1995 ADDENDUM TO "TECHNICAL APPENDIX" OF VITAL STATISTICS OF THE UNITED STATES: MORTALITY, 1994 This document outlines the modifications to the 1994 mortality Technical Appendix needed to make it applicable to the mortality file for the 1995 data year. I. Sources of data State-coded medical data 1995 New Mexico For 1995, of the States in the VSCP, 41 States submitted precoded medical data for all death certificates in the form of electronic data files. In addition, Maine, Montana, North Dakota, and Wyoming contracted with a private company to provide NCHS with precoded medical data. Kansas continued to provide the medical data for Alaska. The remaining nine VSCP States, New York City, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam submitted copies of the original certificates from which NCHS coded the medical data. For 1995 approximately 16 percent of the Nation's death records were multiple-cause coded using SuperMICAR, 72 percent using MICAR, and 12 percent using ACME. This represents data from 13 states which were coded by SuperMICAR and data from 30 states, the District of Columbia, and New York City which were coded by MICAR. Data for the remaining seven States were processed by the States using only the ACME system. All States submitted precoded demographic data for all death certificates on computer tape in 1995. Data for Puerto Rico, the Virgin Islands, and Guam are available on the cd-rom. These data were included for the first time beginning with the 1994 data year. II. Classification of data A. Hispanic origin Data for 1995 were obtained from the District of Columbia and all States except Oklahoma, which was excluded because the death certificates did not include an item to identify Hispanic or ethnic origin. Infant mortality--Infant mortality data by Hispanic origin are based on deaths to residents of the same 49 states and the District of Columbia. In computing infant mortality rates, deaths and live births of unknown origin are not - 1 - distributed among the specified Hispanic and non-Hispanic groups. Infant mortality rates by Hispanic origin may be biased, because of inconsistencies in reporting Hispanic or ethnic origin between the birth and death certificates for the same infant. Estimates of reporting bias have been made by comparing rates based on the linked file of infant deaths and live births with those where the Hispanic or ethnic origin of infant death is based on information from the death certificate (1). In 1990 the 49 States and the District of Columbia accounted for about 99.6 percent of the Hispanic population in the United States, including about 99.5 percent of the Mexican population, 99.8 percent of the Puerto Rican population, 99.9 percent of the Cuban population, and 99.7 percent of the "Other Hispanic" population (2). B. Educational attainment Deaths by educational attainment are included on the 1995 mortality file. These data were included for the first time for 1989. Mortality data on educational attainment for 1995 are based on deaths to residents of 45 States and the District of Columbia whose data were approximately 80 percent or more complete on a place-of- occurrence basis. Data for Kentucky are included on the cd-rom, but are recommended to be deleted from tabulations because more than 20 percent of their death certificates were classified to "unknown educational attainment." Data for Georgia, Oklahoma, Rhode Island, and South Dakota were excluded from the cd-rom because their death certificates did not include an educational attainment item. C. Occupation and industry Deaths by occupation and industry are included on the 1995 mortality file. These data were included for the first time for 1985. These data were obtained from the following items that appear on the U.S. Standard Certificate of Death: o (Item 14a) USUAL OCCUPATION (Give kind of work done during most of working life, even if retired.) o (Item 14b) KIND OF BUSINESS OR INDUSTRY - 2 - For 1995, the occupation and industry mortality data were included for the following 19 reporting States: Colorado New Mexico Georgia North Carolina Idaho Ohio Indiana Rhode Island Kansas South Carolina Kentucky Utah Maine Vermont Nevada West Virginia New Hampshire Wisconsin New Jersey Data for 1993-95 were coded using the revised NCHS Part 19 instruction manual (3) and the Bureau of the Census 1990 occupation and industry titles and three-digit codes, which are shown in the 1990 Census of Population and Housing(4). Occupation and industry mortality data for 1984-92 were based on the 1980 Bureau of the Census occupation and industry classifications. For a listing of the changes between the 1980 and the 1990 classification systems, see Appendix D of the NCHS Part 19 instruction manual(3). In addition to the codes shown in the Bureau of the Census publication(4), the following special codes were created: Occupation Industry 913 Retired; with no 961 Own Home/At Home other occupation 970 Retired: with no other reported industry reported 914 Housewife/ 990 Blank, Unknown, NA Homemaker 915 Student 916 Volunteer 917 Unemployed, never worked, disabled, child, infant 999 Blank, Unknown, NA D. Injury at work Deaths for "Injury at work" were included on the 1993 mortality file for the first time. These data were obtained from the following item that appears on the U.S. Standard Certificate of Death: o (Item 30c) INJURY AT WORK? (Yes or No) E. Report of autopsy Beginning with the 1995 data year, mortality data on autopsy - 3 - are no longer collected. III. Quality of data For 1995, the number of deaths occurring in Alaska are in error for selected causes because NCHS did not receive changes resulting from amended records and because of errors in processing the cause of death data. Differences are concentrated among selected causes of death, principally Symptoms, signs, and ill-defined conditions (ICD-9 Nos. 780- 799) and external causes as shown on the following page. Number of deaths and ratios of deaths for selected causes as tabulated by State of occurrence and NCHS, 1995 [Data by place of occurrence include deths of nonresidents. Numbers after causes of death are category numbers of the Ninth Revision, International Classification of Diseases, 1975] Causes Alaska NCHS Alaska/NCHS All causes ................................ 2,546 2,546 1.00 Symptoms, signs, and ill-defined conditions 780-799 42 43 0.98 Accidents and adverse effects.... E800-E949 368 376 0.98 Motor vehicle accidents..........E810-E825 105 96 1.09 All other accidents and adverse effects... E800-E807,E826-E949 263 280 0.94 Suicide...........................E950-E959 118 105 1.12 Homicide and legal intervention...E960-E978 56 55 1.02 All other external causes.........E980-E999 7 11 0.64 IV. Population bases for computing rates The population used for computing death rates (furnished by the U.S. Bureau of the Census) represents the population residing in the specified area. Death rates for 1995 are based on population estimates as of July 1, 1995 (5,6). The estimates are based on the 1990 census counts. The 1990 census counts by race were modified to be consistent with the U.S. Office of Management and Budget categories and historical categories for death data (7). Population estimates by marital status are available and presented in Table III of the Technical notes of "Report of Final Mortality Statistics, 1995" (8). References 1. National Center for Health Statistics. Technical appendix. Vital statistics of the United States, 1990, vol II, mortality, part A. Washington: Public Health Service. 1994. - 4 - 2. U.S. Bureau of the Census: Unpublished data from the 1990 census for persons of Spanish origin by State. 3. National Center for Health Statistics: Industry and occupation coding for death certificates, 1993. NCHS instruction manual, Part 19. Hyattsville, Maryland: Public Health Service. 1992. 4. U.S. Bureau of the Census: Classified index of industries and occupations. 1990 Census of Population and Housing. Washington: U.S. Department of Commerce. 1992. 5. U.S. Bureau of the Census: United States population estimates, by age, sex, race, and Hispanic origin: 1995. Census file RESD0795. 1996. 6. U.S. Bureau of the Census: Unpublished estimates for 1995, by State. 7. U.S. Bureau of the Census: Unpublished data from the 1990 census, by age, sex, race, and Hispanic origin. 1990 CPH-L-74 8. Anderson RN, Kochanek KD, Murphy SL. Report of Final Mortality Statistics, 1995. Monthly Vital Statistics Report; vol 45 no 11, suppl 2. Hyattsville, Maryland: National Center for Health Statistics. 1997. - 5 -