Vital Statistics Summary of a Workshop (2009) / Chapter Skim
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Appendix B: The U.S. Vital Statistics System: A National Perspective
Appendix B: The U.S. Vital Statistics System: A National Perspective
Pages 87-110
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From page 87... ...
The National Center for Health Statistics (NCHS) is the federal agency legislatively mandated to produce national health statistics based on this cooperative, decentralized system in which data from more than 6 million vital-event records are collected each year by all states and U.S.
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From page 88... ...
The data shall be obtained only from and restricted to such records of the States and municipalities which the Secretary, in his discretion, determines possess records affording satisfactory data in necessary detail and form." Currently this data collection is limited to data from birth and death records (including fetal deaths) , as NCHS discontinued the collection of individual-record marriage and divorce reports after 1995.
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From page 89... ...
In 1847 the AMA addressed memorials to state legislatures on the need for registration laws. To obtain national data, the decennial censuses in the latter half of the 19th century included questions about vital events, but the method was recognized as inefficient and the results as deficient.
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From page 90... ...
There are more than 25,000 fetal deaths in the U.S. each year, similar to the number of infant deaths, and fetal death reporting remains an integral component of NVSS at NCHS.
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From page 91... ...
The records were produced by local officials and transmitted to state vital registration offices for permanent maintenance in central state files and production of state and local vital statistics. Basic standards for definitions, data quality, and methods of collecting, processing, and analyzing vital statistics were in place.
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From page 92... ...
of records, including detailed tabulations from the natality as well as mortality files. Consequently, in January 1998, NCHS ceased publication of provisional mortality data based on the Current Mortality Sample (CMS)
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From page 93... ...
Several data items were also eliminated from the minimum basic data sets for natality (1-minute Apgar score, date of last live birth and last fetal death, and education of father)
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From page 94... ...
During the initial phase of the initiative, a pilot system was developed to demonstrate the practicality of Electronic Verification of Vital Events (EVVE) by creating an online system that would enable federal agencies to query state vital records offices to verify the availability and accuracy of birth and death records, for example, to determine qualification for new or continuing entitlements.
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From page 95... ...
. Congress acted on this report with the passage of IRTPA, including Section 7211 which is the first federal statute to regulate vital registration practices of the states.
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From page 96... ...
Standard Certificates and Reports is a significant area of cooperation for NCHS and the state vital statistics offices, occurring generally every 10 to 15 years. This is a particularly important activity because it brings together various experts -- data users, researchers, and policy makers, both public and private -- to develop recommendations on the content of the certificates and reports that will be used in the registration of live births, deaths, marriages, divorces, fetal deaths, and induced terminations of pregnancy during the next decade.
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From page 97... ...
2003 Changes in Collecting Data on Births and Fetal Deaths With the 2003 revision of the birth certificate and fetal death report, the panel recommended the development of worksheets to collect demographic data from the mother and separately to collect medical and health information from the prenatal care records and the birth facility. This was a significant shift from previous data collection procedures that typically depended on obtaining all relevant information from the mother.
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From page 98... ...
In these cases, the states do not have a consistent statistical data set for the affected year. This creates an extraordinarily difficult problem for compilation of data files and for the analysis and dissemination of national birth and fetal death data.
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From page 99... ...
project is a major area of cooperation between NCHS and the state vital statistics offices. For analytical purposes, it is especially useful to combine information from the birth and death certificates for any infant that dies; the additional variables from the birth certificate make a much richer infant mortality database.
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From page 100... ...
The 1988 National Maternal and Infant Health Survey (NMIHS) is the most recent follow-back survey conducted by NCHS focusing on reproductive health; it included a nationally representative sample of 9,953 live births, 5,332 infant deaths, and 3,309 late fetal deaths.
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From page 101... ...
The LF provided information on infant feeding practices, child care, parental employment, and a wide range of information on early childhood health and development. A subsample of NMIHS women who had infant or fetal deaths (1,000 of each)
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From page 102... ...
DVS annually offers 1-week courses in "Vital Statistics: Measurement and Current Analytic Issues," "Vital Statistics: Measurement and Production," and "Vital Statistics Records and Their Administration." In addition, DVS staff has offered several types of courses on the coding and classification of cause-of-death information from death certificates. The participants in these courses are generally employees of state, county, and city registration offices; however, mortality coders from other countries have also been trained in the use of the NCHS Mortality Medical Data System (MMDS)
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From page 103... ...
Mortality Medical Data System (MMDS) Beginning with the implementation of the eighth revision of the ICD in 1968, NCHS developed and employed several interrelated computer systems to automatically select the underlying cause for each death certificate and to produce multiple cause-of-death data.
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From page 104... ...
Matched Multiple Birth File DVS staff developed the Matched Multiple Birth File (MMBF) to facilitate an analysis of characteristics of sets of births and fetal deaths in multiple deliveries.
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From page 105... ...
DATA DISSEMINATION Releasing Microdata and Compressed Vital Statistics Files On November 20, 2007, DVS/NCHS released a new policy on the release of and access to vital statistics microdata for births, deaths, fetal deaths, linked birth/infant death, and matched multiple births. Effective with the 2005 data year, NCHS revised its microdata release and access policy to comply with state requirements, laws, and policies.
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From page 106... ...
Trend tabulations of natality, fetal mortality, and linked birth/infant-death data by geographic detail at the county level are currently available.7 LOOKING AHEAD: VITAL STATISTICS FOR THE 21ST CENTURY Building on the Present Automation of Vital Statistics at the Source, State, and National Levels Despite the importance of the nation's vital statistics system, in many states it remains based on outmoded vital registration practices and systems, tain only geographic identifiers of counties and cities with a population of 100,000 or greater, and no exact dates. For birth, death, and fetal death files, year, month, and day of week (e.g., Monday)
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From page 107... ...
The complete death-record data do not become computerized until reaching the state vital registration office, sometimes after considerable delay. The lack of automation at the source precludes timely follow-back to improve data quality and does not take advantage of the expanded use of electronic medical records.
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From page 108... ...
Such an ongoing follow-back survey, taking advantage of new electronic health records and improved and linked vital statistics systems, could also on a regular basis target causes of death of public health interest and more fully illustrate demographic disparities in mortality. Possibilities and Challenges The automation of vital statistics data collection at the source and its linkage to electronic health records and the building of responsive electronic transmission and linkage systems that will be required by the IRTPA legislation can provide significant new possibilities for how vital statistics are collected and utilized.
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From page 109... ...
With the future dependence on electronic health records and the growing need to depict chronic conditions, the use of the concept of the underlying cause of death may need to be revisited along with the automated medical coding systems, which turn literal medical nomenclature into an ICD code(s)
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