2: No. 1, January 2005
LETTER TO THE EDITOR
Registration and Statistics Systems
Suggested citation for this article: Nasseri K.
Reengineering vital registration and statistics
systems [letter to the editor]. Prev Chronic Dis [serial online] 2005 Jan [date cited]. Available
from: URL: http://www.cdc.gov/pcd/issues/2005/
To the Editor:
In his timely essay, “Reengineering Vital Registration and Statistics Systems
for the United States,” Charles J. Rothwell raises important
issues about the registration of vital events in the United
States (1). There is no question about the value of taking
advantage of electronic technology to improve the quality and
increase the utility of the registration system. The partnership
mentioned by Rothwell is a step in the right direction.
Currently, only a small portion of the data collected on paper
death certificates is captured in machine-readable format. The
rest — including valuable address and occupation
information — is lost forever for population-based research
and public health purposes.
My primary concern, however, is about the issues that were not
discussed by Rothwell. First, the paper death certificate is a
document whose legality precedes its public health importance.
Unless electronic documents are legally accepted, we must have
the paper documents.
Second, some important data are “mutilated” when captured in
machine-readable format. According to National Center for Health
Statistics (NCHS) guidelines, the place of birth of the deceased is coded only
to the 50 states, the U.S. territories, and a few foreign countries like Canada
and Mexico. All the other nations of the world are grouped together as one code!
Granted, individuals born in foreign lands (i.e., first-generation immigrants)
do not make up a large segment of U.S. death certificates, but from a public
health point of view, they are an important group. Some states defy NCHS
guidelines and collect the exact place of death for each deceased person in
machine-readable format, but the utility of these data is limited
to the state collecting the information; national organizations
are forced to accept NCHS format. Also, information on the place of birth of a decedent’s
parents is of major epidemiological value because it identifies
second-generation immigrants. Some states collect this
information, but following NCHS guidelines, they do not capture
it in machine-readable format.
The issue of accuracy is significant. Technically, we can
evaluate the accuracy of information only against an independent
document. Yet we accept many data on official, technical, and
research documents at face value without verification and use the
data to draw important conclusions. Information on occupation,
for example, can be complex. Most people change their occupation
several times, and upon death, a simple choice of occupation may
not seem so clear. Or, perhaps the next of kin wishes to
“upgrade” the occupation of the deceased. “Retired” and “housewife” are the most common occupations given for men and women,
despite what careers they may have pursued. Nevertheless, with
proper instructions and smart algorithms, we can improve the
process of collecting information on occupation so that it can be
used effectively for research purposes.
My main point in writing this letter is to draw attention to some
important details that might be lost during the process of
upgrading the current vital registration system to an electronic
one. I would also like to suggest that the partnership of the National Association
of Public Health Statistics and Information System, NCHS, and
Social Security Administration be expanded to include a fourth
member that represents the consumer side of these data — epidemiologists or other
public health officials who have closely worked with these data for many years and are intimately aware of
their utility and shortcomings.
Kiumarss Nasseri, DVM, PhD, MPH
Public Health Institute
Tri-Counties Cancer Surveillance Program
Cancer Center of Santa Barbara
Santa Barbara, Calif
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- Rothwell CJ.
Reengineering vital registration and
statistics system for the United States. Prev Chronic Dis [serial online] 2004 Oct [Accessed 2004 Sep 15].
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