Timeliness and Quality of Death Data Essential for Public Health
Dr. Potrzebowski is the Executive Director of NAPHSIS.
Headlines of recent weeks have showcased the value of vital statistics in monitoring the public's health and formulating policies to help improve it. Specifically, the National Center for Health Statistics (NCHS) made news recently when it released new 2015 data, collected and reported by the vital records jurisdictions, suggesting that deaths linked to drug overdoses continue to trend upward. If policymakers are to successfully address the nationwide, opioid epidemic they must first understand the scope of the problem. Vital statistics provide the baseline data foundational to any effective solution.
However, data are only relevant if they are timely and of high quality. Over the last decade, NCHS and the vital records jurisdictions have made significant progress in improving the timeliness and quality of vital statistics. Most states now have operational electronic birth and death registration systems (EBRS and EDRS) and have adopted the 2003 Standard Certificates of Birth, Death, and Fetal Death, which are much more robust sources of public health data than the older 1989 certificates. In addition, NCHS has funded states and territories to speed the release of birth and death statistics of public health importance, including infant mortality and prescription drug overdose deaths. In fact, the percentage of mortality records reported to NCHS within 10 days has increased from 14 percent in 2012 to 40 percent in 2015. This is a vast improvement over the vital statistics of old—often released by NCHS more than a year and sometimes as long as four years after the life event was recorded by the vital records jurisdiction.
Despite these improvements in timeliness, there remains much room for improvement on data quality. The Pew Charitable Trust's publication "STATELINE" recently chronicled the inaccuracies and/or lack of specificity associated with reporting drug overdoses as a cause of death:
Eighty-one percent of all death certificates for a drug overdose listed the drugs involved. That number has grown in the last five years as states have stepped up efforts to include more details about overdoses to help develop strategies for quelling the opioid epidemic…
Still, it's taken some states longer than others to relay the message to the coroners, physicians and medical examiners who fill out death certificates at the local level, he said.
And it's not just cause of death. Basic demographic information also presents a challenge. A NCHS report, The Validity of Race and Hispanic-origin Reporting on Death Certificates in the United States: An Update, finds that about 40 percent of death certificates for Native American and Alaskan Native individuals are marked with the wrong race or ethnicity. Those kinds of mistakes could significantly skew information on causes of death for specific racial and ethnic groups. For policymakers and practitioners, an effective public health response requires data about the problem itself and whom is most affected.
The major challenge in improving the quality of death statistics in particular is the complex nature of death reporting itself, with many steps performed by many actors from start to finish (our 2013 report, outlines the process in detail here). When a death occurs, data providers—funeral homes for demographic data and physicians, coroners, and medical examiners for cause of death data—submit data to the vital records jurisdiction to be reviewed and official registered. As STATELINE reports:
Although death certificates are roughly standard nationwide, the professionals who fill them out and the agencies they report to vary widely from state to state. As a result, the accuracy, timeliness and specificity of death certificates varies. In many states, inadequate funding for vital statistics and death investigations is also an issue…In many states, a chief medical examiner, typically working within the state health department, ensures standards in determining the cause of death. Others have county medical examiners or elected coroners, or a hybrid system of both…States with centralized systems and medical examiners trained in medicine and forensic pathology are more complete in reporting details about the cause of death…
Many vital records jurisdictions haven't the resources to expand technical assistance to medical certifiers including physicians, medical examiners, and coroners. A STATELINE article from last year also chronicled these challenges, and states' efforts to address them.
NAPHSIS has turned its attention to encouraging lawmakers to invest in efforts that will improve vital statistics data quality, including for example, efforts to educate medical certifiers about electronic death registration systems and encouraging their widespread use. Many medical certifiers do not fully understand that the information they enter on the death certificate is critical to identify public health problems like drug overdoses, and that providing complete, accurate, and detailed information on each death certificate is essential. Unfortunately, state vital records offices generally do not have adequate resources to get this message across to all medical certifiers. There needs to be a broader recognition among policymakers and funding authorities that investing in public health data systems like vital records is critical so that we can measure the effectiveness of our prevention efforts.
For more information about vital statistics and efforts to improve them, please click here.