VITAL STATISTICS

SUMMARY OF A WORKSHOP

Michael J. Siri and Daniel L. Cork, Rapporteurs

Committee on National Statistics

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, DC
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VITAL STATISTICS SUMMARY OF A WORKSHOP Michael J. Siri and Daniel L. Cork, Rapporteurs Committee on National Statistics Division of Behavioral and Social Sciences and Education THE NATIONAL ACADEMIES PRESS Washington, DC www.nap.edu

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support of the work of the Committee on National Statistics is provided by a consortium of fed- eral agencies through a grant from the National Science Foundation (Number SES-0453930). The project that is the subject of this report was funded by allocations from the U.S. Census Bureau, the National Center for Health Statistics, and the Social Security Administration (Office of Research, Evaluation, and Statistics) to the National Science Foundation under this grant. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-14164-2 International Standard Book Number-10: 0-309-14164-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW Washington, DC 20001; (202) 334-3096; Internet, http://www.nap.edu. , Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council. (2009). Vital Statistics: Summary of a Work- shop. Michael J. Siri and Daniel L. Cork, rapporteurs. Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the gov- ernment, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR THE WORKSHOP ON VITAL DATA FOR NATIONAL NEEDS L OUISE RYAN (Chair), Commonwealth Scientific and Industrial Research Organisation, Australia; formerly, Department of Biostatistics, Harvard University JANET N ORWOOD, Independent Consultant, Washington, DC E DWARD P ERRIN, Department of Health Services, University of Washington S AMUEL P RESTON, Department of Sociology, University of Pennsylvania K ENNETH P REWITT, School of International and Public Affairs, Columbia University C ONSTANCE F. C ITRO, Study Director DANIEL L. C ORK, Senior Program Officer C ARYN E. KUEBLER, Research Associate (until March 2008) M ICHAEL J. S IRI, Program Associate v

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COMMITTEE ON NATIONAL STATISTICS 2008–2009 W ILLIAM F. E DDY (Chair), Department of Statistics, Carnegie Mellon University KATHARINE G. A BRAHAM, Department of Economics and Joint Program in Survey Methodology, University of Maryland A LICIA C ARRIQUIRY, Department of Statistics, Iowa State University W ILLIAM D U M OUCHEL, Phase Forward, Inc., Waltham, Massachusetts J OHN C. H ALTIWANGER, Department of Economics, University of Maryland V. J OSEPH H OTZ, Department of Economics, Duke University KAREN KAFADAR, Department of Statistics, Indiana University, Bloomington D OUGLAS S. M ASSEY, Department of Sociology, Princeton University S ALLY M ORTON, Statistics and Epidemiology, RTI International, Research Triangle Park, North Carolina J OSEPH N EWHOUSE, Division of Health Policy Research and Education, Harvard University S AMUEL H. P RESTON, Population Studies Center, University of Pennsylvania H AL S TERN, Department of Statistics, University of California, Irvine R OGER T OURANGEAU, Joint Program in Survey Methodology, University of Maryland, and Survey Research Center, University of Michigan A LAN Z ASLAVSKY, Department of Health Care Policy, Harvard Medical School C ONSTANCE F. C ITRO, Director vi

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Acknowledgment This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with proce- dures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that assist the institution in making its report as sound as possible, and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. The planning committee thanks the following individuals for their re- view of this report: Colm A. O’Muircheartaigh, Harris Graduate School of Public Policy Studies, University of Chicago; Edward B. Perrin, Department of Health Services (emeritus), University of Washington; Richard G. Rogers, Population Program and Department of Sociology, University of Colorado; and Harry M. Rosenberg, National Center for Health Statistics (retired), Bethesda, MD. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the content of the report, nor did they see the final draft of the report before its release. The review of this report was overseen by Linda J. Waite, Department of Soci- ology, University of Chicago. Appointed by the National Research Council, she was responsible for making certain that the independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the authors and the institution. vii

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Contents 1 Introduction 1 1–A The Workshop on Vital Data for National Needs 3 1–B Successes and Challenges of the Vital Statistics Program 4 1–C Report Overview 8 2 Uses of Vital Statistics Data 9 2–A Uses in Health Policy and Health Research 10 2–A.1 Social Inequalities in Health 10 2–A.2 Trends in Mortality 14 2–A.3 Uses of Vital Statistics by the Maternal and Child Health Bureau 17 2–B Population Projections and Estimates 21 2–B.1 Population and Fiscal Projections at the Social Security Administration 22 2–B.2 Population Estimates and Projections at the Census Bureau 27 2–B.3 Discussion 30 2–C Growing and Emerging Uses: Vital Statistics and Biosurveillance 31 3 The Federal-State Cooperative Relationship 35 3–A The Role of the States 36 3–B Challenges and Limitations at the National Center for Health Statistics 41 3–C Examples of Federal-State Cooperation in the U.S. Federal Statistical System 42 ix

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x CONTENTS 3–C.1 The Quarterly Census of Employment and Wages 42 3–C.2 The Common Core of Data 46 4 Methodological Issues and the 2003 Revision of Standard Instruments 49 4–A The 2003 Revisions 50 4–B Race and Ethnicity 52 4–B.1 Bridging Single-Race and Multiple-Race Data at NCHS 55 4–B.2 Bridging Single-Race and Multiple-Race Data at the Census Bureau 56 4–C Fetal Deaths and Infant Health Risk Factors 58 4–D Mortality and Causes of Death 61 5 Options for a 21st Century Vital Statistics Program 65 Appendixes 75 A The U.S. Vital Statistics System: The Role of State and Local Steven Schwartz Health Departments 77 B The U.S. Vital Statistics System: A National Perspective National Center for Health Statistics 87 C Workshop Agenda and Participant List 111 D 2003 Revisions, Standard Certificates of Death and Live Birth 117 References 125

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List of Figures 1-1 Flow of vital records and statistics in the United States 2 2-1 Population aged dependency ratio, historical and projected through 2080 22 2-2 Historical and projected total fertility rates, 1915–2075 23 4-1 Rates of gestational diabetes by age of mother and plurality, 12-state reporting area, 2005 59 4-2 Rate of surfactant therapy by gestational age and race and Hispanic origin of mother, 12-state reporting area, 2005 60 4-3 Steroids for fetal lung maturation received by the mother prior to delivery, by gestational age and race and Hispanic origin, 12-state reporting area, 2005 60 xi

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List of Tables 4-1 Adoption of 2003 Revised Certificates and Multiple-Race Reporting for Births and Deaths, by State, 2005 53 xii

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List of Boxes 1-1 Successes of the U.S. Vital Statistics System 5 2-1 Performance and Outcome Measures for the Maternal and Child Health Bureau Block Grant Program 18 3-1 Surveys Comprising the Common Core of Data 46 4-1 Major Changes to the U.S. Standard Certificates for Vital Events, 2003 Revision 51 xiii

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