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: [email protected]
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