# Presentation: 199209

## Impact of Hurricane Katrina on 

**Vital Statistics and NCHS Surveys**

**Centers for Disease Control and Prevention**
**National Center for Health Statistics**

**Stephanie Ventura**

**Board of Scientific Counselors**
**National Center for Health Statistics**
**May 4, 2006**

## National Vital Statistics System

- 57 reporting areas
- Decentralized
- US historical development-self-governing States
- Nothing on registration in US Constitution
- Responsibility based in state law
- Responsibility with provider of services

## Federal Role Defined by the Public Health Service Act – Sec 306 (h) (1)

- Annual collection of data from the records of births, deaths, marriages, and divorces
- Satisfactory data in necessary detail and form
- Detailed data on ethnic and racial populations
- Each State or registration area shall be paid by the Secretary the Federal share of its reasonable costs

## National Vital Statistics System

- Individual Record Data:
- Births
- Deaths
- Fetal Deaths
- Counts:
- Marriages
- Divorces

## Immediate Aftermath of Katrina 

- Most urgent concerns:  Keeping families together; safety; adequate housing and food
- People took few possessions; these included birth records
- Recognition of need to document identity and legal status
- New awareness of importance of basic legal documents long taken for granted

## Offers of Assistance 

- Right after Katrina hit in late August, NCHS offered technical assistance to LA and MS vital records offices
- NAPHSIS and state colleagues also offered assistance
- NCHS offered assistance to LA focusing on mortality coding
- But sadly, Louisiana did not have the resources to accept any assistance until recently

## Ongoing Issues

- LA central vital statistics offices located in New Orleans; building _not _destroyed, but not accessible
- LA offices at first temporarily relocated to Baton Rouge
- Less than one-half of pre-Katrina LA staff is on board (two new staff hired)
- LA offices relocated to Metairie, LA

## Specific Challenges

- LA electronic birth registration system about to restart soon
- Data entry manually in state office and transmitted electronically to NCHS
- Estimated 35,000 of annual total of about 65,000 birth records have been transmitted to NCHS...no estimate of final number for 2005
- Anticipate about 1,600 births Aug-Dec in New Orleans area in a typical year; no information yet for 2005

## Specific Challenges, cont.

- LA still has no nosologists (to code cause of death); the two previously on staff relocated to Texas and Georgia
- 80% of LA’s physical records including historical files are in usable condition, but
- Document restoration underway for 20% of the records

## Specific Challenges, cont.

- Lack of nosologists in LA and inexperience in LA and other states with this level of natural catastrophe: challenges for documenting the facts
- NCHS developed training materials  to provide instructions for coding cause of death for storm-related deaths

## Current Status

- LA has transmitted photocopies of 1/3 of their 2005 death certificates to NCHS for coding
- LA now relying on NCHS to code death records, both the demographic and cause of death sections
- NCHS is accessing the LA web to code into the LA system and then re-transmitting the LA data to NCHS

## Ongoing issues, cont.

- NCHS medical coding expert assessment:
- 	We won’t ever see all the death records for LA
- Tragically, many bodies not identifiable because of decomposition; no DNA available, and
- Confirming status of many missing people may not be possible

## Progress

- LA vital statistics offices now able to provide certified copies of vital records – problems remain for New Orleans events
- Mississippi and Alabama vital statistics offices functioning

## Impact on vital statistics

- Impacts huge for LA: Birth certificates filed for about 47,000 LA residents in 2005, compared with 65,400 in 2004
- TX reports 400+ births to LA residents for 2005 (most in September); usually about 80
- FL, GA, AR, and TN each reported 40-50 births to LA residents in 2005; usually only a handful in each state

**Births:**

## Impact on vital statistics

- Impact huge for LA: To date 28,300 death certificates filed for 2005 compared with 42,200 in 2004
- TX reports almost 700 deaths to LA residents for 2005 (most occurred in Sept and Oct); typical annual total is < 300
- AL, FL, GA, AR, and TN each reported 40-60 deaths to LA residents in 2005, double the usual numbers

**Deaths:**

## Potential impacts on key public health measures

- Fertility and mortality rates for all affected states and especially for Katrina-impacted parishes in LA
- Low birthweight
- Preterm birth
- Infant mortality
- Cause of death statistics

## Estimates of affected MIH population

- Affected parishes and counties in LA, MS, and AL account for about 75,000 live births annually
- Estimate about 130,000 pregnant women and infants potentially impacted by Katrina
- Typically, preterm, LBW, and infant mortality rates significantly higher in Katrina-impacted areas than elsewhere

## Other consequences of Katrina

- Inability to accurately track impacts by geography even though vital records are available at the unit level
- Tracking impacts likely to be especially challenging for New Orleans-area
- Less impact for other geographic areas because of wide dispersion of the affected population
- Trend analysis complicated by changes in size, composition of population

## What could mitigate effects on vital statistics?

- No existing mechanism for addressing Katrina or similar events
- Patient IDs or other linking systems would help; do not exist now
- Develop emergency registration systems

## Next steps for vital statistics

- Continued monitoring
- Ongoing: measuring key maternal and infant health and mortality measures
- Continued outreach to colleagues in LA and neighboring states

## The Impact of Recent Hurricanes on Three NCHS Survey Programs...

**The National Health Interview Survey (NHIS)**
**The National Immunization Survey (NIS)**
**The State and Local Area Integrated Telephone Survey (SLAITS)**

## National Health Interview Survey (NHIS)

- In-person survey of the civilian, non-institutionalized population
- Data collection by the Census Bureau
- Nationally representative, independent weekly samples

## National Health Interview Survey (NHIS)

- 2005 sample target of 40,000 households from 358 PSUs
- Long-time HIS procedures: Uninhabitable units given a specific outcome code which does not count as nonresponse
- Displaced persons in households not specifically identified or probed

## National Health Interview Survey (NHIS)

- Interviewing resumed in all areas
- Closeout of weekly samples limits time to capture each unit
- Lost 435 household interviews in 3 states thru year end
- Adjustments unlikely

## The National Immunization Survey (NIS)

- Random Digit Dialing survey of households with children 19-35 months
- Annual estimates of up-to-date status for 78 areas—50 states, DC, and 27 urban areas
- Over 1 million households screened annually for eligible children

## The National Immunization Survey (NIS)

- Four hurricanes interrupted interviewing
- Hurricane Katrina had longest impact
**TN off for 11 days**
**AL off 55 days**
**Northern LA and MS off for 59 days**
**Southern LA and MS off for 93 days**
**New Orleans closed for duration of 2005**
- Will reach annual targets for all areas except New Orleans

## The National Immunization Survey (NIS)

- Deactivation is driven by news reports and NOAA and FEMA data
- Resumed dialing in all areas

## The National Immunization Survey (NIS)

- Need to consider affects on data quality and reliability
- Impact of limited data collection period and reduced number of completes on annual immunization coverage estimates for the New Orleans area, Louisiana, and the entire U.S.
**no adequate population controls**
**loss of immunization provider records  **
**state and local immunization registries**
**missing data models for the affected areas**

## The State and Local Area Integrated Telephone Survey (SLAITS)

- Uses NIS sampling frame
- Designed to provide in-depth state and local area data for program and policy needs
- 2005-2006 National Survey of Children with Special Health Care Needs
- Does not share same demands as NIS for annual estimates in local areas

## SLAITSNational Survey of Children with Special Health Care Needs

- 850 completed interviews in each state and DC over 2 years
- Florida was temporarily suspended in Q3
- Mississippi and Louisiana suspended for Q3 and Q4
- Compress MS and LA interviewing into 2006

## SLAITSNational Survey of Children with Special Health Care Needs

- Add questions in Q1 2006 on impact for displaced persons
- Self identify thru current screener— residence status for past 2 months
- receive new Katrina specific questions on impact

## SLAITSNational Survey of Children with Special Health Care Needs

- Left home ≥1 night due to Katrina
- Special arrangements due to health conditions
- Trouble finding shelter due to health conditions
- Currently in short term or temp housing
- Move back
- Number of nights away
- While away, need and get health care/med equip
- Get all health care needed and where

## Challenges for Data Release for Vital Statistics and Affected Surveys

- Several questions to consider:
- Changes in size and composition of population of affected areas
- Lack of adequate population controls: Are we sure we are fully capturing affected populations?
- Impact on *trends* for these areas if population composition has changed
- Consider breaking data releases into pre- and post-Katrina data issuances?
- While away, need and get health care/med equip
- Get all health care needed and where

## More Information

- Vital Statistics:
- 		Stephanie Ventura
- 		_[sventura@cdc.gov](mailto:sventura@cdc.gov)_
- 		301-458-4547
- NHIS, NIS, or SLAITS:
- 		Marcie Cynamon
- 		_[MCynamon@cdc.gov](mailto:MCynamon@cdc.gov)_
- 		301-458-4174