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Board of Scientific Counselors Program Review

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Title: Board of Scientific Counselors Program Review


1
Vital Statistics What is Our Future?
Centers for Disease Control and
Prevention National Center for Health Statistics
2
Before we get to the future lets revisit the
past
3
Early History Egypt, Greece, and Rome
  • Gathered through a census for revenue and
    military purposes

4
Early History
  • Ecclesiastical registration
  • With the advent of the modern nation state came -
    Civil registration

5
English and Colonial History
  • 1632Grand assembly of Virginia required clergy
    to keep records of christenings, marriages, and
    burials
  • 1639Massachusetts Bay Colony General Court
    required town officers to register town officers
    to register births, marriages, and deaths

6
English and Colonial HistoryMortality
Surveillance
  • 1662The Bills of Mortality (John Graunt)
  • 1721Use of burial records by Cotton Mather to
    demonstrate effects of smallpox

7
Examples of Diseases Listed in Graunts 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

8
English and U.S. History
  • 1789Edward Wigglesworth developed first U.S.
    life table
  • 1836English Act creates central registry of
    births, marriages, and deaths by cause
  • 1839Vital statistics used to initiate sanitary
    reform (William Farr)

9
English and U.S. History
  • 1842Massachusetts first state to require
    State-wide registration of vital
    events--(Secretary of States office!!)
  • 1855 John Snow demonstrates connection between
    water supply and deaths from cholera in England.
    Florence Nightingale mortality rates in
    hospitals

10
U.S. History
  • 1850-90 - Birth and death data - collected on
    census
  • 1850 Collection of national mortality data
    through the Census
  • 1900 Death registration areas established (10
    States and D.C.)
  • 1915 Birth registration areas established (10
    states and DC)
  • 1933 Birth and Death Registration areas are
    complete

11
Leading Causes
  • 1900
  • Influenza Pneumonia
  • Tuberculosis
  • Diarrhea
  • Heart disease
  • Stroke
  • Population approx 76 million
  • 2004
  • Heart disease
  • Cancer
  • Stroke
  • Chronic lower respiratory diseases
  • Accidents (unintentional injuries)
  • Diabetes
  • Alzheimers Disease
  • Influenza Pneumonia (61k)
  • Population approx 290 million

NOTE Prior to 1933, data are for
death-registration States only. 2004 -Preliminary
12

Life Expectancy and Age-Adjusted Death Rates

Deaths per 100,000 standard population
Age in years

Life expectancy
Age-adjusted death rates
2004
NOTE Prior to 1933, data are for
death-registration States only.
13
Death Rates for Infectious Diseases and
Accidents, Ages 1-19, Selected Years
Rate per 100,000 population

Infectious diseases
Accidents
With HIV infection
2004
SOURCE CDC/NCHS National Vital Statistics
System, 1900-2004
14
Age-Adjusted Death Rates for Heart Disease and
Influenza and Pneumonia
Rate per 100,000 standard population
Heart disease
Influenza and pneumonia
2004
NOTE Data prior to 1933 contain
death-registration States only.
15

Childhood Death Rates by Age at Death

Deaths per 100,000 population
2000
1-4 years
15-19 years
10-14 years
5-9 years
2004
SOURCE CDC/NCHS National Vital Statistics
System, 1900-2004
16
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?

17
How can we build on our past successes for a new
beginning?To measure what is and not just what
was?
18
Some things that should not change
  • 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

19
The futureIs it really all about EDRs and
EBRs?Yes but What about how we currently
do business internally?
20
It certainly begins with EBRs and EDRs
  • From a statistical perspective EBRs and EDRs
    give us the potential for higher quality and more
    timely data
  • If EBRs and EDRs 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.

21
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.
  • We need a Use it now or Lose it mentality or we
    will be at best public health historians.

22
What are some things to consider if we get back
into the surveillance game? How do we get ready?
23
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?
  • 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?
  • Do we strive to match our cause of death
    information immediately with demographic
    mortality and do edits for improbable events?

24
How do we process our data into statistical
files?
  • 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?
  • Are we comfortable with releasing incomplete but
    useful data files ?
  • What type of edits are needed for even incomplete
    data to be released?

25
How do we process our data into statistical files?
  • Do we have systems that would allow updating of
    YTD files as updates and corrections are
    received?
  • Should denominator data be provided with YTD
    files?
  • 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 NCHSs role?

26
What is NCHS planning?
  • We need to take advantage of improved timeliness
    of States using EBRs and EDRs
  • 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.

27
What is NCHS planning?
  • We are planning to provide for surveillance
    purposes demographic mortality data with what
    might be expected from past years complete
    mortality files.
  • 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

28
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
  • Reporting of NCHS back to States on surveillance
    estimates How What?

29
Many Unknowns
  • Data transfer STEVE or SOS (Son of Steve) or
    even DOS?
  • How to handle YTD files with current States while
    dealing with old data from other States
  • We currently do provisional (record count) and
    preliminary data (mostly complete) reports how
    should they change?

30
Many Possibilities
  • 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
  • New surveillance partnerships - adding to
    reporting
  • New interest and use of vitals could mean support
    from different programs

31
How are we perceived may relate to our funding
future Are we seen as
  • Careful and inflexible?
  • Careful, responsive and inflexible?
  • Careful, responsive, and flexible?
  • Inventive, careful, responsive, and flexible?

32
Is this really the time?
  • Dont we have problems funding what we currently
    provide?
  • Perhaps just perhaps there is a reason for our
    situation
  • Perhaps we need to be relevant to the doers not
    just those interested in the past
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