 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
COMMENTARY |
National Center for Health Statistics
Centers for Disease Control
Hyattsville, MD 20782
Department of Population and Family Health Sciences
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
Since 1950, an "Annual Summary of Vital Statistics" article has appeared in every December issue of Pediatrics. For 44 years, the article was written by Myron Wegman,1 a pediatrician and public health leader, who died earlier this year at the age of 95.2 Since 1995, the article has been authored by a group of colleagues from the National Center for Health Statistics (NCHS) and the Johns Hopkins Bloomberg School of Public Health.3 The goal of the article has been to keep pediatricians and public health officials up to date with the changing indicators of reproductive, perinatal, and children’s health in the United States.
The delay in publishing this year’s "Annual Summary" requires an explanation to the many readers who have come to expect it. The specific reason for the delay is late receipt of data from some states. This lack of timeliness is attributed to state systems that were not easily modified to handle the new data standards for the 2003 revisions of birth certificates as well as antiquated collection and processing of mortality data, causing delays in the linking of birth and infant death files. Compounding this delay at the state level was the slow processing at the NCHS of data being provided under either the old or new data standards. We anticipate that the annual summary will appear in the February 2005 issue.
The more general reason for the delay rests with the basic structure of the vital statistics system in the United States. The United States has operated a decentralized vital statistics system since its inception in the 1930s; vital records of birth, death, and fetal death are collected at the local level, compiled by states, and transmitted to the NCHS. Although the measures derived from these vital records are an essential component of health policy formation, the focus of the system itself is on the filing and storage of administrative records.
The strength of this data source is the near completeness that enables population-based analysis and comparisons to be undertaken at the national, state, and local levels by age, race, ethnicity, and gender. The distributed nature of the system and the fact that its uses for health are secondary to administrative requirements present many challenges. The timeliness and, in some cases, the quality of the information on the >6 million annual vital events is hampered by aging collection systems that need to be changed so that the most sophisticated collection and processing methods can be used.
To resolve these issues, vital registration requires more complete automation at the level of primary data collection and changes in the basic relationships between the providers of the source records, the state registration offices, and NCHS that will allow all partners to be more efficient and effective. For example, for almost 20 years, states have been using electronic birth certificate (EBC) systems. Although this has been a significant step forward, states continue to operate dual paper and electronic systems, with the paper record being the official legal document.
The collection of death information, however, continues to be primarily a paper-based process, unchanged at the local level for the last half century. The lack of automation at the source precludes timely follow-back to improve data quality, quick linkage of birth and infant death data, and the timely provision of national information on birth outcomes. For example, the increase in infant mortality that occurred between 2001 and 2002 could not be reported until 2004.4,5 The linked infant birth and death information is needed to understand why the increase occurred, but these files are just now becoming available for analysis. To compound these problems, most states have not been able to modify their existing systems to implement the 2003 revisions to the US standard birth certificate, which would provide a wealth of new information including information on infertility treatment, maternal morbidity, infections during pregnancy, and breastfeeding.
To address these problems, the National Association of Public Health Statistics and Information Systems (NAPHSIS), representing state vital registration executives, NCHS, and the Social Security Administration, has developed a partnership to improve the responsiveness of state vital registration and statistics systems. Their objective is to improve the timeliness, quality, and sustainability of these systems by adopting national, consensus-based standards and guidelines. Modifying existing registration systems is no longer an option. Standalone systems and paper-based processes will no longer be able to meet provider and user needs. Reengineered vital statistics systems will need to be integrated with other health information systems, such as those for immunizations, newborn screening, and hearing screening, and with electronic systems used by data providers, including hospitals and physicians. The national partnership and its consensus process have already had some notable accomplishments, including the development of functional requirements for reengineered birth and death registration. The consensus national requirements will serve as the foundation for the design, development, and implementation of Internet-based vital records and statistics systems for states.
 |
FOOTNOTES |
|---|
Address correspondence to Bernard Guyer, MD, MPH, Zanvyl Krieger Professor of Children’s Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E4146, Baltimore, MD 21205. E-mail: bguyer{at}jhsph.edu
No conflict of interest declared.
|
REFERENCES |
|---|
 TOP REFERENCES |
|---|
This article has been cited by other articles:
 |
|
 |
|
  B. E. Hamilton, A. M. Minino, J. A. Martin, K. D. Kochanek, D. M. Strobino, and B. Guyer Annual Summary of Vital Statistics: 2005 Pediatrics, February 1, 2007; 119(2): 345 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Martin, K. D. Kochanek, D. M. Strobino, B. Guyer, and M. F. MacDorman Annual Summary of Vital Statistics--2003 Pediatrics, March 1, 2005; 115(3): 619 - 634. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
||
|
||
Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2004 American Academy of Pediatrics. All rights reserved. |
||
|
||
