Interview with Dr. Robert Anderson (Part Three): Death Certificates – Provisional vs. Final Data

TRANSCRIPT

HOST: We’re joined today by Dr. Robert Anderson, the Chief of Mortality Statistics at CDC’s National Center for Health Statistics.

HOST: You touched on provisional data – could you walk us through what provisional death data is and then also explain when the data are final?

ROBERT ANDERSON: So the provisional data allows us to see a picture – an incomplete picture – of the situation with regard to mortality in a much more timely fashion. So when we provide data that are incomplete we will call it provisional because it will change over time as more information comes in. We generally have to wait nearly a year after the end of the data year to have final data ready. Now in contrast, we’ve already been releasing provisional data for 2020 but those data are incomplete and subject to change but they do allow us to see a picture, albeit incomplete of the situation with regard to mortality.

HOST: So then the final data are basically when 100% of the death certificates have been recorded and analyzed is that correct?

ROBERT ANDERSON: Yeah that’s correct – those data have been thoroughly checked and we’ve made any corrections that are needed and we feel comfortable that these can form the basis for official mortality statistics.

HOST: So what explains the lag time in the data and the different times each year the date are released? Some years it comes out earlier and other years not as early.

ROBERT ANDERSON: At the national level we’re only as fast as our slowest state so we have to wait to get this information in from the states because we want to have all deaths represented from all states. And there’s quite a bit of variation in timeliness by state and in cases where lengthy death investigations may be needed and the jurisdictions may be strapped for resources, it may take several months to get the cause of death information. Some states – there are a few states that don’t have electronic systems and so they tend to be slower as well. And so we really have to wait to get all of the information in and if we have one really slow state, that may slow us down a bit. In addition, if we find significant problems with the data, the data file, that may take some time as well so normally we go back and forth with the state to make sure that we understand what the problems are and that they are corrected to the extent that we can correct them. And so if we identify significant problems – and this does happen sometimes, particularly as states are implementing electronic systems or maybe implementing new electronic systems, there tend to be bugs in the system and we find issues and those really have to be corrected because we want the data to be as accurate as possible. So when those things arise, that may cause us to adjust the release date for the file data. We don’t have a sort of “static release date” where we release on the same day every year – it really depends on how long it takes to make sure that the data are as accurate as we as they can be.

HOST: So as far as NCHS’s analysis on death certificate data… NCHS does not go into all areas of analysis – sometimes there’s outside research done. Is there untapped information on the death certificate that that could be useful for the public health community – what’s your thoughts on that?

ROBERT ANDERSON: Well I mean you’re right that we don’t we don’t publish on every item on the death certificate in our standard reports. There are some information there that we don’t publish on. We do make the data file available and the data is a public use data file but has some limited information. And then there are some other files that require a research proposal and a data usage agreement that have additional information. Those are made available to researchers and researchers can do that but one thing in particular that I’ll mention that doesn’t get a whole lot of attention but should is what we call multiple cause data. Now I talked about underlying cause information before and the basic official national statistics are based on underlying cause. But multiple cause information is important. We record all of the causes that are reported on the death certificate. So we record that entire causal sequence that’s reported and we also record any contributing conditions as well. And so there’s a lot I think of good information in those multiple cause fields that can be used and one thing that we’ve just begun to start looking at in the last several years is specific drug information which is gleaned from that, from those multiple cause fields. The underlying cause may be due to overdose due to heroin or whatever but there may be multiple drugs reported or there may be some other information in there that can be useful in those multiple cause fields. So that’s something that we don’t typically publish on – it’s quite complicated to present a statistical picture based on multiple cause but that could be very useful I think from a research standpoint.

HOST: Join us next week for part four of our discussion with Dr. Robert Anderson on death certificate data in the United States