Multiple Cause of Death Data

A Resource for Mortality Study

2

Multiple Cause of Death Data

1 Introduction

2 Death Certificates and COD Reporting

3 The Nuts and Bolts of MCOD Data

4 Studies from the Medical Literature

5 Mortality Improvement

6 Q and A

3

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

US Cause of Death Mortality Trends

4

Major Shifts in U.S. Cause of Death During Last Century

At beginning of 20th century Infectious diseases were a major contributor Acute illness often progressing to death Clear underlying cause of death

Even non-infectious diseases e.g. cancers, heart disease Tended to strike suddenly, progress rapidly Clear underlying cause of death

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

5

Major Shifts in U.S. Cause of Death During Last Century

At end of 20th century Infectious diseases no longer a major contributor Chronic illness, may progress to death Less clear as an underlying cause of death

Non-infectious diseases Primarily chronic illnesses Unclear underlying cause of death

ComortalityMultiple Cause of Death data

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

6

The National Vital Statistics System

In the United States, legal authority for the registration of births, deaths, marriages, divorces, fetal deaths, and induced terminations of pregnancy (abortions) resides individually with the states (as well as with cities, in the case of New York City and Washington, D.C.).

In effect, the states are the full legal proprietors of the vital statistics records and the information contained therein, and are responsible for maintaining registries according to state law, and issuing copies of birth, marriage, divorce, and death certificates.

Under the Vital Statistics Cooperative Program (VSCP), the federal government, acting through its agent, the National Center for Health Statistics (NCHS), partially supports state costs of producing vital statistics through a contract with each state. The Division of Vital Statistics (DVS) within the NCHS administers the VSCP.

Weed JA; Population Index 61(4):527-539. Winter 1995.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

7

Developments in Mortality Statistics Throughout the twentieth century, U.S. cause-of-death statistics have been classified

and disseminated according to the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD).

Using the selection rules of the ICD, a single cause is selected from among those reported by the physician certifying a particular death. Ideally, this should be the "disease or injury that initiated events resulting in death", and this disease or injury is classified and tabulated as the underlying cause of death. Prior to automation, this selection process was done manually by experts in disease classification, called nosologists.

Beginning in 1968, the NCHS developed computer systems to automatically select the underlying cause for each death certificate and to produce multiple cause-of-death data.

Moreover, it has long been recognized that good use could be made of the multiple causes of death if it were properly "cleaned" and reduced. The computer systems accomplish this.

Public Use files containing multiple-cause data (plus all demographic information and the underlying cause for each decedent) are available from the NTIS for all data years since 1968.

Weed JA; Population Index 61(4):527-539. Winter 1995.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

8

NCHS Computer Systems

Automated Classification of Medical Entities (ACME) automatically selects the underlying cause of death

MICAR (Mortality Medical Indexing, Classification, and Retrieval) a data-entry system to ACME that requires less coder training maintains accurate and consistent results

Super-MICAR – for electronic death certificates TRANSAX

produces multiple cause-of-death data

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

9

Multiple Cause of Death Data

1 Introduction

2 Death Certificates and COD Reporting

3 The Nuts and Bolts of MCOD Data

4 Studies from the Medical Literature

5 Mortality Improvement

6 Q and A

10

Death Certificates: WHO => NCHS => States

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

11

Death Certificates

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

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Death Certificates

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

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Death Certificates

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

14

Death Certificates

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

15

Death Certificates

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

16

Death Certificates

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

17

Multiple Cause of Death Data

1 Introduction

2 Death Certificates and COD Reporting

3 The Nuts and Bolts of MCOD Data

4 Studies from the Medical Literature

5 Mortality Improvement

6 Q and A

18

MCOD Public Release Data

Annual datasets Currently running @ ~ 2.5 million deaths per annum All deaths within U.S. with the exception of years 1972, 1981, and 1982 Wide format with many empty fields Not designed with longitudinal studies in mind!

Cause of death coding 1968 thru 1978: ICDA (modified version of ICD-8) 1979 thru 1998: ICD-9 (with substitutions for traumatic causes)

34-, 61-, 72-, and 282-bin cause of death recodes 1999 thru 2009 (most recent release): ICD-10

39-, 113-, 130-, and 358-bin cause of death recodes Other fields

Actual date of death thru 1988 Constants: age, sex, month of death, marital status

12-, 22-, 27-, 52-bin age recodes Variable: education level Variable to non-existent: geography codes

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

19

MCOD Public Release Data - 2003

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

··················11AK999AK9AK··AK9999999992AK00009900OR··OR14·001··F1079·412110··4W4·······················11AK999AK9AK··AK9999999992AK00009900NY··NY17·001··F1088·432311··1W6·······················11AK999AK9AK··AK9999999992AK00009900WA··WA15·001··F1059·371708··6D7·······················11AK999AK9AK··AK9999999992AK00009900TX··TX16·001··F1084·422210··4W7·······················11AK999AK9AK··AK9999999992AK00009900AK··AK12·001··M1039·331306··4S1·······················11AK999AK9AK··AK9999999992AK00009900AK··AK12·001··M1082·422210··4M6·······················11AK999AK9AK··AK9999999992AK00009900AK··AK16·001··M1086·432311··1M4·······················11AK999AK9AK··AK9999999992AK00009900ID··ID09·001··M1072·402009··4M4·······················11AK999AK9AK··AK9999999992AK00009900AK··AK00·001··M2004·150201152S1·······················11AK020AK2AK··AK0200300021AK03802100MI··MI12·001··F1075·412110··4M3·······················11AK020AK2AK··AK0200300021AK03802100AK··AK12·001··F1062·381808··1M4·······················11AK020AK2AK··AK0200300021AK03802100OH··OH12·001··F1079·412110··1W3·······················11AK020AK2AK··AK0200300021AK03802100CA··CA15·001··F1058·371708··1M6·······················11AK020AK2AK··AK0200300021AK03802100AK··AK00·001··F2002·130201132S2·······················11AK020AK2AK··AK0200300021AK03802100HI··HI12·001··F1022·301004··7S6·····

First 15 of 2,452,154 rows First 90 of 488 columns

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MCOD Public Release Data - 2003

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

··············································01··11·································280·5··············································02··32·································100·7··············································01··11·································280·5··············································01··11·································100·6··············································02··32·································100·7··············································02··32·································100·7··············································01··11·································998·9··············································01··11·································260·2··············································01··11·································260·2··············································02··32·································100·7··············································02··32·································998·9··············································02··32·································100·7··············································01··11·································280·5··············································02··32·································998·9··············································01··11·································100·6··············································01·111·································280·5

RaceLast 15 of 2,452,154 rows Last 90 of 488 columns

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Death Certificate

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

I233

I21

I240

I250

E14 J449 Z720

Entity axis: 11I233 21I21 31I240 41I250 61E14 62J449 63Z720

Record axis: E14 I21 I250 J449 Z720

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MCOD Public Release Data - 2003

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

1911T179·12W80··13J189·21K319·22E119·31G309·41I64··42N390·43I500·44I48··45I454·61I64··62L890611C349·12C793·13C795·61N19··62E46··63F179················································0111I250···················································································0211C349·21C349············································································0711A419·21C61··61E889·62E872·63N19··64N390·65I251·········································0811J189·21J690·61C444·62C795·63I48··64R000·65T455·66X44···································0211N19··21I500············································································0611C793·21C349·61G309·62C509·63C189·64F179················································0111C259···················································································0611I219·21I251·31E149·61I802·62I500·63F179················································0511I64··12I678·21I48··61I500·62F03························································0111C20····················································································0311I269·21I802·31J449·····································································0411F03··21G20··22G049·61I10·······························································0211C109·61F179············································································

Entity AxisColumns 163 - 253Rows 1,057,500 – 1,057,514

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MCOD Public Release Data - 2003

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

13·A419·D649·E115·G309·I454·I48··I500·I64··J189·K319·N390·T179·W80····06·C349·C793·C795·E46··F179·N19·······································01·I250·······························································01·C349·······························································06·A419·C61··E872·I251·N19··N390······································08·C444·C795·I48··J189·J690·R000·T455·X44·····························02·I500·N19···························································06·C189·C349·C509·C793·F179·G309······································01·C259·······························································06·E149·F179·I219·I251·I500·I802······································05·F03··I48··I500·I64··I678···········································01·C20································································03·I269·I802·J449·····················································04·F03··G049·G20··I10·················································02·C109·F179··························································

Record AxisColumns 341 - 410Rows 1,057,500 – 1,057,514

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Relational Data Storage

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

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MCOD Public Release Data

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

Column 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20091 year2d year2d year2d year2d year2d year2d year2d year2d year2d year2d year2d year2d year2d

                           

2                            

3 repArea repArea repArea repArea repArea repArea repArea repArea repArea repArea repArea repArea                              4                                                      5                                                      6                                                      7                                                      8                                                      9                                                      

10 shipNo shipNo shipNo shipNo shipNo shipNo shipNo shipNo shipNo                                   

11                                    

12                                                      13                                                      14                                                      15                                                      16                                                      17                                                      18                                                      19 rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype rectype          20 restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus restatus21 Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc Nstateoc stateoc stateoc

         

22          

23Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc Ncountyoc countyoc countyoc

         

24          

25          

26 Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc Nregionoc exstatoc exstatoc         

27 Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc Ndivisionoc          

28 Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub Nstateocsub popsizoc popsizoc          

29 Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc Nexstatoc staters staters         

30          

31 Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters Nstaters              

32              

33Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs Ncountyrs

statersr statersr         

34          

35countyrs countyrs

         

36Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs Ncityrs

         

37          

38

cityrs cityrs

         

39 popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers popsizers          

40 metro metro metro metro metro metro metro metro metro metro metro metro metro metro metro metro metro metro metro metro          

41 Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs Nregionrs          

42 Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs Ndivisionrs          

43 Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub Nstaterssub popsize popsize          

44 Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstares Nexstaresmetro metro          

45 exstares exstares         

46Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares Npmsares

         

47

pmsares pmsares

         

48          

49             popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc popsizoc          

50             popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs popsizrs          

51             popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popmsa   popsizrs popsizrs          

52             educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89   educ89  popmsa popmsa          

53             cmsares cmsares         

54             educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r  educ89r           

55 monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth monthdth statbth statbth         

56          

57 daydth daydth daydth daydth daydth daydth                                         

58              

59 sex sex sex sex sex sex sex sex sex sex sex sex sex sex sex sex sex sex sex sex statbthr statbthr         

60 race race race race race race race race race race race race race race race race race race race race         

61 educ89   educ89   educ89   educ89   educ89   educ89   educ89  62 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer3 racer363 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 racer2 educ03 educ03 educ03 educ03 educ03 educ03 educ03

64 ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit ageunit educflag educflag educflag educflag educflag educflag educflag

65 age age age age age age age age age age age age age age age age age age age age monthdth monthdth monthdth monthdth monthdth monthdth monthdth6667 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52 ager52

             

68              

69 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 ager27 sex sex sex sex sex sex sex70 ageunit ageunit ageunit ageunit ageunit ageunit ageunit71 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12 ager12

age age age age age age age7273 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager22 ager2274 ageflag ageflag ageflag ageflag ageflag ageflag ageflag75 placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth placdth ager52 ager52 ager52 ager52 ager52 ager52 ager5276                                        77 marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat marstat ager27 ager27 ager27 ager27 ager27 ager27 ager2778 statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth statbth79 ager12 ager12 ager12 ager12 ager12 ager12 ager1280   hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico hispanico81   ager22 ager22 ager22 ager22 ager22 ager22 ager2282             hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr hspanicr

26

Multiple Cause of Death Data

1 Introduction

2 Death Certificates and COD Reporting

3 The Nuts and Bolts of MCOD Data

4 Studies from the Medical Literature

5 Mortality Improvement

6 Q and A

27

Redelings MD, Sorvillo F, Simon P. A comparison of underlying cause and multiple causes of death: US vital statistics, 2000-2001. Epidemiology. 2006 Jan;17(1):100-3.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

28

Redelings MD, Sorvillo F, Simon P. A comparison of underlying cause and multiple causes of death: US vital statistics, 2000-2001. Epidemiology. 2006 Jan;17(1):100-3.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

29

Paula H, Asrani SK, Boetticher NC, Pedersen R, Shah VH, Kim WR. Alcoholic liver disease-related mortality in the United States: 1980-2003. Am J Gastroenterol. 2010 Aug;105(8):1782-7. Epub 2010 Feb 23.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

OBJECTIVES: Data on temporal changes in alcoholic liver disease (ALD)-related mortality in the United States are lacking. This longitudinal assessment is important, given the divergent data on trends in worldwide ALD-related mortality, concerns for underestimation of mortality attributed to ALD in previous investigations, and shifting attention to hepatitis C virus (HCV)-related mortality.

METHODS: We analyzed mortality data compiled in the multiple cause-of-death public-use data file from the National Vital Statistics System from 1980 to 2003 using categorization by both International Classification of Diseases (ICD)-9 and ICD-10 systems. The main outcome measure was age- and sex-adjusted death rates attributable to ALD, HCV, or both (ALD/HCV) listed as immediate or underlying cause of death.

The standard death certificates were extracted for information in part I of the certificate, which records the “immediate” or “underlying” causes of death. Information from part II, which includes information on other “significant conditions contributing to death but not resulting in the underlying cause given in Part I,” was not extracted...

30

Paula H, Asrani SK, Boetticher NC, Pedersen R, Shah VH, Kim WR. Alcoholic liver disease-related mortality in the United States: 1980-2003. Am J Gastroenterol. 2010 Aug;105(8):1782-7. Epub 2010 Feb 23.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

RESULTS: A total of 287,365 deaths were observed over the 24-year period. Age- and sex- adjusted incidence rates of ALD-related deaths decreased from 6.9/100,000 persons in 1980 to 4.4/100,000 persons by 2003. After introduction of HCV diagnostic testing, HCV-related liver mortality increased to 2.9/100,000 persons by 2003. Death rates for subjects with concomitant ALD/HCV rose to 0.2/100,000 persons by 1999 and then remained unchanged through 2003…

CONCLUSIONS: Despite a decline in ALD-related mortality, the proportion of alcohol-related liver deaths is still considerably large and comparable in scope to that of HCV.

When hepatitis C serology testing was introduced in the early 1990s, a rapid increase in HCV-related deaths was observed. Therefore, it is possible that alcohol-related mortality may have remained at a constant rate throughout the 1980s and 1990s, but HCV-related deaths may have been mistakenly classified as alcohol related, leading to the apparent decline.

31

Redelings MD, Wise M, Sorvillo F. Using multiple cause-of-death data to investigate associations and causality between conditions listed on the death certificate. Am J Epidemiol. 2007 Jul 1;166(1):104-8.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

…analysis of the 114,380 deaths reported in the United States from 1990 to 2001 in which pressure ulcers were listed as a cause of death…septicemia is also reported on 45,374 (39.7 percent) of these death certificates…this percentage is far higher than we would expect to see among decedents without pressure ulcers..

3.11/ CBmEORmMOR

32

Multiple Cause of Death Data

1 Introduction

2 Death Certificates and COD Reporting

3 The Nuts and Bolts of MCOD Data

4 Studies from the Medical Literature

5 Mortality Improvement

6 Q and A

33

Extrapolation: e.g. life expectancy

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

34

Components of Mortality Change

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

IDMOA: Males ages 50+

35

U.S. Males Ages 75-84: Underlying Cause of Death

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

1979 1982 1985 1988 1991 1994 1997 2000 2003 2006

residual diseases

trauma

infectious disease

pulmonary

lung cancer

other misc

other heart disease

other cancers

other vascular disease

atherosclerotic heart disease

36Global Life

Mortality rate mx by Cause-of-Death Male 75-84Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

37Global Life

Diabetes Mellitus: Market Share AnalysisIntroduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

38Global Life

Diabetes Mellitus: Mortality RatesIntroduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

39Global Life

Diabetes Mellitus: Overall Mortality RatesIntroduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A

40

Multiple Cause of Death Data

1 Introduction

2 Death Certificates and COD Reporting

3 The Nuts and Bolts of MCOD Data

4 Studies from the Medical Literature

5 Predicting Future Mortality Improvement

6 Q and A

41

Typical Questions

Aren’t the certifying physicians’ opinions as to cause of death highly subjective and inaccurate? Yes, and no. For any particular death certificate the ucod (and other cod’s) could be way off.

However, MICAR and TRANSAX software do a good job of eliminating most errors and converting DC entries into usable data. At the very least, the MCOD data is a good survey of what is killing Americans.

Don’t the changes in field types and values make it difficult to do longitudinal studies? Yes. As with many datasets, one is limited to certain well-conserved fields for longitudinal

study. Other studies can provide shapshots of mortality phenomena using data fields that are available for a few years only.

What is the significance of the lack of geography codes for the years 2005 to present? Geography fields can help distinguish phenomena on the basis of socioeconomics.

Fortunately, education is an excellent proxy for socioeconomic status and the educational level fields are well-conserved in the MCOD data.

How can you use comortality rates when they “don’t add up?” I would never use any comortality statistic alone. Instead, always in combination with ucod or

other more straightforward statistic. I would always keep in mind that there is no “conservation of mortality.” There are other measures of comortality besides mortality rate.

Introduction | Death Certificates | Nuts & Bolts | Medical Literature I Mortality Improvement I Q & A