From Once a Year to On Demand, DVS Rewrites the Rules of Mortality Surveillance

Suppose, after years of being able to look back and see only where you had been, you were suddenly able to see exactly where you are, right now, in a clearer, more revealing light.

That’s a fair description of the position the Division of Vital Statistics (DVS) finds itself in. Thanks to innovative approaches to data warehousing, data access, and data reporting, researchers used to the annual reporting of mortality information in the National Vital Statistics System (NVSS) now have near real-time access to this information.

“As little as 3 years ago, it was almost impossible for a DVS analyst to see the mortality data until the annual file had been closed and processed,” says Dr. Paul Sutton, DVS Deputy Director. The death (and birth) certificate data received from state vital records offices were received and stored on NCHS’ mainframe computer system, inaccessible to all but IT staffers. Once a year, the data in these state files were merged and processed to create the annual data files and reports. You could view last year’s mortality data, but getting an accurate picture of current mortality statistics was out of the question.

“Vital statistics has traditionally been something that was a retrospective look at how things were,” Sutton says. “We produced annual reports a year or more after the data year, and that’s just what we did.”

The transition from the mainframe system to a database environment gave DVS an opportunity to re-envision what could be done with mortality data. Real-time accessibility became a real possibility. But would it have real-world applicability?

Sutton and his team worked with partners in CDC’s Influenza Division set up a pilot program to evaluate the feasibility of using the real-time NVSS-based mortality data to track pneumonia and influenza (P&I) mortality and as a potential replacement for the 122 Cities Mortality Reporting System (CMRS).” [Influenza Division staffers] were having increasing difficulty getting their data from the122 cities system,” Dr. Sutton says.

Beginning in October 2014, FluView, CDC’s weekly influenza surveillance report, began including P&I deaths pulled directly from the real-time NVSS. NVSS-based P&I counts and percentages are presented by the week the death occurred and are being released 2 weeks after the week of death to allow for collection of enough data to produce a stable P&I percentage. The pilot has been very successful, and plans are being made to replace the current 122 CMRS P&I data with NVSS-based data for the 2015–2016 flu season.

Ease of use is a key feature of the new system. Innovative “data cubes”—preaggregated select mortality data—are populated nightly, allowing DVS staff and surveillance partners to create customizable views of real-time data nearly instantaneously. “They turn on the computers,” Sutton says, “flip a switch, and that information’s there.”

The new NVSS-based P&I mortality surveillance system also has the potential to greatly improve data quality. With a database that includes death certificates from 57 reporting jurisdictions, NCHS is able to provide a more comprehensive national count of deaths (total and cause-specific) within 24 hours of receiving and coding the record. NCHS codes every death certificate it receives according to the current International Classification of Diseases (ICD–10). “We’re using those codes consistently across all areas, we’re using the same methodology, so there’s no variation,” Sutton says.

While the upgraded mortality surveillance program is still in its infancy, it has already attracted attention from several potential partners. DVS is currently developing surveillance partnerships to track deaths related to suicide, Creutzfeldt-Jakob disease, respiratory syncytial virus, and disasters. Other potential partnerships could focus on mortality surveillance data on firearm-related deaths, HIV/AIDS, stroke, Alzheimer’s, diabetes, and many more.

Sutton says that DVS is currently working with states to improve the timeliness and frequency of mortality reporting. “Our stated goal right now is to have 80% of deaths reported to us within 10 days,” he says.

“As the quality and completeness of our data improves, it’s just going to get better and better,” Sutton says. “In terms of potential, the improvements over the existing system are huge. We believe it’s superior in every way.”