Vital Statistics Research

A report from the American College of Obstetricians and Gynecologists (College) highlights the important role vital statistics plays in American health policy. The College firmly believes that maternal and infant mortality statistics depict the nation’s health, influences policy development and leads to funding for critical programs while helping to measure the overall quality of the country’s health care.

Interestingly, a report from the College’s special Committee describes in detail how births, maternal deaths and fetal deaths are registered. The report also identifies challenges for accurately collecting and distributing this data while underscoring the important role obstetricians and gynecologists play in improving the accuracy of reporting these vital statistics.

To the average American, vital statistics are records of certain events that occur from birth to death. But to medical experts including the Center for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS), these statistics are treasured resources.

The National Vital Statistics System

The National Vital Statistics System is one of the oldest and most successful collaborations of intergovernmental public health sharing. The system has several moving parts and is complex. The federal government, state governments and local governments each play important roles in this system.

In fact, vital statistics data is collected and managed through a number of contracts between the CDC, NCHS and state and locally operated vital registration systems. When all components work together, this process ensures maximum accuracy.

The CDC and NCHS work in concert with the federal government to gather vital statistics that allow analysts to track important medical trends. In 2003, NCHS revised the standard forms used to collect and report birth and death certificates. This action has greatly improved accuracy and completeness while reducing variables.

Birth Registration

Birth certificates play a number of important roles for national surveillance, research, public health prevention and development of intervention strategies. The NCHS Standard Certificate of Live Births contains valuable information such as:

• Prenatal care

• Maternal sociodemographic data

• Behavioral data

• Place of birth

• Apgar scores

• Information relative to medical and obstetric complications during pregnancy

US laws mandate that completion and registration of birth certificate information is the responsibility of the professional birth attendant, physician or midwife. All states in the US require registration of births. However, not all states agree on the definition of what constitutes a live birth.

Death Registration

Every state requires reporting of maternal deaths. Information collected from death certificates also helps measure trends in US health. Death certificates provide:

• Information about the deceased person

• Circumstances of the death

• Cause of death, which is coded in accordance with the World Health Organization’s International Classification of Diseases (ICD)

Of course, the College is especially interested in maternal deaths and the corresponding death certificates. Coding guidelines for ICDs were expanded in 1999 to include more details about maternal deaths.

The Physicians’ Handbook on Medical Certification of death says the physician is responsible to complete the death certificate and include the medical portion of the death certificate which details cause of death.

When US standard certificates pertaining to live birth and death were revised in 2003, it was believed that all states would adopt the forms and guidelines by 2016. This would increase the uniformity and accuracy of reporting and give valuable insight into important trends in US health care and national health policy.

Vital statistics are important. The CDC and NCHS emphasize the importance of timely reporting of a vital statistics pertaining to births and deaths. At the same time, a lack of timeliness can greatly distort analysis. One of the great challenges of vital statistics is the decentralized nature of data collection. The College is committed to improving the entire system, which will benefit us all.