# Presentation: 125889

## National Mortality Data Set

**Kenneth D. Kochanek**
**Mortality Statistics Branch**
**Division of Vital Statistics**
**National Center for Health Statistics**

**Data Users Conference**
**July 12-14, 2004**

## Presentation Outline

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

## Nature of the National Vital Statistics System 

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

- SOURCE: CDC/NCHS

## Role of States 

- State laws govern filing of certificates and reports
- States produce their own certificates and reports
- States code the information
- Vital Statistics Cooperative Program (VSCP)
- Availability of certificates and reports

- SOURCE: CDC/NCHS

## Role of NCHS 

- To compile and publish national and sub-national vital statistics
- To promote coherence and uniformity of the data collected through the VSCP

- SOURCE: CDC/NCHS

## Promote Data Quality 

- Model law
- Handbooks
- Training and instruction manuals
- Various publications
- Standard certificates and reports
- Quality control

- SOURCE: CDC/NCHS

## Slide 7

## Mortality Data

- Mortality statistics are based on information from the approximately 2.3 million death certificates filed each year in the 50 States and the District of Columbia
- The Death Certificate serves two very different purposes

## Death Certificate

- A legal document regarding the facts and circumstances of a death
- A statistical resource providing information on characteristics of the decedent

- SOURCE: CDC/NCHS

## Slide 10

## Slide 11

## Role of World Health Organization

- Promoting standardization of mortality statistics through the International Classification of Diseases (ICD)
- Compiling international mortality statistics

- SOURCE: CDC/NCHS

## Role of ICD

- Provides standard definitions
- Prescribes the format for cause-of-death information on the death certificate
- Describes how death certificate should be completed
- Provides rules for selecting the underlying cause of death

- SOURCE: CDC/NCHS

## Underlying Cause of Death

- “The disease or injury which initiated the chain of morbid events leading directly to death, or
- The circumstances of the accident or violence that produced the fatal injury.”

- SOURCE: CDC/NCHS

## Computer Software

- ACME: Automated Classification of Medical Entities
- TRANSAX: Translation of Axes
- MICAR: Mortality Medical Indexing, Classification and Retrieval
- SuperMICAR

- SOURCE: CDC/NCHS

## Advantages of Underlying Cause of Death 

- Simple and one dimensional
- Conceptually easy to understand
- Well-accepted measure of mortality
- Useful to public health officials

- SOURCE: CDC/NCHS

## Limitations of Underlying Cause of Death 

- Only one disease selected
- Arbitrary selection
- Excludes information
- Certifier mistakes
- Only as good as the information on the death certificate

- SOURCE: CDC/NCHS

## Multiple Cause of Death

- Portrays the number of deaths in which a given condition is a significant factor contributing to death, if reported
- Portrays the Interaction of diseases
- Contains two fields:
- Record Axis
- Entity Axis

- SOURCE: CDC/NCHS

## Entity Axis Applications

- Relationships among conditions
- Accuracy of certification reporting
- Testing traditional assumptions of underlying cause selection

- SOURCE: CDC/NCHS

## Record Axis Applications

- Classifiable in manner like the underlying cause of death
- Best representation of ICD codes

- SOURCE: CDC/NCHS

## Electronic Death Certificate (EDC)

- Certifier and funeral director data entry in electronic form, including
- prompts
- tutorials
- querying for incomplete or uninformative terms
- querying for implausible cause of death sequences

- SOURCE: CDC/NCHS

## Data Dissemination

- Preliminary Report
- Final Report
- Monthly National Vital Statistics Reports
- Special reports
- Public use micro data – CD-ROM
- Confidentiality

- SOURCE: CDC/NCHS

## CD-ROM’s

- Mortality Public Use Data Sets
- ASCII Dump CD-ROM’s  1968-2001
- SETS CD-ROM’s  1991-98

-    Compressed Mortality File (CMF)

## Slide 24

## Slide 25

## Slide 26

## Mortality Data from the National Vital Statistics System website:http://www.cdc.gov/nchs/about/_x000b_major/dvs/mortdata.htm