National Mortality Surveillance: Building a

FoundationPaul D. Sutton, Ph.D.

Mortality Surveillance Team Lead

NAPHSIS/NCHS Joint MeetingPhoenix, ArizonaJune 2-6, 2013

National Center for Health Statistics

Division of Vital Statistics

Mortality Surveillance

The ongoing systematic monitoring and analysis of mortality data and the dissemination of information that leads to actions to address data quality and public health concerns.

VALIDATION OF RARE VACCINE-PREVENTABLE CAUSES OF DEATH

Vaccine-Preventable Diseases[underlying and multiple cause-of-death unless otherwise

specified]

ICD Description Age limitations

A08.0

Rotaviral enteritis (Rotavirus) <5 years

A36 Diphtheria any

A37 Whooping cough (Pertussis) <5 years

A80 Acute poliomyelitis (Polio) any

B01 Varicella <50 years

Varicella [underlying cause only] 50 years and older

B05 Measles any

B06 Rubella any

B26 Mumps any

P35.0 Congenital rubella syndrome any

NCIRDs Investigation and Validation

CDC/National Center for Immunization and Respiratory Diseases (NCIRD) working with the state epidemiologist and/or immunization program investigates.

If NCIRD verifies the COD NCHS marks the cause as confirmed.

If NCIRD cannot verify the COD NCHS notifies the state vital records office and attempts

to coordinate an update/correction. Pending the receipt of an update/correction NCHS

changes the COD to R99 (Other ill-defined and unspecified causes of mortality)

First Year (2012) Achievements

Over 40 deaths with a rare vaccine-preventable cause of death (underlying or multiple-cause) were identified and have/or will be validated using the new process

Jurisdiction participation Formal approval from 20 jurisdictions Approval pending for 6 additional jurisdictions

Results of validation Data quality

• 10 Validated, 3 Corrected, and 7 Not Validated Public health surveillance

• Identified previously unknown cases• Helped complete surveillance record (i.e. case resulted in

death)

INFLUENZA MORTALITY SURVEILLANCE

Influenza Surveillance in the United States

Find out when and where influenza activity is occurring

Track influenza-related illness Determine what influenza viruses are

circulating Detect changes in influenza viruses Measure the impact influenza is having on

hospitalizations and deaths in the United States

122 Cities Mortality Reporting System:Reporting Guidance and Case

Definitions

Report all deaths registered during the week of the report that occurred in the city

Case definitions

Definition Exclusions

Death due to Influenza

Influenza listed anywhere on the death certificate (Part I or Part II)

Mentions of:• Haemophilus

influenzae• Parainfluenzae

virus

Death due to Pneumonia

Pneumonia listed anywhere on the death certificate (Part I or Part II)

• Aspiration pneumonia

• Pneumonitis• Pneumococcal

meningitis

If both pneumonia and influenza are listed, count as influenza.

Current 122 Cities Influenza Mortality Surveillance System

Incomplete reporting About 25% of all deaths Increasingly difficult to get reports from some cities

Inconsistent reporting Not all jurisdictions follow the case definitions (e.g. some only

report underlying cause of death) Certificate review automated or semi-automated in some

jurisdictions, manual review in other jurisdictions. Deaths reported by week the death was

registered Lag between date of death and registration is unknown and

varies from place to place Deaths reported only by place the death occurred

Place of death not necessarily the same as place of residence

Future Vital Statistics based Influenza Mortality Surveillance

Improvements Reported by date of death Automated and consistent process for certificate review

based on coded cause of death information True national representation Deaths available by place of occurrence and residence

Potential new capabilities More focused regional, state, or local surveillance may

be possible Ability to switch from weekly to daily reporting in a

pandemic

Projects

Parallel surveillance for 2013-14 influenza season Real-time comparison of vital statistics and 122 city

based influenza mortality surveillance Reporting lag evaluation

Difference between date of death and the date NCHS receives the cause of death

Compute new baselines Seasonal baseline Epidemic threshold -- 1.645 standard deviations above

the seasonal baseline

Vital Statistics based Pneumonia and Influenza Mortality Surveillance, for

122 Cities

2007402008062008242008422009072009252009432010092010272010452011112011292011472012132012312012492013152013334

5

6

7

8

9

10

11

12

Epidemic Threshold Seasonal Baseline P&I Ratio - Any Entity-Axis MentionP&I Ratio - 122 Cities Mortality System

YearWeek

% o

f All

Deat

hs D

ue to

P&

I

(county equivalents)[Week ending April 13, 2013]

201320122010 201120092008

Vital Statistics based Pneumonia and Influenza Mortality Surveillance, for the

United States

200740 200806 200824 200842 200907 200925 200943 201009 201027 201045 201111 201129 201147 201213 201231 201249 201315 2013335

6

7

8

9

10

11

12

Epidemic Threshold Seasonal Baseline P&I Ratio

YearWeek

% o

f All

Deat

hs D

ue to

P&

I

[Week ending May 4, 2013]

201320122010 201120092008

Reporting Lag and the Importance of Timeliness

Just over 40% of the way through 2013

Percent of Expected Annual Deaths

Received

Number of Jurisdictions

40+ 2

35-39 15

30-34 11

25-29 6

20-24 4

15-19 3

10-14 2

5-9 3

0-5 6

MORTALITY SURVEILLANCE USER/WORKGROUP

Charge

MissionAdvance the use of vital statistics for public health surveillance at the local, state, and national level by identifying practical guidance for the vital statistics and surveillance communities on how to create and operate a vital statistics based public health surveillance system.

National Mortality Surveillance: Building a Foundation

For more information please contact

Paul D. Sutton3311 Toledo Road, Hyattsville, MD 20782Telephone: (301) 458-4433E-mail: PSutton@cdc.gov

The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Health Statistics

Division of Vital Statistics