MAKING VITAL STATISTICS MAKING VITAL STATISTICS MORE VITAL SUPPLEMENT: THE MORE VITAL SUPPLEMENT: THE

NEW DEATH CERTIFICATENEW DEATH CERTIFICATE

The Last WordThe Last Word

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

National Center for Health StatisticsNational Center for Health Statistics

Division of Vital StatisticsDivision of Vital Statistics

Mortality Statistics BranchMortality Statistics Branch

Development of the Revised Death Development of the Revised Death Certificate 11Certificate 11thth Revision Revision

The U.S. Standard Certificate of Death had 10 revisions during The U.S. Standard Certificate of Death had 10 revisions during the 20th century. The last revision, still in use, was in 1989.the 20th century. The last revision, still in use, was in 1989.

– The revision process began with a consensus from the States that a The revision process began with a consensus from the States that a revision was needed.revision was needed.

– In 1998, the National Center for Health Statistics (NCHS), Centers for In 1998, the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) assembled an expert panel to Disease Control and Prevention (CDC) assembled an expert panel to evaluate the current certificate and recommend changes.evaluate the current certificate and recommend changes.

Development of the Revised Death Development of the Revised Death CertificateCertificate

The Panel to Evaluate the U.S. Standard Certificates and Report The Panel to Evaluate the U.S. Standard Certificates and Report Parent Group was composed of:Parent Group was composed of:

– State vital registration and statistics executives - State vital registration and statistics executives - Patricia W. Patricia W. Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Potrzebowski (Chair), PA; Donald Berry, DE; Carol V. Getts, MI; Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, Karen Grady, NH; Dorothy S. Harshbarger, AL; Michael R. Lavoie, GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; GA; A.Torrey McLean, NC; Barry Nangle, UT; Alvin T. Onaka, HI; Lorne A. Phillips, KS; Steven Schwartz, NYCLorne A. Phillips, KS; Steven Schwartz, NYC. .

– Researchers and representatives of data providers and user Researchers and representatives of data providers and user organizations - (e.g., CAP, NAME, NFDA, AHA, and AMA).organizations - (e.g., CAP, NAME, NFDA, AHA, and AMA).

Development of the Revised Death Development of the Revised Death Certificate -- cont.Certificate -- cont.

In a series of meetings over 16 months, the Panel In a series of meetings over 16 months, the Panel reviewed literature, suggestions, and recommendations reviewed literature, suggestions, and recommendations and heard outside testimony from other experts and and heard outside testimony from other experts and private citizens.private citizens.– The revision was viewed as a opportunity to improve the data The revision was viewed as a opportunity to improve the data

collection process.collection process.– Recommendations were made as to:Recommendations were made as to:

ContentContent FormatFormat InstructionsInstructions

– The Panel made its final recommendations in 1999.The Panel made its final recommendations in 1999.– NCHS was mandated to test the new documents.NCHS was mandated to test the new documents.

Guides to Completing Death Guides to Completing Death CertificateCertificate

To assist the funeral director completing To assist the funeral director completing demographic and legal items, the funeral demographic and legal items, the funeral director’s handbook has been revised.director’s handbook has been revised.

To assist physicians, medical examiners, To assist physicians, medical examiners, and coroners completing cause of death, and coroners completing cause of death, the physicians’ and medical examiners’ the physicians’ and medical examiners’ and coroners’ handbooks have been and coroners’ handbooks have been revised. revised.

Detailed Specification for Electronic Detailed Specification for Electronic SystemsSystems

Because an increasing number of deaths are expected to be Because an increasing number of deaths are expected to be registered electronically, for the first time, detailed specifications registered electronically, for the first time, detailed specifications for each data item on the electronic death certificate have been for each data item on the electronic death certificate have been developed. The specifications include:developed. The specifications include:

– Suggested electronic screensSuggested electronic screens– Response categoriesResponse categories– Drop-down menusDrop-down menus– EditsEdits– Help screensHelp screens– Ability to edit and query at data Ability to edit and query at data

entry; resolution of data issues at entry; resolution of data issues at the sourcethe source

Proposed New Death Certificate:Proposed New Death Certificate:Modified ItemsModified Items

– Decedent’s race, Decedent’s race, captures multiple race captures multiple race identificationidentification

– Decedent’s education, Decedent’s education, captures highest degree captures highest degree attainedattained

– Decedent’s marital status Decedent’s marital status distinguishes “Married” distinguishes “Married” from “Married, but from “Married, but separated”separated”

– Place of death includes Place of death includes hospice facilityhospice facility

Proposed New Death Certificate:Proposed New Death Certificate:Important New ItemsImportant New Items

– If female, pregnancy If female, pregnancy status at time of death status at time of death that will help identify that will help identify maternal and pregnancy-maternal and pregnancy-related deathsrelated deaths

– If transportation injury, If transportation injury, decedent’s role with decedent’s role with respect to vehiclesrespect to vehicles

– Did tobacco use Did tobacco use contribute to death?contribute to death?

– Separate instructions for Separate instructions for funeral director and funeral director and person completing person completing medical portionmedical portion

SummarySummary

The quality of death certificate data will be improved as a result of:The quality of death certificate data will be improved as a result of:

– Expanded instructions in the death certificate packetExpanded instructions in the death certificate packet– Revised handbooksRevised handbooks– Detailed specifications for the electronic system and the ability to edit Detailed specifications for the electronic system and the ability to edit

and query as data are enteredand query as data are entered

Public Health ImplicationsPublic Health Implications

Number of deaths and age-adjusted death rates: United States, 1940-2000

700

1,000

1,300

1,600

1,900

1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

De

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s p

er

10

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tan

da

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1,200

1,500

1,800

2,100

2,400

Nu

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– Cause-of-death trendsCause-of-death trends

– Leading causes of deathLeading causes of death

– Life expectancyLife expectancy

– Socio-economic Socio-economic differentialsdifferentials

– Demographic differentialsDemographic differentials

More accurate and comprehensive reporting on the death More accurate and comprehensive reporting on the death certificate will enhance our ability to analyze and track crucial certificate will enhance our ability to analyze and track crucial indicators of health, including demographic characteristics and indicators of health, including demographic characteristics and causes of death.causes of death.

Number of deaths

Age-adjusted death rate