaths are those for which the certifying phy-sician has desigrrated a maternal mmdition as the underlyingcause of death. Maternal conditions are those axsigned toComplications of pregnancy, childbirth and the puerperiurn(ICD-9 NOS 630-676). In the Ninth Revision the WorldHealth Organization (lg~i, p. 764) for the kt time &fisteda maternal death as follows

A maternal death is defined is the death ofa womanwhile pregnant or within 42 days of termination ofpregnwIcY.inspective of the duration and tAe siteof the pregnancy, fi-omany cause related to or ag-gravated by the pregnancy or its management butnot from ●ccidental or incidental causes

undertheEighth R&sicnsMternddeaths wereasx@edto category title “Complications of pregnancy, childbirth,wd the puerperiuns”’ (lCDA-8 Nos.630478).AkhoughWHO did not define matemd mortafity, there w- anNCHS classification de that limited a maternal death to ●

death within a year aRer termination of pregnancy fromxny ““maternal cause,” that is, any cause within the range ofICDA-8 Mm 630-678. This rufe applied only if a durationcf time for the condition was given. Mno duration was spec~fied and the underling cause of death was a maternal con-dition. then the duration was assumed to be within a yearand the death was cuded by NCHS as a maternal death.me change fmsn an ssnde~l-year limitation on durationused in the Eighth Revision to an under-42-&ys limitationused in the Ninth Revision is not expected to have much●ffect on the comparability of maternal mortality statistics.H omspmWy isdfe@edby &e fobvingclassifi-m~~Udertbe Nfstdt RevMosLsxmted saaueShave beers expanded to fsschsde Indirect obatetdc causes(lCD-9 Nos. 647+48). These causes include Infective andparasitic conditions x well as other cument conditions inthe mother that are classifiable efsewhere but which comp-licate pregnancy. chffdbirth, and the puesperium. such asSyph& Tubemdosis, Diabetes mellitus. Dmg dependenceand Congenital cardiovascukr disordess

Maternal mostafity rates are computed on the basis ofthe number of live birtk The snatemd mostdity rate indi-cates the likelihood that ● pregnant woman will die frommaternal causex The number of live births used in the de-nominator is xn approximation of the population of preg-nant women who are at risk of a maternal death.

Infant deaths

Age-An infant death is defined as a death under 1year of age. The term excludes fetal deaths infant deathsare tssssdly divkded into two categories according to age,neonatal and postneonatal. Neonatal deaths are those thatoccur during the fmt 27 days of fife, and postneonatd deathsare those that occur between 28 days and 1 year of age. hhas generally beers believed that different factors influenc-ing the chifds SWWM predominate in these two periods:Factors -Sociated with prenatal development. heredity.md the birth process were considered dominant in theneonatal period; and environmental factors. such as nutri-tion. hygiene. and accidents. were considered more im-potit in the postneonatd period Recently, however, thedistinction between these two periods has blumed due inp-to advances in neonatology, which have enabled morevery d premature infants to susvive the neonatal period

Ro@-infant mortality rates shown in section 2 andsection 8 are the most commonly used index for measuringthe risk of dying during the first year of life: they are ca-lculatedby dividing the number of infant deaths in a cakndaryear by the number of live births registered for the samepxiod and are presented as rates per 1,000 or per 100,000live Whs. Infant mortality rates use the number of livebirths in the denominator to approximate the population atrisk of dying before the first b~day. TMS measure is anapproximation of the sisk of dying in infancy because someof the live births will not have been exposed to a full year’srisk of dying end some of the infants that die during a year

SECTION 7 -TECHNICAL APPENDIX- PAGE 11

will have been born in the previous }ear. The ●rror intr~duced in the infant mo~ality rate by this inexactness isUSuaflysmall, especially when the birth rate is relati} elyconstant from year to year (Guralnick and \Vinter. 1965,NCHS. 196ba). C)ther sources of emor m the infant mortahhrate have been attributed to differences in appl!ing thedefinitions for infant death and fetal death when registeringthe event (M&adIy, et al, 1980; National Office of VitalStatistics, 1947).

In wmtrast to infant mortality rates based on live births.infant death rates shown in section I are based on the esti-mated ppuldon tinder 1 year of age. Infant death ratqwhicbsppearin tabuMom of SgMpecifiC dedr ~ mcalculatedby dfvkling the number of infant deqths in acafendar year@ the estimated midyear population of per-sons under I year of age and are presented as rates per100,000 population in this age group. Patterns and trendsin the infant death rate may diKer somewhat fhsss those ofthe more commonly used “infant mortality rate”’ mainlybecause of differences in the nature of the denominatorand in the time reference period W’hereas the populationdenominator for the infasrt death rate is estimated usingdata on births, infant deathq and migration for the 12-month period of july through june, the denominator forthr infant mo~ality rate is a count of births occurring duringthe 12 months of ]anuaq through December. The differ-ence in the time reference period can result in differenttrends between the two indices during periods when birthrates are markedl! moving up or down.

In addition. the infant death rate is also subject togreater Imprecision dsan is the infant mofidity rate becauseof problems of enumerating and estimating the populationunder 1 year of age (National OffIce of vital Sta&ti~1947).

Rote- Infant mortality rates for specified races otherthan white or black ma! be underesttmatecL based on re-sults of studies in which race on the birth and death certifi-cates for the same infant were compared (Frost and Shy.1980). The f]gures should be interpreted witlr caution because of possible inconsistencies in reporting of race be-tween the numerator and denominator of the rates. Thisreflects differences in the nature of reporting and processingrace on these two vital records. 0ss the birth certificate,race of parents is reported bv the mother at the time ofdelivery. On the death certi~icate, race of the deceaedinfant is reported by the funeral director based on observa-tion or on information supplied by an informant such as aparent. With respect to processing, race of infant ●t birth iscoded using coding roles that take ●ccount of the race ofeach parent (see the Technical Appendix in Vital Statistic~the Urr&.dW* J986, Volume I, Wtaiity, section entitkd“Race or natiorrd origin”). For infant deaths. the race ofchild is coded directly from the race reported on the deathcestflcate.

Hispanic osi#n-infant mortality rates for the HPoattic-~“gin population we based on numbers of resider. infantdeaths reported to be of Hispanic origin (see sectic “His-panic. origin”) and numbers of resident live births j His-

panic origin of mother for the 15 reporting States and theDistrict of Columbia In computing infant mortalih rates.deaths and live births of unknown origin are not d~tributedamong the specified Hispanic and non-Hispanic groupsBecause for 1966 the percrnt of infant deaths of unhwrrongm was 8.1 percent and the percent of li}e births ofunknown origin was 3.1 percent. infant mortality mtesbyspecifiedHispanic ohgin and mce for rson-Hispanic qnmay be somewhat underestimated.

Small numbers of infant deaths for specific Hispanic-Origirrgroups can result in infant mortality rates subject toSeWveiykgercrsdom WMilss(secasrcIkm ”RU%lsmsvaL@tiorlio rsrsderxofdeu4 death masidmoditymd ratios-’).

Tobu&tion Jist-Causes of death fix infants are tabrs-lated according to a list of causes that is different from thefist of causes for the population of all ages. except for theEach CUM List (See section “’cause+f-death classifica-tion”)

Fetal deaths

1ssMay 19S0 the World Health Organization recosn-mended the following definition of fetal death he adoptedfOr internatiomd use (!(atlond] Offwe of ~ltd] Statistics1950):

Death prior to the complete expulsion or extrac-tion from its mother of a product of conception.irrespectit e of the duration of pregnancy, the deathis indicxted by the fact that after such separation,the fetus does not breathe or show any other evi-dence of lie such as beating of the he- pulsationof the umbilical cord. or definite movement of vol-untary muscles

‘lhe term “fetal death” was defined on an all-inclusivebasis to ●nd confusion arising from use of such term asstillbirth. abortion. and miscaniage.

Shortly thereafter. this definition of fetal death wasadopted by the NationaJ Center for Health Statistics as thenationally recommended standard, Currently dl registrationareas except Puerto Rico have definitions similar to thestandard definition Puerto FUCOhas no formal definition.(For definitions used by the States and other registrationareas, see NCHS (1981).)

As another step toward increasing the comparability ofdata on fetal deaths for different countriq the World HealthOrganization rewsmmended that for statistical purposesfetal deaths be chssified as ●arly. intermediate, and late.These groups are defined as follows:

Lesstlsan20 CurnpletedWeb ofgest&tion(early fetddeaths) . . . . . . . . . . . . Group I

20 completed weeks of gestation butless than 98 (intemwdiate fetaldeaths) . . . . . . . . . . . . . . . . . . . . . . . . . . Group I1

SECTION 7- TECHNICAL APPENDIX+ PAGE 12

2S completed weeks of gestation andover (late fetal deaths) . . . . . . . . . . . . . Group 111

Gestation period not classifiable ingroups I.ll. and III . . . . . . . . . . . . . . . . Croup IY

Note that in table 3-I 3. group IV consists of fetal deathswith gestation not stated but presumed to be 20 weeks ormore gestation.

Until 1939 the nationally recommended procedure forregistration of ● fetal death required the filing of both aliveAMhusd adaatbowMcsb% IJ11939ssepmase StadardCdficateofSdIlbMh (tktaf&atb) waa~torepkethe fomrser prcmdum This was rdsed kn 1949, l@5S,19S6, and 1966. In 1978 the Standard Certificate of FetalDeath was replaced by the Standard Report of Eetal Death(Rgure 7-B).

‘flse 1977 revision of tbe Mmk!l State V@ Sfuttstics&t and Model State Vital Stotistia Regulations (NCHS,1978) recommended that spontaneous fetal deaths of 20weeks or more gestation. or a weight of 3s0 grams or more,and all induced terminations of pregnancy regardless ofgeatational age be reported and hsrther that they be r-ported on separate forms. These forms are to be consideredlegally required statistical rrports rather than legal docu-ments.

Beginning with 1970 fetal deaths procedures were irmplemented that ●ttempted to separate reports of apontan~ous fetal deaths from those of induced tmdnaths ofpreg-nancy. These procedures were implemented because thehealth implications are different for spontaneous fetal deathsand induced terminations of pregnancy. These proceduresare still in use.

Gsmparabflity and cznnplctmaw ofduta-Registrationarea requirements for reporting fetal deaths VW. Most ofthese areas require reporting fetal deaths of gestations of20 weeks or more. Table A shows the minimum period ofgestation rquired by each State for fetal-death reporting.‘flrere is substantial evidence that not all fetal deaths forwhich reporting is required are reported (Crd Pauli andfirby, 1987).

For registration areas not requiring the reporting offetal deaths of all periods of gestation. underreporting ismore likely to occur in the earlier gestatfonal periods. Thisis Wsstnted by the fact that for most tias requiring report-ing of fetal deaths of 20 weeks or more, the total numberreported for 20-23 weeks is lower than the numbers re-ported for 24-27 and 26-31 weeks. For areas requiring thereporting of all fetal deaths however. the opposite is gen-●rally true.

To maximixe the eomparabilifi of data by year and byState. most of the tables in section 3 are based on fetaldeaths oecuning at gestations of 20 weeks or more, Thesetables also include fetal deaths of n~ stated gestation forthose States requiring reprting at 20 weeks or more only.Beginning with 1869, fetal deaths of not stated gestationwere ●xcluded for states rquiring reporting of all products

of conception except for those with a stated birth weight of600 grams or more. in 1966 this rule was applied to thefollowing States Coksrado, Ceorg@ Hawaii New York (in-cluding New York City), Rhode Ialard and Virginia Eachyear there are some exceptions to this procedure.

The data in table&3 include or+ fetal deaths to resi-dents of selected areas in the United States that reported811periods of gestation The areas are Colorado, GeorgiaHawti New York (inchsding New YorkCity), Rhode Islandand Yirgink excluded are fetaldmthsto residents of Maine.

Absssa+Since 1971, Arkamas has been using two re@g* h fd dh: A cdiderstial !@cssstaneousAbartion formthat isnatsent totlse Natiorsal CessterfbrHealth StMatkamdaFetd Ded@ii$fsetMk Dwirrgthepeti 1971thrusgh lWO, itisbelieved thatrrssxtsp0mtaneous fetal deaths of less than 20 weeks. gestation wererepofied on the confidential form and therefore, were notreposled to NCHS tig the period 1981 through 1983,Arkansas specified that f~ deaths of less than 28 weeks’gestation or weighing less than 1,000 grams could be re-ported on the ~nfidential form; beginning with 1984 datathe State specified that fetal deaths of 20 weeks’ gestationor wefghirtg 600 grams be reported on the Fetal DeathCertificate. Becusse of these chang~ the carsparability ofcounts of early fetsd deaths maybe affected. In particular.counts of fetal deaths aged 20-27 weeks during 19S1-83were not comparable between ~kansas and other repotiingareas oor with data for 1964+6. It is believed that report-ing has kmproved but is still not smmparable with data for1980 and earlier years.

Maho-Beginning in 1983, Idaho changed its reportingrequirements for spontaneous fetal deaths from ‘“after 20weeks” to “after 20 weeks or a weight of 360 ~ams ormore.”

Mairw-Mairre uses two repoting forms t% fetal deathsA Repat of .4bortion (Spontaneous and Induced) and aReport of Fetal Death. Most spontaneous fetal deaths ofless than 20 weeks’ gestation are reported on the Report ofAbortion and. therefore, are excluded from fetal deathcounts in this volume.

Afissorsri-Beginning in 1984, Missouri changed its re-porting requirements for spontaneous fetal deaths f+om‘after 20 weeks””to .“afier 20 weeks or a weight of 350grams or more.”

WiscosAn-Beginning in 1986, Wisconsin changed itsreporting requirements for spontaneous fetal deaths from“2o week< to “20 weeks or 3S0 grams.”

P* #gsztation-’l%e @d of gestation is the numb-er of completed weeks elapsed between the first day ofthe last nod menstrual period and the date of delivery.The first day of the fastnormal menstmal period (LMP) isused as the initial date because it can be more ●ccuratelydetermined than the date of conception, which usuallyoccurs 2 weeks after LMP. Data on period of gestation arecanputed fiunr information on ‘date of delivesy” snd “datelast normal menses began.” If-date last normal menses bgan” is not on the record or the calculated gestation falls


ToM. A. ?oriod of Qoststlon ●t which fotsl.death ropoftlng 1$ m~ulmd: Each mportlxw oma, 19S0

All p.riodsArea

16 20 20 rooks 20 Wdu 20-ks 6 ~~ ~of

goslation “oM ‘Lee 350 rrcms 400 &ms 500 %ns ‘onths ‘fsms ‘ms

Alsbsms x

Alsxks x IGna 9X

Arkansas xCdtforms xCdorw30 xConnwficut xpO&lXBm xOWiOfofOolumbis xFkorkda xGoofola xHawaII xIdsho xIIH* xlndmns x

Iwa xKanxxs x

Kentucky x

Louimsns x IMain. x

Maryland 2XMssxschusdts x

Mmhmsn xMmnosom x

MISSISSIPPI x

M!uouri x

Montans xNobmsks xNevada xNw Hamostnm xNH ~9fSOY xNcw khXICO xNOWYork

Now York cxcludmg New YOrk CItY x

Now York CIIY x

Nonh Carolins xNorth Dskots x

Oh!o xOklshoma xomgon 3XPonnoylvams I xRhodo Island x I

South Csrolma x60uth Dakol* x

Tonnasscc 6XTOxma x

Umh xVcrmonl $xVvgmm ‘x

Washmoton x 1

W*81 W-wnm x

WWnsm x I

W?Wnlng x


beyond a duration considered biologically plausible. ““ges-tation in week; or “Physician’s estimate of gestation”’ isused When the period of gestation is reported in monthson the report it is allocated to gestational inteswls in weeksas follows

1-3 months to under 16 weeks4 months to 16-19 weeks5 months to 2G23 weeks6 months to 24-27 wjeeks7 months to 28-31 weeks8 months to 32-35 WdS

9montllsto40weekx10 months and over to 43 weeks and over

A]! areas reported LMP in 1986 except Delaware, NewMexico. Puerto Rico, and South Dakota

MA uwight-Moxt of the 55 regisbation areas do notxpecifi how weight should be givem that is, in pounds andounces or in grams. In the tabulation and prexentatiots ofbirth weight data the metric system (grams) has been usedto facilitate comparison with other data published in theunited States and internationally. Birth weight specified inpounds and ounces is assigned the equivalent of the gramintervafs as follows:

Less than 350 grams = Olb 12 oz or less350- 499 gM15W= O lb 1302- 1 lb I 02

s00- 999gmms= llb 2oz-21b 3021,000-1,499 grams = 2 lb 4 OZ- 3 lb 4 oz1.500-1,999 grams = 3 lb 502- 4 lb 6022,000-2,499 grams = 4 lb 702- 5 lb 8022.500-2,999 gMS7M = 5 lb 902-6 lb 9023,000-3,499 ~911M = 6 lb 1002- ~ lb 11023.500-3,999 grams = 7 lb 12 OZ- 6 lb 13 oz4.000-4.499 @UIM = 8lb1402- 9 lb 14024.500+999 gMmS = 9 lb 1502-11 lb 002

5,000 grams or more= 11 lb 1 oz or more.

With the introduction of the Ninth Revision. Intema.tional Classification of Diseases, the birth-weight classifica-tion intervals for perinatal mortality statistics were shifteddownward by 1 gram. as shown above. Previously. the in-tervals were, for example. 1.001-1,500; 1,501-2,000; etc.

Rmx-The race of the fetus ixordinarily classified basedon the race of the parents. If the parents tie of differentraces. the following roles apply. (1) When only one parentix white. the fetus is assigned the other parent’s race. (2)When neither parent is white, the fetus is assigned thefatheis race with one exception: If the mother is Hawaiianor Part. Hawaiian. the fetus is claxs~led as Hawaiian.

When the race of one parent ix missing or ill defineclthe race of the other determines that of the fetus Whenrace of both parents is missing the mce of the fetus is all-ocatedto the specific mce of the fetus on the precedingrecord

TotuI.Mh wder-Totd-bids order refers to the sum

of the live bds and other terminations (including bothspontaneous fetal deaths md induced terminations of preg-

nancy) that a wonum has had including the fetal death kingrecwded For example, if a woman has previously givenbirth to two live babies and to one born dead the next fetaldeath to occur is counted as number four in total-birthorder.

In the 1978 revisionof the Standard Report of FetalDeati total-birth order is calculated &om four items onpregnancy hiatosy Number of previous live births. now fiv-ing number of prmous live births, now dead. number ofother temsinations kfore 20 weeks; and number of otherterminations*er 20 weeks

Allre@&ationareasuwtbe*~_~taining tothexsumber ofpmvims she btrtk Moctueaause the two standard items ~ning to the number of“other terminations” before and afler 20 weeks’ gestation.but some areas use other criteria Total-birth order for dlareas is calculated horn the sum of ●vailable information.I%q infomsation on total-birth order may not be com-pletely msosparable among the registration areas.

Matitsd xt@ss-Table H shows fetal deaths and fetd-death ratios by mother’s marital status States excluded fromthis table are as follow California Connecticss~ %farylasdMichigam Montana New York (including New York City),Ohio, Texas, and Vermont Because live births comprisethe denominator of the ratio, marital status must dso bereported for mothers of live bfis. Marital status of themother of the live bisth ix infemed for States that did notreport it on the birth certificate.

There are no quantitative data on the characteristics ofunmamied women who may misreport their marital statusor who fail to register fetal deaths. underreporting maybegreater for the ssmnawiedgroup than for the rnanied group.

Age of rnother-l%e fetd-deatJ repofi asks for themother’s “age (at time of delive~),” and the ages are editedin NCHS for upper and lower limits. When mothers arereported to be under 10 years of age or 50 years and over.the age of the mother is considered not stated and is assignedas followx Age on all fetddeatb records with age of mothernot stated is allocated according to the age appearing onthe record previously processed for a mother of identicalmce and having the same totrd.birth order (total of li~ebirths and other terminations).

Perirsatd mortality

Perfnotd dej%si--Beginning with data year 1979.perinatal mortality data for the united States and ●ach Statehave been published in section 4. The World Health Orga-nization in the Ninth Revision of the international Classifi-cation of Diseases (IC~9) recommended that “’national’perinatal statistics should include all fetuses md infantsdelivered weighing at least 600 grams (or when birthweight is unauilable, the corresponding gestational age(22 weeks) or body length (25 cm crown-heel)), whetherdive or dead.., .“ It wax further recommended that “court.tries shoufd present solely for international comparisorm“standard perinatd statistics’ in which both the mmxemtorand denominator of dl rates are restricted to fetuses and


infants weighing 1.000 gram or more (or. where birthweight is unavailable, the corresponding gestational age(26 weeks) or l-d} length (35 cm crown-heel) ).” Becausebirth weight and gestation age are not reported on thedeath certificate in the united States. NCHS was unable torecommend adopting these definitions. Three definitionsof perinatd mortdih are currently used by NCHS PennatdDefinition L generally used for international comparisons.which includes fetal deaths of 26 weeks or more gestationand infant deaths of less than 7 days; Perinatal DefinitionIlwbichins4udes fetddAof204w~gtinatdinfantdeaths ofksstlsus 28dayXasld Peainatal Defi-ssition IIL which tncludes fetal deaths of 20 weeks or moregestation and infant deaths of less than 7 days.

Variations in fetal death reporting requirements andpractices have implications for comparing perinatal ratesamong States Because reporting is generalfy poorer nearthe lower limit of the reporting requirement States that r~quire reporting of all products of pregnancy regardless ofgestation are likely to have more complete reporting offetal deaths of 20 weeks or more than are other States. Thelarger number of fetal deaths reported by these .’all periods”States may result in higher perinatal rates compared withStates whose reporting is less complete. Accordingly, r~porting completeness may accosm~ in p- for differencesamong the State perinatal rates, p~icularly differences forDefinitions 11and 11~which use data for fetal deaths of2&27 weeks

Not statesf-Feta! deaths with gestational age not statedare presumed to be of 20 week{ gestation or more if (1)the State requires reporting of ail fetal deaths of gestationalage 20 weeks or more or (2) the fetus weighed S00 gramsor more. in those States requiring reporting of all fetal deathsregardless of gestational age. For Definition L fetal deathswith gestation not stated but presumed to he 20 weeks ormore are aliocated to the category 28 weeks or more. ac-cording to the proportion of fetal deaths with stated gesta-tional age that falls into that category. For Definitions IIand 11!.fetal deaths with presumed gestation of 20 weeksor more are included with those of stated gestation of 20weeks or more.

For all three definitions. following the distribution ofgestation not stated described above. fetal deaths with not-stated sex are allocated within gestational age groups onthe basis of the distribution of stated cases. The allocationof not-stated gestational age and sex for fetal deaths ismade individually for each State. for metropolitan andnonmetropolitan are= and separatelyfor the United Statesas ● whole. Accordingly. the sum of perinataldeaths for theareas according to Definition I may not qual the totalnumber of pennatal deaths for the United States

QUALITY OF DATA

Completeness of registration

All States have adopted laws that rquire the registmtion of births and deaths. and the reporting of fetal deaths

It is believed that over 99 percent of the births and deathsoccurring in this count~ are registered

Reporting requirements b fetal deaths vary smnewhatEom State to State (see “-Compwability and completenessof data..). Overall reporting completeness is not as good forfetal deaths as for births and deaths, but it is believed to berelatively complete for fetal deaths of 28 weeks” gestationor more. National statistical data on fetal deaths includeonly those fetal deaths with stated or presumed gestationof 20 weeks or more.

The 1964 statistics for deaths ●xclude approximately6.000 ●vents registered in Massachusetts. primarily to resi-dents of that State. Microfilm mpies of these records werenot received by NCHS Figures for the United Stttes andthe Nw England Division are also somewhat affected

Quafity control procedures

~U - 0SSthedeuthce@cote-As pm.viously indicated, b 1986 the mortality data b these itemswere obtained from two sources (1) Microfdm images ofthe original eertifkates b-nished by the Virgin Islands andphotocopies front Guam and (2) records on data tape fur-nished by the so States the Mtrict of COlumbia New YorkCity. ●nd Puerto Rico. For the Virgin islands and (ham.which sent only copies of the original certificates, the derrt-~hic items were ceded for 100 percent of the deathcertificates. The demographic coding fbr 100 percent ofthe certificates was independently verified

As part of the qusdity control procedures for mortafitydata each registration area has to go through a cafibratlonperiod during which it must ●chieve the specified errortolerance level of 2 percent per item for 3 consecutivemonths. based on NCHS independent verification of a S&percent sample of that area-s records. once the area hasachieved the required error tolerance level a sample of70-80 reccsrds per month is used to monitor quality ofcoding. Al] areas providing data on computer tapes prior to1986 have schieved the specified esmr tolerarw WCOd-@Y, the demogr+hic items on about 70-80 recor& perarea per month were independently verified by NCHSl%e estimated average ●rror rate for all demographic itemsin 1986 was 0.25 percent.

These veti]cation procedures invofve controlling twotypes of ●rror (coding and ●ntering into the data remrd~) ~ the same time, and the emor rates area amrbinedmeasure of both types. It maybe assumed that the enteringemssmaremndomlydistsitast ed~allitems osstherearrd.butthis assumption cannot be made as readily for coding~-~ “Cermmin cdlrginbquent swentsmay escape detection dssring sample verification it is pro&able that some of these errors were detected during theinitial period when SOpercast of the fife was being verified,thus providing an opportunity to retrain the coders.


.$fedictd items on the death crrtijkate-.4s for demmgraphic data mordi~ medical data are also subject to quakity cuntrol procedures which control for ●rrors of kth cod-ing and data entn. Each of the 22 registration areas thatfiwmshed NCHS with coded medical information accordingto NCHS specifications first had to qualifi for sample veri-fication. During an initial calibration period the area hadto demonstrate that its staff could achieve a specified errortolerance level of less than 5 percent for coding all medicalitems. Aher the axea has achieved the required error toler-ance level a sampk of 70-80 records per month * Wed tomonitor quahty of medical coding. For these !22States, the-e cQ3i0g emor rate in 1986 was estimated●t justover 4 percent.

For the remaining 33 registration area+28 States. theDistrict of Columbia New York City. puerto Rico, theVirgin Mar& and Gsam-NCHS coded the medical itemsfor 100 percent of the death records. A l-percent sampleof the records wu independently coded for quality controlpurposes. The estnnated average error rate for these are=was about 3 percent.

‘l%eACME system for selecting the underlying causeof death through computer application eontribsstes to thequality control of medical items on the death certificate.(See section “’Automated selection of underlying cause ofdeath.’”)

Demographic itmss on the ~ ofj2tol deuth-For1986, all data on fetal deaths. except for New York State(excluding New York City), were coded under contract bythe U.S. Bureau of the Census. Coding and entering infor-mation on data tapes were verified on a 100-percent basisbecause of the relatively small number of records involved

Other control procedures-After coding and ●nteringon data tape are completed record counts are balancedagainst control totals for each shipment of records from aregistration area Editing procedures ensure that recordsw“th inconsistent or impossible edes are modified. hrccm-sistent codes arc those. for example. where there is contra-dlct]on between cause of death and age or se~ of thedeceden~ Rermrdsso identified doring the smmputermfitingprocess are either corrected by reference to the sourcerecord or adjusted by arbitr~ code assignment (NCHS.1979). Further, conditions specified on a list of infrequentor rare causesof death need to be rxsnfmed by the eetieror State Health Officer. For 1985 records, cryptosporidiosiswas no longer confirmed by NCHS although this rxmditionwas still on the list of infrequent or rare causes of deaththrough 1986. Because cryptosporidiosix has increased inhequency due to its association with the human immune.deficiency virus (HIV) infection, it is no longer consideredinfiquent AII subsquent operations in tabulating and inpreparing tables are verified during the computer proees~ing or by statistical clerks.

Estimates of emors arising from S&percentsample for 1972

Death statistics for 1972 in this report (excluding fetal.death statistics) are based on a 50-percent sample of aft

deaths occurring in the sO States and the District of Co-lumbia

A description of the sample design and a table of thepercent ●mors of the estimated numbers of deaths by sixeof estimate and total deaths in the area are shown in theTechnical .\ppendix of Vital Statistics o~dse L’nited States1972, Vohsme IL Mortidity, Pti A.

●ovulationbxes

llre ~prdation bases from which death rates shown inthis report are computed are prepared by the L.’.S.Bureauof the Census. Rates for 1940, 1950.1960, 1970, and 19b0are based on the population ●numerated as of Apti 1 in thecensuses of those years. Rates for all other years sue theestimated midyear (]uly 1) population. wads rates for theUnited States, individual States, and s\fSA’s are based onthe total resident populations of the respective areas. Ex-cept ax noted these populations exchsde the hssed Forcesabroad but include the hsred Forces stationed in, eacharea

The resident populations of the birth- and death-reg-istration States for 190&32 and of the United States for190046 are shown in table 7-1. In addition, the paprda-tion including -ed Forces abroad is shown for the UnitedStates. Table B lists the sources for these populations.

Poprdotion txtimotes & 1986-The population of theUnited States estsmated by age, race, and sex for 19b6 isshown in table 7-!2, and the population for ●ach State bybroad age groups follows in table 7-3. Population estimatesfor 1984-86 incorporate new estimation procedures fornet migration and net undocumented immigration. The 1986●stimates are comparable with those for 1964 and 1965 butare not tictly comparable with the postcenxal estimatesfor 1981-83 shown in tables 7-2 and 7-3 of Vita! Strxtisticsof the United Sta~ Volume II, for those years. Althoughthe death rates and estimates of life expectancy for 1984-86 are not sbictly ~mparable with those for prmious years.the trends for the total population and most age-race-sexgroups are not substantially affected. For additional details,see the Technical Appendix in Vital Statistics o~the ~%itedStot~ 1984, Volume 11 and the report of the U.S. Bureauof the Census (1988). Population data by race are consistentwith the modified (see below) 1980 population by race.

Popdotion jbr 1980-The population of the UnitedStates by age, race, and sex and the population for eachState by age, are shown in tables 7-2 and 7-3, respectively.of Vital W- o$the United Stoteq J980, Volume 11.Th~figures by race have been modified as described below=

The racial counts in the 1980 census are affected bychanges in reporting practices particularly of the Hispanicpopulatio~ and in coding and classifying One particularchange created a major inconsistency between the 1980census data and historical data series including censusesand vital statistics. About 40 percent of the Hispanic population counted in 1980. over5.8 mihon personadid not

TSbla ●. Sourcu tor rooldont POpUMIOn Wsd PopulatlanW@udlng Armad Forws abroad ●lrttw●4 daauweesabetsan *tea,IWO-1.32, ond Unltad Statms, 1S00-16S6

Yaw Sourc~

1986------------------U.S Bureau ot tho Census. Currxnl Pofwmon Rcpom SerIos P-25, No 1022. M8r 1988

1985 ------------------ U.S Burcw of tha CWW& CurronfPopul#fionRcpof?s S&ii P-25, No, lCCQ Fob. 1987.1s64------------------ U.S. Burobu C4W Cmaus, Curmnf Popul@on Roporrs SariU P-25, No. 965, Apr. 1986.19s3------------------ U.S. Buraw of tha Canaux, Currw Popufstion Rworr4 Sows P-2$1.No. S65. Mm. 19S5.19e2------------------ U.S. Bufcw al tha C+naus, Currant Popu/#fmnRoportc S4rii P-25, No. S40, May 1%64.1s81------------------ U.S. Bumw of tha Conauc,CurrwntPopulwon Ropotis Sarhs P-25, No. 929. May 1983.1980------------------ U.S. Bureau of the Cwws.W.S Conzus of Population: 1SS0,Numbarofhh@#mf6 PC60-1-A1, Unitad SWae

Summmy, 1983.1071 -79--------------- U.& Suruu of the Cenauh Currsnt Popu&lJon~ 8uhs P-26, Na 917. J@ 1SS2.1070------------------ u.a m d the mu us cows of Pwwon’ l$7a wmbes d mhabftmsts Fw newt KVW.

UJMtad Stataa Summefy, 1971.lW1-60 --------------- U.& BWSU OStht C4W& CWMntPOPUS4tIOtI S14POIT4 &fie4 P-26, Na 610, ktdi 1974.1s60------------------ U.S. Sweau at the Census, U.S Canws of Popu$alion:19S0, Numbw Of fnhabR8nta PCXl)-Al. W@ x

Summwy, 1S$4.19s1-59 --------------- U.S. Bureau OSW Cwmu.. Curmnr Popu/stion R@otr& Swiso P-25, No. 310, June 30,1965.lMO-50 --------------- U.S. Ourow 01tlw Cornus. Currenf PopulationRoport&Sews P-25, No 46S, May 187S1930-39--------------- U.S. Buro8u of tho Can8u8, Curmnf ~ul.ation Reports S9rw P-25, No 40Q, htay 1S73, ●nd Natmnal Ottioa

Of Vial SMXWX,Vit#lStstMc8 Rat.: in fho UnMd St#t*& ?900-1940, 1047.1020-29 --------------- Natmrml Othce of Vlt81St@twcs. Vlfalstwwxs Rgrasin th4 Uniltd Swo& fBW-W4Q 1M7.1817-10 --------------- 6amou for 1$30-30.1600-1016 ------------- same u for 1020-29,

mark one of the specified races listed on the census ques.tionndre but instead morked the ““Other”category.

In the 1980 census. coding procedures were modifiedfor persons who marked “’Other- race and wrote in a na.tional origin designation of ● Latin American country or ●

specific Hispanic-origin group in responsr to the racialquestion. These persons remained in the “other” racialcategory in 1980 census data in previous censusesand invital statisticssuch responseshad almost alwaysbeen codedinto the “White”’ categoq.

hr order to maintain comparability. the “other”” racialcategoty sn the 1960 census was reallocated to be consis-tent with previous procedures. Persons who marked the“’Other” racial category and reported any Spanish origin onthe Spanish origin question (5.840,646 persons) were dis-tributed to white and black races in propotion to the distri-bution of persons of Hispanic origin who actually reportedtheir race as %’bite” or ‘“Black.””This was done for eachage-sex group,

As a result of this procedure, 5.705,155 persons (9Epercent) were added to the white population and 135,493persons (2 percent) to the black population. Persons whomarked the “other” racial categon and reported that theywere not of Spanish origin (916,338 persons) were distributed ss foUows. zo percent in each ag~sex group wereadded to the ““Asian and Pacific Islander” categon (1S3268persons). and 80 percent were added to the “White” cate-gory (733,070 persons). The count of American Indians.Eskimos. and A]euts was not tiected by these procedures.Unpublished tabulations of these modified census countswere obtained from the L’.S. Bureau of the Census andused to compute the rates for this volume.

Pspfoth estimotes jbr 1971-79-Death rates in thisvolume for 1971-79 used revised population estimates thatare consistent with the 19S0 census levels The 19S0 census

enumerated approximately S.S miUion more persons thanhad pmlously been estimated for Apn] 1, 19S0 (W. Bureaussfthe Cen~ 1982b). ?lwse revised estimates fbrthe UnitedStates by age, M end sex are ptsbfished by the LX. Bureauof the Census in Csrmmsthpsslotksn ~ Series P-25.hhsrtsber917. Unpublished revised estimatesfor States wereobtained km the U.S. Bureau of the Cenxsw For PuertoRice. the Virgin Isle.rs& and G- revised estimates arepublished in Crmstst Popu&tlo+r~ Series P-25. Mm.ber 919.

PopuMon extimotcs jbr 1961-69-Death rates in thisvolume for 1961+9 are based on revised estimates of thepo+tion and thus may differ xlightly from rates publishedbefore 1976. The rates shown in tsbles 1-1 snd 1-2. thelife table values in table 6+ and the population estimatesin table 7-1 for ●ach year in the period 1961-69 have beenrevised to reflect modified population bax~ ax pubfishedin the L’.S.Bureau of the Cenxu% Crmerst Popu&tim Rc-~ series P-25, Number 519. The &ta shown in table1-10 for 1961-69 have not been revised.

bti and raiios hosed an k Mhs-infant and ma-ternalmortality ratea and fetal death and ~~ ~~ihratios. are computed on the basis of the number of liwe both~Fetal death and perinatal modity rates are computed onthe baxis of the number of live births and fetal deaths.counts of live births we published annuafly in Vita/ Statis-m of the United Stat.sx Volume L NateW’.

New &sey-As previously indicated. data by race erenot available for New Jemey t%r1962 and 1963. Thereforefor 1962 and 1963 the National Center for Heafth statistimestimated a population by age, race. and sex exchdng Newjersey for rates shown by mce. ‘The methodology used toestimate the revised population excluding New Jersey isdiscussed in the Technical Appendixes of the 1962 and1963 volumes


Net census undercount

Just as the underenumeration of deaths and the mis-reporting of demographic cha.ractertstics on the death cer-tificate can introduce error mto the annu~ ratq So canenumeration errors in the latest decennial census. This isbecause annual population estimates for the postcensal in-terval which are used in the denominator for calculatingdeath sates, are computed using the decennial census countas a base (M. Bureau of the Census, 1988). Net censussmdercount is the result of miscounting and dsrqathof demographic cb~eristics such ss age. ~~-gdeath rates areaffectedbybo ththenti~und~nt-d the misre~g of age on the death certificate (NCHS.1968b). To the ●xtent that the net undermsunt is xubstan-tisl and that it vsuiesamong subgroup and geographic aressit may have important consequen~ foi- vital statisticsmeasures.

Although death rates based on a population adjustedfor net census undercvunt maybe more accurate than ratesbased on an unadjusted popssfatiomrates in this volume arenot adjust~ rather, they are computed using populationestimatesthat presen,e the age pattern of the net censusundercount across the postcensal intend l%us, it is imp-ortant to consider the possible impact of net census under-count on death rates.

The M Bureau of the (%MUShas conducted extensiveresearch on completesscssof merage oftJe U.S.population(including smderenumeration and misstatement of age, race,and sex) in the last four decennial censuses—19S0. 1960,1970, and 19s0. From this work have come estimates of thenational population that wax not counted by age. race, andsex (U.S. Bureau of the Census, 1974, 1977). The reportsfor 1980 include estimates of net census undercwunt usingalternative methodological assumptions for age, race. andsex subgroups of the national population (Passel and Robin-son, 1985). These studies indicate that. although coveragewas improved over previous censuses there was differentialcoverage in the 19130 census among the population subgroups; that is some age, race. and sex groups were morecompletely counted than others.

Net census undercounts can afTect (1) levels of theobsemed vital rates, (2) differences among groups. and (3)levels and group differenws shown by summ~ measuressuch as agt+adjusted death rates and life ●xpectancy.

f.iaxls ad di@rerstMs-lf adjustments were made fornet census undercount, tht sise of denominato~ of thedeath rates generally would increase and the rates there-fime, would decrease. The adjusted rates for 1980 can becomputed by multiplying the reported rates by ratios of thecensus-led resident population to the resident populationadjusted for the estimated net census undercount (table 7-4). A ratio of less than 1,0 indicates a net census undercountand when applied. results in ● corresponding decrease inthe death rate. A ratio greater than l.O-indicating a netcensus overcount-rnrdtiplied by the reported rate resultsin so increase in the death rate.

Coverage ratios for all ages show that in general, fe

males were more completely enumerated than males andthe white population more rmmpletely than the populationof afl other races in the 1980 Census of Population. Theblack population was undercounted relative to the totalpopulation of all other races.

For the totaf population. underenumeration varied byage group, with the greatest differences found for personsaged 80-84 and 85 years and over. Al] other age groupswere wer~unted or undercounted by less than 3 percent

Among the age-sex-race groups, rmverage was kswesth black males aged 40-44 and 45-49 years. Underenu-mesationfbrthese grosrpswas 19parcenLh~~whjtefemales in these age groups were essentially completelyenumerated For black females and white mafes in thesesame age groups the undercount ranged fiorn 3 to 6 percent,For the under-l-year age group the white population wasoveremunerated by 2 percent. whereas infarrk of other raceswere underenusnemted by 9 percent

If vital atathtics measures were calculated with adjust-ments for net census undercounts for each population subgroup, the resulting rates would be differentially ieducedfrom their original levels; that is, rates for those groups withtJse greatest ●stimated undercounts would show the great-●st relative reductions due to these adjustments. Similareffects would be evident in the opposite direction forgroups with overcounts. As a consequence, the ratio ofmortality between the rates for males and females, and be-tween the rates for the white population and the popula-tion of other races, or the black population. usuafly wouldbe reduced.

Similsuly, the differences between the death ratesamong subgroups of the population by cause of death wouldbe affected by adjustments for net census undercounts. For●xample, for the age group 3s-39 years in 19&o.the ratioof the death rate for Homicide and legal intenention forblack males to that for white males is 7.3, where= the ratioof the death rates adjusted for net census undercount is6.2. For Ischemic heart disease for males aged 40-44 years,the ratio of the death rate for the population of all otherraces to that for the white population is 1.2 using the unad-justed rates but it is 1.1 when adjusted for estiated under.enumeration.

Summary measures-The effect of net census under-count on ag-adjusted death rates depends on the under-emmseration of each age group and on the distribution ofdeaths by age. Thus, the ag~adjusted death rate in 1980for A]] causes would decrease from 585.8 to 579.3 per100,MK)population if the age-specific death rates were cor-rected for net census undercount.

For Diseases of the heart. the age-adjusted death ratefor white males would decrease from 277.5 to 273.0 per100.000 population, ● decline of 1.3 pesters; For blackmales the change, Iium an unadjusted rate of 327.3 to anadjusted rate of 308,3, would amount to 5.8 percent.

U death rates by age were adjusted, then the corre-sponding life expectancy at bids computed from theserates would change. The importance of adjustments variesby age; that& when calculating life ●xpectancy, the impact


of an undercount or overcount is greatest at the youngerages. h general the effect of mmecting the death rates isto increase the estimate of life ●xpectancy at birth. DifTer-entiaJ underenumeration among racesex groups wuld leadto greater changes in life ●xpectancy h some groups thanfor others. For w’bite females who were completely ●nu-mesated in 1980, m$sed estimates of life ●xpectancy wouldrernxin roughly cmnstank those for black maleswould showthe greatestincrease.

&eedjusted death rates shown m thii vohxmeare con+puted by using the distribution in lo-year age intervals ofthe enumerated population of the United States in 1940 asthe standard population. Each figure represents the ratethat woufd have existed if the age-specific rates of the par-tkular year prevaifed in ● papufation whose age distributionwas the same as that of the United States in 1940. fie ratesfor the total population and tbr each raceaex group wereadjusted using theaameshndard popuMom Itisimportantnot to mrnpare ●ge-adjusted death rates wfth mude rates.The standard 1940 population. on the basis of one milliontotal populatirmisasfollows:

A]) axes . . . . . . . . . . . . . . . . . . . . . . . . . .

L%derlyeu . . . . . . . . . . . . . . . . . . . .l-4}esr$ . . . . . . . .S14}ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-wyem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-34>*us . ..... ... ..... ............3.3+4>ears . . . . . . . . . . . . . . . . .

4s-34yrars. ... .. ...S644 years . . . . . . . . .

65-74year> ,. .,.. . . . . . . . . . . . . . . . . . . . .

%84year$.. . .. . ....... .... ......63yearsmd oter . . . . . . . . . . . . . . . . .

N&

l,wo.tno

1s.34364.715

170.3s5181,677162.066139.23:117.61180.2944&42617,3032.770

Life tables

U.S. abridged life tables are constructed by referenceto ● standard table (!SCHS. 1966). Life tables for the decen-nial period 19X+8 1 are used as the standard life tables inconstructing the 1980-86 abridged life tables. With theavailability of the 1979-81 standard life tables. revised lifetable values were computed for 1980-82, these appearedfor the tit time in vital St@tics of the UnftecfStutq 1983.

Life tables for the decennial period 1969-71 are usedas the standard life tables in constnscting the 1970-79abridged life tables. Life table values for 1970-73 werefirst revised in Vital Statistics of theUnited Stateg 1977;before 1977. life txble values for 1970-73 were constructedusing thr 19s8-61 decennial life tables. in addition. lifetxble values for 1951-s9, 1961-69, and 1971-79 appearingin this volume are based on mixed intercensal estimates ofthe populations for those years. As such, these life table

values may differ from life table values for those years pubIished in previous volumes

The change in the population estimation methodolo~{see 8bove section “Population ImseF) results in life ex-pectancies at certain 5-year agt intends for 1984-66 thatare lower than those that would have occumd had theybeen based on the same metbado~ used to c4srnpute1883life expectmcies. For dditiorsel details. see Technical ApDendixbr vital statistics of the united sta* 1964, vol-irneu.

TbereIMsbeenaainuesduitlt-th&me-@les@ofMe~kr*dendupuS*kWtbssoftbearmuddx’ishdkfetabkaerfe$ kwsebrsedsate.sex groups in 1945.-Tlse figures in table 6-5 ftw therace and sex groups for the following years were ●stimatedto meet these needs. For estimating procedures, see Xa-tional Office of Vital StatMcs (1951).

krs

IWO+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-7 ...............................

MOO-47... . . . . . . . . . . . . . . . . . . . . . . . . . . . .MIOa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1004M4 . . . . . . . . . . . . . . . . . . . . . . . . . . . .leoo-s4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1WL50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lw1144 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lWO-S4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TadweRsnakW%lte\!’hIfr mdh.

M%w kmdr

AU otherAm Mhc’r. maleU&r, fade

The geographic areas covered in life tabl~s before1929-31 were limited to the death.regis~atv-m areas. Lifetables for lWO-1902 end 1909-11 were constmcted usingmortality data fionr the 1900 death-registration States- 10States and the Distxict of Columbia-and for 1919-21 fromthe 1920 death-registration States-34 States and the Di*tric+of Columbia The tables for 1929-31 thrrmgh 1956 coverthe mmtenninous United States. Decennial life table vxluesfor the 3-year period 18s9-61 were derived from data thatinclude both Aluka and Hawaii for each year (table 6-4).Data for ●ach year shows in table 6-5 include Alaska be-ginning in 1959 and Hawaii begimsing in 1960. It is believedthat the inclusion of these two States does not materiall>affect life table values.

Random vuietion in numbers of death deathrateq end mofiality rates end ratios

Deaths end papulatiadased rat~-Except for 1972.the numbers of deaths reported for ● community representcomplete counts of such events. ASsuch they are not subject to sampling error, afthough they xre subject to emors inthe registration process. However, when the figures =eused for analytical purpssx such as the wrnpariaan ofretesover ● time period or for different areas, the number ofevents that actually ocmtmed maybe considered as one ofa

largeseriesof possible results that could have arisen underthe same circumstances (National OfRcwOfvital Statistics,

..


1961). The probable range of values maybe estimated fromthe actual figures according to certain statistical assumptions

in general. distributions of vikl events may he assumedto follow the binomial distribution. Estimates of standarderror and tests of significance under this assumption aredescribed in most standard statistics texts.When the numberof events is large, the standard ●rror, expressed at a percentof the number or rate, is uaudly smaJL

When the number of events is smafl (perhaps less than100) and the probability of such art ●vent is S4 arsaider-able caution must be observed in interpreting the cosrcWtions described by the figures. ‘f%isis particularly true forinfant mortadity rate% cause-specific death rates, asaddeathrates for counties. Events of a rare nature maybe mssumedtQfollow a Poisson probability distribution. For thii distribwtion a simple approximation maybe used to estimate ●con-fidence interval. as follows.

If h’ is the number of registered deaths in the popula-tion and R is the corresponding rate, the chances are 19 in20 that

1. h’-2\Tand N’+2\?T

covers the “’true”number of events.

covers the ““true”.rate.

If the rate R ecmesponding to N events is compared withthe rate S corresponding to iif ●vents, the difference be-tween the two rates may be regarded as statistically sig-nificant if it exceeds

For example. if the observed death rate for CommunityA were 10.0 per 1,000 population and if this rate were basedun 20 recorded deaths, then the chances are 19 in 20 thatthe .“true” death rate for that communi~ lies between S.5and 14.5 per 1000 population. If the death rate for Com-munity A of 10.0 per 1,000 popsdation were being comparedwith a rate of 20.0 per 1,000 population for Community B,which is based on 10 recorded deaths, then the differencebetween the rates for the two communities is 10.0. Thisdifference is leas than twice the standard ermsr of thedifference

of the two rates, which is computed to be 13.4. From this, itis concluded that the difference between the rates for thetwo communities ia not statistically significant.

STMBOLS t.3ED IX TABLES

D@amotavaikabk -------------------

Categoq not applicable ----------------

Quantit} zero ----------------------

Quantity- thanzem butlessthan0.0S ----

Quantio m.rr than zero’but lest than .500where numbem are rounded to thousand, ----

Piguredoss00Smsst stdarsfs ofrelitillit~orprscisioo ----------------------

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---

. ..

0,0

z

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d.ts.covuu4hfuvrmfwu4comcm9t9 J+o -952/00t63

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