{"id":4766,"date":"2020-01-30T10:15:10","date_gmt":"2020-01-30T15:15:10","guid":{"rendered":"http:\/\/nchstats.com\/?p=4766"},"modified":"2020-01-30T10:15:10","modified_gmt":"2020-01-30T15:15:10","slug":"q-a-new-release-of-2018-mortality-data-and-new-data-on-maternal-mortality","status":"publish","type":"post","link":"https:\/\/blogs.cdc.gov\/nchs\/2020\/01\/30\/4766\/","title":{"rendered":"Q & A: New Release of 2018 Mortality Data and New Data on Maternal Mortality"},"content":{"rendered":"

https:\/\/www.cdc.gov\/nchs\/pressroom\/podcasts\/20200130\/20200130.htm<\/a><\/p>\n

TRANSCRIPT<\/strong><\/p>\n

Robert Anderson is Chief of the Mortality Statistics Branch at NCHS. Dr. Anderson joined me to discuss the new release of\u00a02018 mortality data<\/a>\u00a0as well as the new data on\u00a0maternal mortality\u00a0<\/a>in the United States:<\/p>\n

Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Before we get into the subject of maternal mortality, there are a number of other mortality topics in this release that are significant. Let\u2019s start with life expectancy.<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So as I\u2019m sure you\u2019re aware, life expectancy has, we\u2019ve experienced a decline in life expectancy over the last few years. Since 2014, life expectancy declined 2 out of 3 years through 2017, and from 2017 to 2018, though, we saw a slight increase, so it appears that that trend is reversed.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Do we know what causes of death contributed to this increase in life expectancy?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Yeah we do \u2013 we did an analysis of the causes of death that contributed to that change and the main causes that are contributing to the increase in life expectancy are declines in cancer mortality and declines in unintentional injuries and in most instances that involves drug overdoses \u2013 so a slight decline in the rate for drug overdose.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 How much of that impact you think was due to the decline in drug overdoses?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 It probably accounts for about 15% of the decline \u2013 it\u2019s not a whole lot.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Can you talk about which drugs we\u2019re making progress on as far as overdose deaths and which are now emerging as the biggest threat to the country?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So, between 2017-2018 in particular we saw declines in the natural and semi synthetic opioids which are drugs that are commonly available by prescription \u2013 like oxycodone and hydrocodone. We saw declines in methadone overdose. And we also saw declines, a slight decline, in overdose deaths due to heroin. But the synthetic opioids, other than methadone, seem to be a continuing problem \u2013 the overdose death rate for the synthetic opioids other than methadone continued to increase from 2017 to 2018.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So just to be clear \u2013 these synthetic opioids we\u2019re talking about are fentanyl?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fentanyl and tramadol \u2013 a very large proportion of those deaths involve fentanyl.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Now, pivoting to maternal mortality. With maternal mortality there\u2019s a whole back story \u2013 can you share that with us?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Yeah, it\u2019s sort of a long and involved process that we\u2019ve gone through over the last decade and a half or so. So in the past, as we\u2019ve collected data on maternal deaths \u2013 and here we\u2019re talking about years prior to 2003 in particular \u2013 research had shown that we tended to underestimate maternal deaths. And so in order to address that issue, we felt that adding a checkbox item to the death certificate asking whether the decedent was pregnant or recently pregnant was a good idea. And so we revised our standard death certificate \u2013 this is the standard that the states use to base their own state death certificates on \u2013 we revised that to include this checkbox item. So that was implemented in 2003 but only in a few states. Unfortunately, not all states implemented at the same time and so over the next, well, decade and a half \u2013 a little bit more than that actually \u2013 we had states implementing gradually this checkbox item and as a result that we saw increases in maternal mortality. And it got to the point that in 2007, we decided that we couldn\u2019t adequately interpret what was going on and so we stopped reporting maternal mortality altogether, waiting for all of the states to get onto the standard certificate at which point we planned to resume. So the final state implemented the checkbox item in mid-year 2017, so 2018 is the first data year for which we have data from all states that is based on that checkbox. So we decided we needed to do an evaluation though, of the data because research post 2003 showed that there were some problems with the checkbox \u2013 some errors that were evident. And so we did this evaluation and we found indeed there were some problems and so we had to come up with a new method to code maternal mortality that would mitigate those errors. So with the 2018 data we\u2019re now releasing a figure that we believe reasonably represents the risk of maternal mortality in the United States.<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 We\u2019re releasing data for 2018 and it\u2019s based on this new coding method. We will be releasing some data for previous years as well, coded in multiple ways. Our goal is to make the data as transparent as possible so that the researchers can see what we did and what went into the new coding method and, you know, what went into the statistics that we\u2019re releasing. But also, you know, if they choose to make some different decisions in their research they would be able to do that as well \u2013 they\u2019ll be able to count them however they like.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So how many maternal deaths are we seeing in the U.S. according to 2018 data?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 In 2018, we found 658 maternal deaths for the United States \u2013 it\u2019s a rate of 17.4 deaths for every 100,000 live births.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Can we say that the maternal mortality deaths and the maternal mortality rate increased over time?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Well, we can\u2019t really say that with any sort of certainty. We do know that the increases that we\u2019ve seen compared to the older data that we released, the increases that we\u2019ve seen are largely \u2013 mostly even \u2013 due to implementation of the checkbox. They don\u2019t appear to be real increases.<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 We did an analysis based on 2015 and 2016 data. The purpose of that particular analysis was to look at the effect of the checkbox on maternal mortality and what we found was that there was a dramatic increase in the number of maternal deaths detected as a result of using the checkbox. And we also found that that increased very dramatically by age, so at the older ages, the checkbox increased the number of maternal deaths detected by quite a lot<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So the checkbox you feel then is giving a clearer picture of what the scope of the problem is?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 I wish I could say that was the case \u2013 we feel like it is definitely allowing us to detect maternal deaths that we weren\u2019t able to detect before. That said, we know that there are some errors in the checkbox and we\u2019re not entirely sure why these errors are occurring. This is something that we\u2019re going to be exploring over the course of the next year. We\u2019re trying to sort that out so we can actually correct it. But the effect of these errors on the checkbox is that we are finding deaths to women who were not pregnant but for whom that the checkbox was checked that they were pregnant. And some of these women are quite old actually \u2013 beyond reproductive age.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So when did you start uncovering those problems along this process?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Well, we didn\u2019t actually discover this. There were some states that were doing their own research on this \u2013 the state of Texas, for example, did some important research and they found errors. CDC\u2019s Division of Reproductive Health did some work with four states recently, that they recently published, that showed that this was the case as well. And so we were really taking the results of that research, along with our own evaluation, to determine what was going on.<\/p>\n

\n

Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 What else have you found \u2013 are there any geographic patterns that suggest maternal deaths are more prevalent in certain parts of the country?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Well, we can\u2019t really say much about maternal mortality by state or by region. Unfortunately, we really don\u2019t understand very well the variation in data quality from state to state and in addition you\u2019re talking about 658 deaths in a year spread over 50 states. The numbers get quite small and it\u2019s difficult to make judgments based on small numbers \u2013 the death rates, mortality rates, get to be very unstable with small numbers.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So some have been saying or arguing that the problem has been getting worse over time, that even now we don\u2019t have a complete picture. What would you say to that?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Well, I would agree that we don\u2019t have a complete picture. The evidence that we\u2019re seeing suggests that the problem isn\u2019t really getting worse, but it doesn\u2019t appear to be getting better either. And that\u2019s, uh, that\u2019s something to be concerned about. We have data from maternal mortality back to 1915 and we saw substantial declines \u2013 they\u2019re really dramatic declines, we\u2019ve seen dramatic decline since then and in recent decades the rate has been rather flat in comparison.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 So one of these new reports looks at a 20 year period prior to the 2018 data. Could you talk about that?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sure. As part of our evaluation we did this initial study based on the 2015 and 2016 data to get a sense of the impact of the checkbox and that was based on actual data that we had, we recoded not using the checkbox and then compared it to what we had with the checkbox. This other study was a little more involved and involves some statistical modeling, and so what we wanted to do with that study was to get a sense for what things would have looked like had all of the states implemented in 2003. So that was the goal and so we have this trend based on these statistical modeling procedures that shows a fairly stable trend .<\/p>\n

\n

Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The second report was more focused on the years 2015 and 2016 \u2013 can you talk about that work?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sure. Yeah, the report based on the data years 2015 and 2016 is really an evaluation of the effect of the checkbox. And those years were chosen because those were years for which we had data coded without the checkbox. So we took these data, assuming no checkbox existed, and then we compared that with the data that we had that included the checkbox to get a sense for, to evaluate the effect of the checkbox on the maternal mortality.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Looking forward, are there any more initiatives underway in terms of improving this whole process and the quality of the data?<\/p>\n

RA<\/strong><\/em>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Yeah, there\u2019s a lot of, a lot more work to do, really. I mean, we have to understand better why these errors are occurring in the checkbox. It may have something to do with electronic registration systems in the way they\u2019re configured. We\u2019re not really sure, but what we really need to understand if we\u2019re going to correct these errors \u2013 we really need to understand why they are occurring and so that\u2019s something that we\u2019ll be working on over the course of the next year. In addition, we need to work with states and our plan is to do this, to work with states to investigate deaths to women of reproductive age to determine if a pregnancy or recent pregnancy was a factor in their death and this is this can be done using some data linkage to look in birth records and fetal death records for evidence of a pregnancy. I think we can glean a lot of information if we just, you know, take the time and effort to go and look and see. What we have to do is, we have to work with the states to do this because they are the keeper of those records. They\u2019re the ones that will have to do it and if we can support them in those efforts then hopefully we can get information that will feed back into the vital statistics system and provide us with better data in the future.<\/p>\n

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Q<\/strong>:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Robert Anderson thank you for joining us.<\/p>\n","protected":false},"excerpt":{"rendered":"

https:\/\/www.cdc.gov\/nchs\/pressroom\/podcasts\/20200130\/20200130.htm TRANSCRIPT Robert Anderson is Chief of the Mortality Statistics Branch at NCHS. Dr. Anderson joined me to discuss the new release of\u00a02018 mortality data\u00a0as well as the new data on\u00a0maternal mortality\u00a0in the United States: Q:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Before we get into the subject of maternal mortality, there are a number of other mortality topics in this<\/p>\n","protected":false},"author":195,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[62268,49481,32494,47317,53751],"tags":[],"_links":{"self":[{"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/posts\/4766"}],"collection":[{"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/users\/195"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/comments?post=4766"}],"version-history":[{"count":0,"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/posts\/4766\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/media?parent=4766"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/categories?post=4766"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.cdc.gov\/nchs\/wp-json\/wp\/v2\/tags?post=4766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}