High and Rising Mortality Rates Among Working-Age Adults (2021) / Chapter Skim
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5 U.S. Mortality Data: Data Quality, Methodology, and Recommendations
5 U.S. Mortality Data: Data Quality, Methodology, and Recommendations
Pages 169-184
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From page 169... ...
The chapter covers issues related to the methodologies used to collect death certificate data and link them to survey data, the advantages and limitations of these types of mortality data, and the analytical methodology used by the committee in conducting its analyses. The chapter also includes the committee's recommendations for improving data quality to expand the capacity for future research on trends and disparities in U.S.
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From page 170... ...
Vital statistics death certificate data include a limited amount of information about each decedent, including age at death, sex, race and ethnicity, educational attainment, place of residence, location of death, and cause(s) of death, as well as a few other items.
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From page 171... ...
The process by which death certificate data are collected can also result in issues of data quality and accuracy that affect the quality of mortality estimates and the comparability of these estimates over time. This section outlines the limitations of death certificate data and the steps that data providers have taken to address these issues so as to improve the utility of these data and expand the types of research questions they can be used to address.
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From page 172... ...
For example, educational attainment is only one dimension of socioeconomic status; other socioeconomic factors, such as income and wealth, may be important for understanding trends and disparities in working-age mortality, but this information is not available on death certificates. In addition to restricting the types of mortality disparities that can be examined, the relatively modest set of characteristics available on death certificates restricts researchers' ability to examine the factors that might explain mortality trends and disparities.
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From page 173... ...
Census. The dataset contains information from 3.8 million individuals and more than 550,000 death certificates.2 The large sample size and number of deaths, combined with detailed information on socioeconomic status (SES)
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From page 174... ...
Despite these limitations, the above linked mortality datasets provide a wealth of information that would otherwise not be available using vital statistics data alone. The ability to link the NDI data to existing survey datasets provides an invaluable resource for researchers, public health officials, and policy makers.
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From page 175... ...
because of misclassification of metastatic disease. In addition, chronic conditions are often missing from death certificates or assigned the status of a contributing cause rather than the underlying cause of death, even though they are relatively easy to diagnose (Gao et al., 2018)
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From page 176... ...
. Although NCHS produces decision tables in the ACME to improve the consistency of cause-of-death reporting and identification of the underlying cause of death in death certificate data, these decision tables rely on not only the conditions reported as cause of death but also the causal sequencing of these reports.
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From page 177... ...
Census-based sources for population estimates provide data on such characteristics as race, ethnicity, and educational attainment that are collected, reported, and coded differently from similar data appearing on death records. These inconsistencies can compound the effects of recording errors in the death certificate data, leading to biased estimates of mortality and mortality disparities.
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From page 178... ...
Although improvements over time in the quality of death certificate reports for Asians limited the committee's ability to interpret their mortality trends over the period covered by this report, reporting of Asian race on death certificates has improved substantially as well and is now of sufficient quality that researchers, policy makers, and public health officials can have confidence in mortality estimates for this population. Given that underascertainment of mortality among Asians is now estimated to be about 3 percent, similar to that for Hispanics, it is time for Asians to be included in regular NCHS reports on life expectancy.
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From page 179... ...
Similar reporting issues affect the quality of educational attainment reports on death certificates. Vital statistics and census data are the only large-enough data sources that allow for detailed examination of educational disparities in mortality by specific place of residence.
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From page 180... ...
In 2003, during the period covered by the committee's analyses, NVSS adopted new recommendations for the coding of racial/ethnic data on death certificates that allowed the reporting of more than one race; however, the timing of the adoption of this change varied across states. For this reason, the population counts by age, sex, and race and ethnicity that the committee combined with these mortality data to calculate mortality rates were based on the U.S.
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From page 181... ...
This report's summary of research on mortality trends and differentials by educational attainment draws on previously published studies that use both vital statistics data and survey-based data linked with the NDI. Given the issues of the quality of educational attainment data raised above, especially in vital statistics mortality data, the committee used only the highest-quality studies in this area in which such data quality issues are best taken into account.
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From page 182... ...
. For the analyses in this report, cause of death was assigned to one of 20 broad, nonoverlapping categories based on the underlying cause of death identified on the decedent's death certificate (Table 5-1)
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From page 183... ...
401–405, I00–I99, exc. I10–I15, Diseases of the Circulatory System 425.5 I142.6 Mental and Behavioral Disorders 290–319 F01–F99 Diseases of the Nervous System 320–359, exc.
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From page 184... ...
, state vital statistics offices, and local-area health agencies should work together to develop a plan and set of activities for improv ing the accuracy of reporting on U.S. death certificates of educational attainment, American Indian and Alaska Native identity, and multiple causes of death.
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