Transcript What Is Our Future?

Vital Statistics:
What is Our Future?
Centers for Disease Control and Prevention
National Center for Health Statistics
Before we get to the future
let’s revisit the past
Early History–
Egypt, Greece, and Rome
Gathered through a census for
revenue and military purposes
Early History
• Ecclesiastical registration
• With the advent of the modern
nation state came - Civil
registration
English and Colonial History
• 1632–Grand assembly of Virginia
required clergy to keep records of
christenings, marriages, and
burials
• 1639–Massachusetts Bay Colony
General Court required town
officers to register town officers to
register births, marriages, and
deaths
English and Colonial History
Mortality Surveillance
• 1662–The Bills of Mortality (John
Graunt)
• 1721–Use of burial records by
Cotton Mather to
demonstrate effects of
smallpox
Examples of Diseases Listed in
Graunt’s Bills of Mortality
• Bloody Flux-dysentery
• Bursten-hernia/rupture
• Falling Sickness-Epilepsy
• French Pox-Venereal Disease
• Horseshoehead-inflammation of brain
• Livergrown-Cirrhosis of the liver
• Planet Struck-Paralytic/confounded
• Tissick-Consumption/TB
• Tympany-obstructed flatulence
English and U.S. History
• 1789–Edward Wigglesworth
developed first U.S. life
table
• 1836–English Act creates central
registry of births, marriages,
and deaths by cause
• 1839–Vital statistics used to
initiate sanitary reform
(William Farr)
English and U.S. History
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1842–Massachusetts – first state to
require State-wide registration of vital
events--(Secretary of State’s office!!)
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1855– John Snow demonstrates
connection between water supply and
deaths from cholera in England. Florence
Nightingale – mortality rates in hospitals
U.S. History
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1850-90 - Birth and death data collected on census
• 1850 – Collection of national mortality data
through the Census
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1900 – Death registration areas established
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1915 – Birth registration areas established (10
(10 States and D.C.)
states and DC)
• 1933 – Birth and Death Registration areas are
complete
Leading Causes
1900
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Influenza & Pneumonia
Tuberculosis
Diarrhea
Heart disease
Stroke
Population approx 76 million
2004
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Heart disease
Cancer
Stroke
Chronic lower respiratory diseases
Accidents (unintentional injuries)
Diabetes
Alzheimer’s Disease
Influenza & Pneumonia (61k)
Population approx 290 million
NOTE: Prior to 1933, data are for death-registration States only. 2004 -Preliminary
Life Expectancy and Age-Adjusted
Death Rates
Deaths per 100,000 standard population
2600
Age in years
80
Life expectancy
2080
60
1560
40
1040
520
20
Age-adjusted death rates
0
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
NOTE: Prior to 1933, data are for death-registration States only.
2004
Death Rates for Infectious Diseases
and Accidents, Ages 1-19,
Selected Years
Rate per 100,000 population
1000
Infectious diseases
100
10
Accidents
With HIV
infection
1
0.1
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
SOURCE: CDC/NCHS: National Vital Statistics System, 1900-2004
2004
Age-Adjusted Death Rates for Heart
Disease and Influenza and Pneumonia
Rate per 100,000 standard population
Heart disease
600
500
400
300
200
100
Influenza and pneumonia
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
2004
NOTE: Data prior to 1933 contain death-registration States only.
10000
Childhood Death Rates
by Age at Death
Deaths per 100,000 population
2000
1000
1-4 years
15-19 years
100
10-14 years
10
5-9 years
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
2004
SOURCE: CDC/NCHS: National Vital Statistics System, 1900-2004
Do we believe that Vital Statistics
continues to provide the
• Core of our health data system?
• Baseline for public health, social science,
and related programs?
• Ability to monitor key indicators of health
world-wide and at the local, state and
national level ?
• Ability to track progress to health goals?
• Ability to identify disparities in outcomes?
• Ability to alert to emerging problems?
How can we build on our past
successes for a new beginning?
To measure what is and not just
what was?
Some things that should not change
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States: Register all events correctly and
quickly
• States: Efficiently issue certified copies of
certificates
• States: Maintain historical records
• NCHS and States: Provide high quality
annual reports/data files of vital events for
trend analysis and for measuring the
attainment of health objectives
The future
Is it really all about EDR’s and
EBR’s?
Yes … but …
What about how we currently do
business internally?
It certainly begins with EBR’s and
EDR’s
•
From a statistical perspective EBR’s and
EDR’s give us the potential for higher
quality and more timely data
•
If EBR’s and EDR’s meet appropriate data
standards, they provide the potential to tie
in with electronic medical records
• With quicker receipt and better quality both
States and NCHS can provide end of year
reports and data soon after the end of the
year.
But is this all we can get out of the
investment?
•
Even if we could make an end of year file
and report available a week after the end of
year … some events will be 6--12 months
old and most will be of no better quality
than when they came in!
•
Why not get Vitals back into surveillance?
A “Back to the Future” movement.
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We need a “Use it now or Lose it” mentality
or we will be at best public health
historians.
What are some things to
consider if we get back into the
surveillance game?
How do we get ready?
How do we process our data into
statistical files?
•
Do we now examine the data carefully upon
receipt or do we wait until we close the
end of year file?
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Do we ever utilize our demographic
mortality data before we code cause of
death information?
• Have we thought of modeling current
demographic mortality data with past
complete mortality reporting for public
health surveillance purposes?
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Do we strive to match our cause of death
information immediately with demographic
mortality and do edits for improbable
events?
How do we process our data into
statistical files?
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Could we release data files on a YTD basis
or just at the end of the year?
• Are our systems capable to do YTD release?
• Do we have staff ready to interact with a
YTD data release system? Do we need staff
with different interests or is that the role of
partner organizations?
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Are we comfortable with releasing
incomplete but useful data files ?
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What type of edits are needed for even
incomplete data to be released?
How do we process our data into
statistical files?
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Do we have systems that would allow
updating of YTD files as updates and
corrections are received?
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Should denominator data be provided with
YTD files?
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Is the YTD file just for in-state occurrences
or should a national data transfer system
be in place to handle out of state events?
What should be NCHS’s role?
What is NCHS planning?
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We need to take advantage of improved
timeliness of States using EBR’s and EDR’s
• Through funding from Pan Flu, DVS is re-
engineering its internal mortality systems
and processes to be able to support a YTD
surveillance system …
• We will be doing edits sooner and linking
mortality demographic and medical records
on an ongoing basis
•
Although we plan to release YTD data for
surveillance purposes … the “how” is yet
unknown.
What is NCHS planning?
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We are planning to provide for surveillance
purposes demographic mortality data with
what might be expected from past years
complete mortality files.
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I believe the release of surveillance files
can be accommodated through our existing
data release agreement with a little
tweaking … but further study with
NAPHSIS is needed before that takes place
Many Unknowns
•
Impact on internal staff in dealing with YTD
processing
• Scheduling of updating of YTD files for
external surveillance use
• Methods of data access for surveillance
• Impact on States with NCHS doing earlier
edits
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Reporting of NCHS back to States on
surveillance estimates – How – What?
Many Unknowns
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Data transfer: STEVE or SOS (Son of
Steve) or even DOS?
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How to handle YTD files with current
States while dealing with old data
from other States
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We currently do provisional (record
count) and preliminary data (mostly
complete) reports … how should they
change?
Many Possibilities
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As you send us your files … if
addresses are provided we could
geo-code your records at no cost and
send those records and associated
files back to you for State
surveillance purposes
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New surveillance partnerships adding to reporting
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New interest and use of vitals could
mean support from different
programs
How are we perceived may relate to
our funding future: Are we seen as
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Careful and inflexible?
Careful, responsive and inflexible?
Careful, responsive, and flexible?
Inventive, careful, responsive, and
flexible?
Is this really the time?
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Don’t we have problems funding
what we currently provide?
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Perhaps … just perhaps there is a
reason for our situation
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Perhaps we need to be relevant to
the doers … not just those interested
in the past