5 Analysis of Vital Statistics V1.0

U.S.
Centers for Disease Control and Prevention

National Center for Health Statistics
International Statistics Program
Analysis of Vital Statistics Data
These materials have been developed by the National Center for Health Statistics, International Statistics Program, Hyattsville,
Md., as part of the CDC Global Program for Civil Registration and Vital Statistics Improvement.
Outline
 Uses, general principles, & standardization of

VS data
 Types of vital statistics measures
 Visualizing data (general)
 Natality
 Mortality
 Linking data 2

Uses of Vital Statistics
 Planning human development
 Dynamics of reproduction
 Life-tables
 Risks of dying
 Population growth dynamics Population Pyramid,

Statistics Canada
 Population projections
 Monitoring & evaluating interventions 3
Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter I.B.; NCHS, Unit 15.
Can facilitate information for:
 Provision of services for vulnerable

populations (i.e. single mothers & children)
 Regional & urban/rural comparisons
 Allocation of resources (i.e. health care,

education, & social security)
Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter I.B.

Only nationally representative source for:
 Mortality by cause of death
 Risks of premature death

by sex & age
CDC, NVSS, 2007

 Relative risks of death among subgroups
 Cause-specific risk of dying trends 5
Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter I.B.

General Principles:
Useable Statistics
 Clear, explicit, & simple definitions
– Universal acceptance / international standards
– Comparability (geographically & over time)
 Continuity
– Setting targets
– Evaluating social & economic plans
 Flexibility to adapt
– New methods / requirements
– Computing technology
– Changes described in reporting (titles, footnotes) 6
Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter I.B.; Chapter II.G.3.;
NCHS, Unit 15.
Standardization of VS Data:
ICD & International Comparison
 WHO: International Statistical Classification
of Diseases and Related Health Problems
 Revisions
– Currently in 10th Revision (1993)
– Recommended every 10 years; getting longer
– Countries are slower to adopt
 Ideal source for international comparison

– Universal morbidity & mortality coding
– Only cases seen by physician 7
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5;

NAPHSIS.
Standardization of VS Data:
ICD & International Comparison
 ICD in (country):
– (current status)
– (future steps)
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5;

NAPHSIS.
Standard Definitions &
Guidelines
 Adopted by World Health Assembly
(ICD-10 Volume 1, pp 1233-1238)
 Necessary for international

comparison
WHO, 1998  List of definitions
– Cause of death – Perinatal / neonatal period
– Live birth – Maternal / late maternal death
– Fetal death – Pregnancy related death
– Birth weight – Direct obstetric deaths
– Gestational age – Indirect obstetric deaths
9
– Pre-term, term, post-term
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 1, p 1233-1238;

Volume 2, Chapter 5.
Differences in Reporting Requirements:
“Live Birth”
10
SOURCES: MacDorman, MF and Mathews TJ. Behind International
Analysis of Vital Statistics Data Rankings of Infant Mortality: How the United States Compares with
Europe. NCHS Data Brief No. 23. Nov. 2009. See also: Healy, B. Behind
the Baby Count. US News & World Report. 2 Oct 2006.
Review: Vital Statistics Data
 Uses
– Variety of indicators
– Generate information for services
– Nationally representative data source
 General Principles
– Clear, explicit, & simple
definitions
– Continuity
– Flexibility to adapt
 Standardization 11
Analysis of Vital Statistics Data PAHO, 2009

Discuss
How are causes of death classified in your

country?
How often are the ICD codes revised? What

version is currently used in your country?
If ICD10 is in use, what edition of that revision is

being used in your country?
12

Types of Vital Statistics Measures:
Absolute versus Relative
Absolute counts
 Not comparable over time/geography
 Can stratify number of events (count) by:
– Demographics (age, sex, marital status, race/ethnicity)
– Time (month, year)
– Location (district, region)
– Place of occurrence (home vs. health institution)
13
Analysis of Vital Statistics Data SOURCES: NAPHSIS; NCHS, Unit 17.

Absolute versus Relative
Relative numbers: percentages, ratios, and rates
 Relating absolute counts to population at risk:
must have denominator information
 Place- and time- specific
 Comparable
 Source of information / denominators:
– Census projections
– Hospital reports (limited to events that take place in a
14
health institution)
Analysis of Vital Statistics Data SOURCES: NAPHSIS; Kenya; NCHS, Unit 17.
Percentages
 Computing by hundredths
 Numerator must be part of denominator
 Example: % of premature babies
= number of premature births X 100
total number of births
 Percentages as summary statistics
– Array of subcategories, using total as denominator
– Can obtain percentage distribution
– All percentages should add up to 100 percent
15
Analysis of Vital Statistics Data Source: NAPHSIS; NCHS, Unit 17.

Ratios
 Used to indicate relative size of one number compared
with another number
 Numerator does NOT have to be part of denominator
 Example: Sex Ratio at Birth

= number of male live births X 100 (or 1,000)
number of female live births
= number of male live births per 100 (or 1,000) female

live births
16

Rates
 Describes rapidity of occurrence during a stated
period of time
 Example: infant mortality rate

= # deaths under 1 yr during given calendar year X 1,000
# live births during same year
 Two types of rates

– Based on vital statistics only
– Based on vital statistics and population statistics
17

Rates
 Based on vital statistics only
Infant mortality rate
# live births during same year
 Based on vital statistics and population statistics
Age-specific (infant) death rate
mid-period total population of children under 1 yr
 Importance of census data 18

Discuss
How will percentages help you to summarize
statistical data?
19

Review: Types of Vital Statistics Measures
 Absolute versus relative
 Percentages
 Ratios
 Rates
20

Visualizing Data: Tabulations
 Degree of detail
– Cause
– Sex, race
– Age
– Geographical area
 Depends on
– Purpose of statistics
– Range/completeness
of data
 Column and row totals should add up correctly 21

SOURCES: WHO ICD-10, Volume 2, Chapter 5; NCHS,
Unit 17.
Tabulations:
Specify Time Reference
 By date of registration
– For provisional tabulations only
– Need to evaluate differences expected
– May be quicker for weekly, monthly, or quarterly
summaries
 By date of occurrence of event

– Recommended for final tabulations
– Must define “cut-off” date for reporting events
• Legislation
• Organizational structure 22
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5; UN

Handbook, Module 18, A1.
Tabulations:
Specify Geographic Reference
 Goal: complete coverage of country’s total
population
 May focus on areas of known coverage

– Incentive for lower-quality areas to improve
– Interim measure
– Data not nationally representative; supplement data:
• Statistical adjustment for under-reporting
• Collecting supplementary data by field surveys
23

Tabulations:
Specify Geographic Reference
 Normal assumption: little difference between resident
population & population present
 By place of usual residence

– Use for final tabulations for civil divisions & large cities
– Can present by events of residents versus non-residents
– Must consider legal definition of “residence”
 By place of occurrence:
Recommended for subnational areas
24

Visualizing Data:
Charts, Graphs & Figures
• Customize for local

needs
• Use to expand data

interpretation
The Guardian, UK, 2011
• Use to explain/justify needs to stakeholders
25

Review: Visualizing Data
 Tabulations
– Time reference
– Geographic reference
 Charts, graphs, & figures
26

Natality Statistics
 Various rates/ratios/percentages
 Age specific rates
 Fertility rates
 Tabulations
UN, World Fertility Patterns, 1997
 Graphs/charts/figures
27
Analysis of Vital Statistics Data SOURCES: NAPHSIS

Crude Birth Rate
 # resident live births for a specific area during a specified
period
 divided by total population for that area (usually mid-year)
 multiplied by 1,000
Total resident live births X 1,000

Total Population
ON YOUR OWN: What is the birth rate in this area in 2005?
180,000 live births in 2005 among area residents
12,300,000 estimated population in 2005 for area residents
28

Crude Birth Rate: Example
180,000 live births in 2005 among area residents
12,300,000 estimated population in 2005 for area

residents
180,000 X 1,000 = 14.6

12,300,000
14.6 live births per 1,000 area residents in 2005 29

Sex Ratio at Birth
 # resident male live births for a specific area during a
specified period
 divided by # of resident female live births for that area &

period
 multiplied by 100 or 1,000
# of resident male live births X 100 (or 1,000)

# of resident female live births
ON YOUR OWN: What is the sex ratio at birth for the area in 2008?
58,000 = male live births in 2008 to area residents
55,000 = female live births in 2008 to area residents 30

Sex Ratio at Birth: Example
58,000 = male live births in 2008 to area residents

55,000 = female live births in 2008 to area residents
58,000 X 100 = 105.5

55,000
105.5 male births per 100 female live births

among area residents in 2008
31

% Low (Very Low) Birth Weight
period with a birth weight of less than 2,500 (1,500) grams
 divided by # of resident live births for that area & period
 multiplied by 100 to get a %
# of resident live births < 2,500 (1,500) grams X 100

# of resident live births
ON YOUR OWN: What is the % low birth weight for the area in 2005?
10,500 = live births < 2,500 grams in 2005 among area residents
150,000 = live births in 2005 to area residents 32

% Low Birth Weight: Example
10,500 = live births < 2,500 grams in 2005 among

area residents
150,000 = live births in 2005 to area residents
_10,500_ X 100 = 7.0

150,000
7.0 % of all live births in 2005 among area

residents were low birthweight births 33

% Preterm Live Births
period with a gestational age < 37 completed weeks
 divided by # of resident live births for that area & period
 multiplied by 100 to get a %
# of resident preterm (< 37 weeks) live births X 100

ON YOUR OWN: What is the % preterm live births in the area in 2008?
15,900 = preterm (< 37 weeks) live births in 2008 among area residents

% Preterm Live Births: Example
15,900 = preterm (< 37 weeks) live births in 2008

among area residents
15,900 X 100 = 12.5

127,000
12.5 % of all live births in 2008 among area

residents were preterm births. 35

Age-Specific Birth Rate
 # resident live births to women in a specific age group for a
specific area during a specified period
 divided by the total population of women in the same age group

for that area & period
 multiplied by 1,000 to get a rate
# resident live births to women in a specific age group X 1,000

# of women in the same age group
ON YOUR OWN: What is the 2008 area birth rate for women 20-24 yrs?
36,000 = live births in 2008 among resident women 20-24 years old
310,000 = area resident women who are 20-24 years old in 2008 36

Age-Specific Birth Rate: Example
36,000 = live births in 2008 among area resident
women who are 20-24 years old
310,000 = area resident women who are 20-24
years old in 2008
36,000 X 1,000 = 116.1

310,000
116.1 live births per 1,000 area resident women

who are 20-24 years old in 2008 37

General Fertility Rate
period
 divided by the female population age 15-49 years (usually
estimated for a mid-year) for the same area/period
# of resident live births X 1,000

# of females aged 15-49
ON YOUR OWN: What is the general fertility rate in the area in 2008?
180,000 = live births in 2008 among area residents
2,700,000 = estimated # of area resident females 15-49 yrs in 2008
(estimated for 1 July, 2008) 38

General Fertility Rate: Example
180,000 = live births in 2008 among area residents

2,700,000 = estimated # of area resident females who
are 15-44 years old in 2008 (estimated for 1 July,
2008)
180,000 X 1,000 = 66.7

2,700,000
66.7 live births per 1,000 area resident women

who are 15-44 years old in 2008
39

Total Fertility Rate
 sum the age-specific birth rates (5-yr age groups between 10 & 49) for
female residents of a specific area during a specified period
 multiply by 5
(ΣASBR) x 5
where ASBR is each 5-year age-specific birth rate: Bx x 1,000
Px
where Bx is the # live births to mothers age x
 Bx age groups: <15, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, & 45+
Px is the # resident women age x

 Px age groups: 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44 & 45-4940

Total Fertility Rate
1. Determine Bx and Px
a) List # live births to moms in each age group (Bx)
b) List # resident women in each age group (Px)
2. Calculate the age-specific birth rates (ASBR)

a) Divide Bx by Px
b) Multiply by 1,000
3. Sum the age-specific birth rates (ASBR)
4. Multiply the total ASBR by 5 41

Total Fertility Rate for
an area for year 2000:
1. Determine Bx and Px (given)
Mother’s 2000 Live 2000 Mid-year Female
Age Group Births (Bx) Population (Px) ASBR
10-14 300* 165,000
15-19 11,000 179,000
20-24 20,000 192,000
25-29 22,000 222,000
30-34 20,000 213,000
35-39 10,000 212,000
40-44 2,000 210,000
45-49 500* 200,000
*For groups 10-14 & 45-49, births to ages < 15 and 45+ are used.
42

2. Calculate the age-specific birth rate (ASBR)
ASBR = Bx x 1,000
Px
2000 Live 2000 Female

Age Group Births (Bx) Population (Px ASBR rounded)
10-140-14 300 165,000
43

2. Calculate the age-specific birth rate (ASBR)
ASBR = Bx x 1,000
Px
Mother’s 2000 Live 2000 Female
Age Group Births (Bx) Population (Px ASBR rounded)
10-140-14 300 165,000 1.8
ASBR = 300 X 1,000 = 1.8 live births per 1,000

165,000 44

Finish the remaining groups …
Age Group Births (Bx) Population (Px) ASBR (rounded)
10-14 300* 165,000 1.8=300/165,000*1,000
15-19 11,000 179,000
20-24 20,000 192,000
25-29 22,000 222,000
30-34 20,000 213,000
35-39 10,000 212,000
40-44 2,000 210,000
45-49 500* 200,000
45

Finish the remaining groups …
10-14 300* 165,000 1.8
15-19 11,000 179,000 61.5
20-24 20,000 192,000 104.2
25-29 22,000 222,000 99.1
30-34 20,000 213,000 93.9
35-39 10,000 212,000 47.2
40-44 2,000 210,000 9.5
45-49 500* 200,000 2.5
46

10-14 300* 165,000 1.8
15-19 11,000 179,000 ---
20-24 20,000 192,000 ---
25-29 22,000 222,000 ---
30-34 20,000 213,000 ---
35-39 10,000 212,000 ---
40-44 2,000 210,000 ---
45-49 500* 200,000 ---
Total or Σ of ASBRs _____ live births per 1,000 47

10-14 300* 165,000 1.8
15-19 11,000 179,000 61.5
20-24 20,000 192,000 104.2
25-29 22,000 222,000 99.1
30-34 20,000 213,000 93.9
35-39 10,000 212,000 47.2
40-44 2,000 210,000 9.5
45-49 500* 200,000 2.5
Total or Σ of ASBRs 419.7 live births per 1,000 48

4. Multiply the total ASBR by 5

Total or Σ of ASBRs _____ live births per 1,000
TFR = (ΣASBR) x 5
49

4. Multiply the total ASBR by 5
Total or Σ of ASBRs 419.7 live births per 1,000
TFR = (ΣASBR) x 5
419.7 X 5 = 2,098.5 live births per 1,000 female area
residents in 2000 who live through their reproductive yrs
An alternative interpretation:
2,098.5 / 1,000 = 2.1 children per woman during
reproductive years 50

Natality Statistics
What types of natality statistics are

produced/used in your country?
51

Review: Natality Statistics
 Crude birth rate
 Sex ratio at birth
 % low (very low) birth weight
 % preterm live births
 Age-specific birth rates
 General fertility rate
 Total fertility rate
52

Natality Statistics:
Tabulations & Figures
 Data based on information recorded on birth

certificate/registration
 Where necessary, use census/projections for

denominators
 Uses: identify population group with highest #

or % of births
53

Live Births by Age of Mother &
Live Birth Order
Live All ages < 15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54
birth years years years years years years years years years
order
(child)
1st 194,990 1,245 40,367 49,976 44,294 32,894 16,928 8,289 997 25
2nd 164,574 53 10,944 39,678 42,028 39,288 21,934 9,427 1,183 39
3rd 108,726 5 2,023 17,823 35,098 27,185 17,932 7,926 715 19
4th 55,737 - 589 6,023 12,377 22,047 9,022 5,078 585 16
5th 45,061 - 128 2,133 6,992 19,832 8,043 7,012 898 23
6th 10,339 - 15 849 3,514 3,349 1,970 590 48 4
7th 5,000 - 3 195 1,364 1,802 1,210 393 29 4
8th+ 4,783 - 2 76 788 1,645 1,573 640 50 9
Not 6,858 33 1,010 2,153 1,763 1,133 588 166 11 1
stated
54
Analysis of Vital Statistics Data SOURCES: NVSS Births, p 31.

Live Births and Fertility Rates
Year Number of Live Births Rate per 1,000
among women aged 15- women
44 years aged 15-44 years
1996 3,928,442 61.4
1997 3,810,292 60.9
1998 3,319,013 57.6
1999 3,421,573 56.4
2000 3,701,352 58.9
2001 3,910,102 60.2
2002 3,892,047 61.5
2003 4,277,382 63.8
2004 4,729,100 64.2
2005 4,779,291 64.5 55
Analysis of Vital Statistics Data SOURCES: NVSS, p 4.

Number of Live Births
Year Number of Live Births
among women aged
15-44 years
1996 3,928,442
1997 3,810,292
1998 3,319,013
1999 3,421,573
2000 3,701,352
2001 3,910,102
2002 3,892,047
2003 4,277,382
56
2004 4,729,100
Analysis of Vital Statistics Data 2005 4,779,291
6
Number of Live Births
5 Year Number of Live Births

among women aged 15-
4 44 years
Number
Millions of births
1996 3,928,442
3 1997 3,810,292
1998 3,319,013
2
1999 3,421,573
2000 3,701,352
1
2001 3,910,102
0 2002 3,892,047
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
2003 4,277,382
Year 57
2004 4,729,100
Analysis of Vital Statistics Data 2005 4,779,291
Fertility Rates
Year Rate per 1,000
women
aged 15-44 years
1996 61.4
1997 60.9
1998 57.6
1999 56.4
2000 58.9
2001 60.2
2002 61.5
2003 63.8
SOURCES: NVSS, p 4. 58
2004 64.2
Analysis of Vital Statistics Data 2005 64.5
Fertility Rates
6 66
Rate
Rate per 1,000 women aged 15-44 years

5 64
62
4
Millions of births
60
3
58
2
56
1 54
0 52 59
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
6 66
Rate

5 64
62
4
Number
Millions of births
60
3
58
2
56
1 54
0 52 60
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
6 66
Rate

5 64
62
4
Number
Millions of births
60
3
58
2
56
1 54
0 52 61
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
6 66
Rate

5 64
62
4
Number
Millions of births
60
3
58
2
56
1 54
0 52 62
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
% Low Birthweight
by Age of Mother
Age of Mother Number Low % low Birthweight
Birthweight
All Ages 351,974 8.3
Under 15 years 856 13.4
15-19 years 43,369 10.0
20-24 years 89,982 8.3
25-29 years 88,386 7.5
30-34 years 72,524 7.6
35-39 years 43,855 8.8
40-44 years 11,589 11.0
45-54 years 1,413 20.3 63
Analysis of Vital Statistics Data Sources: NVSS Births, table 35, p 78.
Number of Low Weight
Births by Age of Mother
400,000 25
350,000
Number Low Birthweight
20
300,000
% Low Birthweight
250,000 15
200,000
150,000 10
100,000
5
50,000
0 0
All Under 15-19 20-24 25-29 30-34 35-39 40-44 45-54 64
Ages 15
Analysis of Vital Statistics Data Years SOURCES: NVSS Births, table 35, p 78.
% Low Birthweight
by Age of Mother
400,000 25
350,000
Number Low Birthweight
20
300,000
% Low Birthweight
250,000 15
200,000
150,000 10
100,000
5
50,000
0 0
All Under 15-19 20-24 25-29 30-34 35-39 40-44 45-54 65
Ages 15
Analysis of Vital Statistics Data Years SOURCES: NVSS Births, table 35, p 78.
Total Fertility Rates &
Birth Rates by Age of Mother
Birth Rates (live births per 1,000 females)
Total
Fertility 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Year Rate Years years years years years years years years
2006 2,100.5 0.6 41.9 105.9 116.7 97.7 47.3 9.4 0.6
2005 2,053.5 0.7 40.5 102.2 115.5 95.8 46.3 9.1 0.6
2004 2,045.5 0.7 41.1 101.7 115.5 95.3 45.4 8.9 0.5
2003 2,042.5 0.6 41.6 102.6 115.6 95.1 43.8 8.7 0.5
2002 2,013.0 0.7 43.0 103.6 113.6 91.5 41.4 8.3 0.5
2001 2,034.0 0.8 45.3 106.2 113.4 91.9 40.6 8.1 0.5
2000 2,056.0 0.9 47.7 109.7 113.5 91.2 39.7 8.0 0.5
1999 2,007.5 0.9 48.8 107.9 111.2 87.1 37.8 7.4 0.4
1998 1,999.0 1.0 50.3 108.4 110.2 85.2 36.9 7.4 0.4
1999 1,971.0 1.1 51.3 107.3 108.3 83.0 35.7 7.1 0.4 66
Analysis of Vital Statistics Data SOURCES: NVSS Births, p 33.

Exercise: Graph the %
of Preterm Live Births
Year Country North Central South
• Bar graph
2002 12.8 11.7 18.5 12.2
• Over time, by year
2003 12.7 11.7 18.4 12.1
• Total & by region
2004 12.5 11.5 17.9 12.0
2005 13.2 11.3 17.8 11.9
2006 12.1 11.0 17.7 11.6

67
Analysis of Vital Statistics Data SOURCES: NVSS Births

% Preterm Live Births by Region
2002-2006
20
18
16
% Preterm Live Births
14
12
Country
10
North
8 Central
6 South
4
2
0 68
2002 2003 2004 2005 2006
Year
Exercise: Graph the # of Live Births
by Attendant and Place of Delivery
Attendant Place of Delivery
Clinic/
Year Physician Midwife Other Hospital Residence
• Bar & Line graph
2002 25,487 32,864 3,477 34,862 26,786 • Over time, by

year
2003 27,855 30,893 2,796 35,489 26,001
• By attendant
2004 26,783 30,455 3,711 33,786 27,163 (bar) & place of
delivery (line)
2005 29,325 29,861 2,421 37,104 24,503
2006 31,499 28,471 2,468 37,949 24,489

69
Analysis of Vital Statistics Data SOURCES: NVSS Births

Number of Live Births by Attendant &
Place of Delivery
40,000
35,000
30,000
# of Live Births
25,000
Physician
20,000 Midwife
Other
15,000
Clinic/Hospital
10,000 Residence
5,000
0
2002 2003 2004 2005 2006
70
Year

Mean Age of Mother
at First Birth By State
71

Mortality Statistics
 Crude rates
 Age specific, cause specific, race specific

rates
 Age adjusting
 Tabulations
 Graphs/charts/
figures
72

Crude Death Rate
 # resident deaths for a specific area during a specified
period
 divided by the total population (mid-year estimate) for the
same area/period
# of resident deaths X 100,000

Total Population
ON YOUR OWN: What is the crude death rate in the area in 2006?
15,231 = total deaths in area during 2006
2,010,787 = estimated 2006 mid-year population for area residents 73

Crude Death Rate
15,231 = total deaths in area during 2006

2,010,787 = estimated 2006 mid-year population
for area residents
15,231 X 100,000 = 757.5

2,010,787
757.5 resident deaths per 100,000 area

population in 2006
74

Age Specific Death Rate
 # resident deaths for a specific age or age group in a specific area
during a specified period
 divided by the population (mid-year estimate) of the same age or
age group in the same area/period
# of resident deaths in specified age/group X 100,000

Total population in same specified age/group
ON YOUR OWN: What is the area death rate for children ages 1-14 in 2006?
37 = deaths among area children ages 1 -14 during 2006
381,910 = estimated 2006 mid-year population for area population
aged 1-14 75

Age Specific Death Rate
37 = deaths among area children ages 1-14

during 2006
381,910 = estimated 2006 mid-year population
for area population aged 1-14
37 X 100,000 = 9.7
381,910
9.7 deaths per 100,000 area population aged

381,910 1-14 in 2006 76

Cause Specific Death Rate
 # resident deaths from a specified cause in a specific area during a
specified period
 divided by the total population at risk (mid-year estimate) in the same
area/period
# of resident deaths from specific cause X 100,000

Total population at risk
ON YOUR OWN: What is the 2006 area death rate for homicide deaths?
137 = homicide deaths among area residents in 2006
2,010,787 = estimated 2006 mid-year population for area 77

Cause Specific Death Rate
137 = homicide deaths among area residents in

2006
2,010,787 = estimated 2006 mid-year population
for area
137 X 100,000 = 6.8

2,010,787
6.8 deaths from homicide per 100,000 area

population in 2006 78

Infant Mortality Rate
 # resident newborns dying under 1 year of age for a specific
area during a specified period
 divided by the number of resident live births for the same
area/period
# of resident infant deaths X 1,000

ON YOUR OWN: What is the area infant mortality rate in 2008?

1,300 = infant deaths in area during 2008

Infant Mortality Rate
1,300 = infant deaths in area during 2008

1,300 X 1,000 = 8.7

150,000
8.7 infant deaths per 1,000 live births among

area residents in 2008 80

Maternal Mortality Rate
 # resident maternal deaths within 42 days of pregnancy
termination due to complications of pregnancy, childbirth, and the
puerperium in a specific area during a specified period
 divided by total resident live births for the same area/period
__# of resident maternal deaths X 100,000

ON YOUR OWN: What is the 2008 area maternal mortality rate?

84 = maternal deaths in area during 2008

Maternal Mortality Rate
84 = maternal deaths in area during 2008

84 X 100,000 = 64.6
130,000
64.6 maternal deaths per 100,000 live births

among area residents in 2008 82

Pregnancy-Related Mortality Rate
 # resident deaths of individuals within 42 days of pregnancy
termination due to any cause in a specific area during a specified
period
 divided by total resident live births for the same area/period
# of resident pregnancy-related deaths X 100,000

ON YOUR OWN: What is the 2008 area pregnancy-related mortality rate?

91 = pregnancy-related deaths among area during 2008

Pregnancy-Related Mortality Rate
91 = pregnancy-related deaths among area

during 2008
91 X 100,000 = 70.0
130,000
70.0 pregnancy-related deaths per 100,000 live

births among area residents in 2008 84

Life Expectancy at Birth
 Derived through life table calculations

 Standardized summary measure
 Used as an overall gauge of health, based on
population’s age-specific mortality experience
 Index of the level of mortality within a
population
 Represent hypothetical # years a newborn
would live under prevailing mortality levels
85

LIFE TABLE FOR STATE RESIDENTS, 1999-2001
SOURCES: NAPHSIS Of 100,000 Born Alive Stationary Population
Age at Probability # Living # Dying # of Person- # of Person- Average
Start of of Dying at Start of During Years Lived Years Lived in Years of
Interval During Interval Interval In the Interval & All Remaining
(years) Interval Interval Years After Lifetime
x nqx lx ndx nLx Tx ex
0 0.00842 100,000 842 99,229 7,682,595 76.8
1 0.00132 99,158 131 396,306 7,583,366 76.5
5 0.00072 99,027 71 494,956 7,187,060 72.6
10 0.00093 98,956 92 494,632 6,692,103 67.6
15 0.00347 98,864 343 493,535 6,197,472 62.7
20 0.00499 98,521 491 491,374 5,703,937 57.9
25 0.00443 98,030 434 489,090 5,212,563 53.2
30 0.00555 97,595 542 486,695 4,723,473 48.4
35 0.00760 97,054 737 483,565 4,236,779 43.7
40 0.01161 96,316 1,118 479,004 3,753,214 39.0
45 0.01766 95,199 1,681 472,041 3,274,211 34.4
50 0.02458 93,517 2,299 462,316 2,802,169 30.0
55 0.03950 91,219 3,603 447,796 2,339,853 25.7
60 0.06192 87,615 5,425 425,422 1,892,057 21.6
65 0.09363 82,190 7,965 392,871 1,466,635 17.8
70 0.14175 74,495 10,560 347,266 1,073,764 86
14.4
75 0.20809 63,935 13,304 287,616 726,498 11.4
80 0.31556 50,631 15,977 216,239 438,882 8.7
85 1.00000 34,654 34,654 222,643 222,643 6.4
LIFE TABLE FOR STATE RESIDENTS, 1999-2001
SOURCES: NAPHSIS Of 100,000 Born Alive Stationary Population
Age at Probability # Living # Dying # of Person- # of Person- Average
Start of of Dying at Start of During Years Lived Years Lived in Years of
Interval During Interval Interval In the Interval & All Remaining
(years) Interval Interval Years After Lifetime
x nqx lx ndx nLx Tx ex
0 0.00842 100,000 842 99,229 7,682,595 76.8
1 0.00132 99,158 131 396,306 7,583,366 76.5
5 0.00072 99,027 71 494,956 7,187,060 72.6
10 0.00093 98,956 92 494,632 6,692,103 67.6
15 0.00347 98,864 343 493,535 6,197,472 62.7
20 0.00499 98,521 491 491,374 5,703,937 57.9
25 0.00443 98,030 434 489,090 5,212,563 53.2
30 0.00555 97,595 542 486,695 4,723,473 48.4
35 0.00760 97,054 737 483,565 4,236,779 43.7
40 0.01161 96,316 1,118 479,004 3,753,214 39.0
45 0.01766 95,199 1,681 472,041 3,274,211 34.4
50 0.02458 93,517 2,299 462,316 2,802,169 30.0
55 0.03950 91,219 3,603 447,796 2,339,853 25.7
60 0.06192 87,615 5,425 425,422 1,892,057 21.6
65 0.09363 82,190 7,965 392,871 1,466,635 17.8
70 0.14175 74,495 10,560 347,266 1,073,764 87
14.4
75 0.20809 63,935 13,304 287,616 726,498 11.4
80 0.31556 50,631 15,977 216,239 438,882 8.7
85 1.00000 34,654 34,654 222,643 222,643 6.4
Years of Potential Life Lost (YPLL)
 Difference between a predetermined end point age (usually
75 years) and the age at death for a death or deaths that
occurred prior to that end point age
YPLL = (predetermined end point age – age of

decedent who died prior to end point age)
ON YOUR OWN: What is the YPLL for a given area resident in 2008?
75 = predetermined end point age
54 = age at death for an area resident in 2008 (who died prior to end
point age)
88

Years of Potential Life Lost (YPLL)
75 = predetermined end point age

54 = age at death for an area resident in 2008
(who died prior to end point age)
75 – 54 = 21
21 years of potential life lost to that resident who

died at age 54 in 2008
89

Using Years of Potential Life Lost:
YPLL by Cause of Death, USA and Russia, 2000
0 1000 2000 3000 4000 5000
Infectious diseases
Malignant neoplasms
Diseases of heart
Cerebrovascular disease
COPD USA
Chronic liver disease and… Russia
Pneumonia and influenza
Motor vehicle accidents
Other external causes
Suicide
Homicide
(per 100,000 population) 90

Review: Mortality Statistics
 Crude death rate
 Age specific death rate
 Cause specific death rate
 Infant mortality rate
 Maternal mortality rate
 Pregnancy-related mortality rate
 Life expectancy at birth
 Years of potential life lost
91

Mortality Statistics: Age Adjusting
 Controls for effects of differences in population

age distributions
 Used to compare relative mortality risks

among:
– groups (i.e. geographic areas)
– over time
 View as relative indices rather than actual

measures of mortality risk 92
Analysis of Vital Statistics Data SOURCES: NAPHSIS; NVSS Deaths.

2011 Deaths per 1,000 Population
15
14
13
12
11
# of Deaths / 1,000
10
9
8
7
6
5
4
3
2
1
0
93
Analysis of Vital Statistics Data Population Reference Bureau, 2011

2011 Deaths per 1,000 Population
15
14
13
12
11
# of Deaths / 1,000
10
9
8
7
6
5
4
3
2
1
0
94
Analysis of Vital Statistics Data Population Reference Bureau, 2011

Mortality Statistics:
Age Adjusted Death Rate
 A death rate that

controls for the
effects of differences
in population age
distributions
 Necessary for
comparing across
geographic areas
Goovaerts, 2005 95

Age-adjusted Death Rate:
Direct Age-Adjustment
 Same as calculating weighted average
 Applying age-specific death rates in observed pop. to
standard pop. age distribution (weights)
 Calculation:
1. Need standard population weights
Weight = # of persons in a given age group
total # of persons in standard population (all ages combined)
2. Calculate age-specific rate for each age group
3. Multiply age-specific rate for each age group by weight
4. Sum the products
96
Analysis of Vital Statistics Data SOURCES: NAPHSIS; NVSS Deaths; WHOSIS.

Exercise - Calculate:
Age-adjusted death rates

from diabetes mellitus
for State A and State B
using data from 2003-2005
97

1. Standard Population Weight
Age Weight World Average
Group (Proportion, %)
WHO World Standard 0 0.018 1.8
Population Distribution 1-4 0.07 7.0
5-14 0.173 17.3
World Average: 2000-2025 15-24 0.167 16.7
25-34 0.155 15.5
35-44 0.138 13.8
45-54 0.114 11.4
55-64 0.083 8.3
65-74 0.052 5.2
75-84 0.024 2.4
85+ 0.006 0.6
All Ages 1.00 100.098
Analysis of Vital Statistics Data SOURCES: NAPHSIS; NVSS Deaths; WHOSIS.

2. Calculate age-specific rate
for each age group
99

Rate for Diabetes Mellitus, 2003-2005
STATE A STATE B
Age # of Population Age- # of Population Age-
Group Deaths Counts Specific Deaths Counts Specific
(years) Rate Rate
Under 1 0 84,952 0 350
1-4 0 325,508 0 1,266
5-14 2 828,663 0 4,384
15-24 2 893,809 0 4,526
25-34 19 718,484 0 2,977
35-44 61 810,632 1 4,269
45-54 160 833,948 0 5,581
55-64 297 602,768 1 5,985
65-74 443 381,451 11 5,946
75-84 546 235,030 6 4,086
100
85 + 369 82,660 3 1,584
AllAnalysis
Ages of Vital
1,899 Statistics
5,797,906 Data 22 40,952
Death Rate for Diabetes Mellitus, 2003-2005
STATE A STATE B
Age Group # of Population Age- # of Population Age-
(years) Deaths Counts Specific Deaths Counts Specific
Rate Rate
Under 1 0 / 84,952 = 0 0 350
1-4 0 325,508 0 1,266
5-14 2 828,663 0 4,384
15-24 2 893,809 0 4,526
25-34 19 718,484 0 2,977
35-44 61 810,632 1 4,269
45-54 160 833,948 0 5,581
55-64 297 602,768 1 5,985
65-74 443 381,451 11 5,946
75-84 546 235,030 6 4,086 101
85 + 369 82,660 3 1,584
AllAnalysis
Ages of Vital
1,899
Statistics
5,797,906
Data 22 40,952
STATE A STATE B
Age # of Population Age- # of Population Age-
Group Deaths Counts Specific Deaths Counts Specific
(years) Rate Rate
Under 1 0 / 84,952 = 0 0 / 350 = 0
1-4 0 / 325,508 = 0 0 / 1,266 = 0
5-14 2 / 828,663 = 0.24 0 / 4,384 = 0
15-24 2 / 893,809 = 0.22 0 / 4,526 = 0
25-34 19 / 718,484 = 2.64 0 / 2,977 = 0
35-44 61 / 810,632 = 7.52 1 / 4,269 = 23.43
45-54 160 / 833,948 = 19.19 0 / 5,581 = 0
55-64 297 / 602,768 = 49.27 1 / 5,985 = 16.71
65-74 443 / 381,451 = 116.14 11 / 5,946 = 185.01
75-84 546 / 235,030 = 232.31 6 / 4,086 = 146.85
85 + 369 / 82,660 = 446.41 3 / 1,584 = 189.45
102
All Ages 1,899 / 5,797,906 = 32.75 22 / 40,952 = 53.72
3. Multiply age-specific rate
for each age group by weight
103

STATE A STATE B
Age Group Age- WHO Age Age- WHO Age
(years) Specific Standard Adjusted Specific Standard Adjusted
Rate Pop Rate Rate Pop Rate
Weight Weight
Under 1 0 X 0.018 = 0 0 0.018
1-4 0 0.07 0 0.07
5-14 0.24 0.173 0 0.173
15-24 0.22 0.167 0 0.167
25-34 2.64 0.155 0 0.155
35-44 7.52 0.138 23.43 0.138
45-54 19.19 0.114 0 0.114
55-64 49.27 0.083 16.71 0.083
65-74 116.14 0.052 185.01 0.052
75-84 232.31 0.024 146.85 0.024 104
85 + 446.41 0.006 189.45 0.006

STATE A STATE B
Age Group Age- WHO Age Age- WHO Age
(years) Specific Standard Adjusted Specific Standard Adjusted
Rate Pop Rate Rate Pop Rate
Weight Weight
Under 1 0 X 0.018 = 0 0 X 0.018 = 0

1-4 0 X 0.07 = 0 0 X 0.07 = 0
5-14 0.24 X 0.173 = 0.042 0 X 0.173 = 0
15-24 0.22 X 0.167 = 0.037 0 X 0.167 = 0
25-34 2.64 X 0.155 = 0.409 0 X 0.155 = 0
35-44 7.52 X 0.138 = 1.038 23.43 X 0.138 = 3.233
45-54 19.19 X 0.114 = 2.188 0 X 0.114 = 0
55-64 49.27 X 0.083 = 4.089 16.71 X 0.083 = 1.387
65-74 116.14 X 0.052 = 6.039 185.01 X 0.052 = 9.621
105
75-84 232.31 X 0.024 = 5.575 146.85 X 0.024 = 3.524
85Analysis
+ of VitalXStatistics
446.41 0.006 Data
= 2.678 189.45 X 0.006 = 1.137
4. Sum the products
106

STATE A STATE B
Age Age- WHO Age Age- WHO Age
Group Specific Standard Adjusted Specific Standard Adjusted
(years) Rate Pop Rate Rate Pop Rate
Weight Weight
Under 1 0 X 0.018 = 0 0 X 0.018 = 0
1-4 0 X 0.07 = 0 0 X 0.07 = 0
5-14 0.24 X 0.173 = 0.042 0 X 0.173 = 0
15-24 0.22 X 0.167 = 0.037 0 X 0.167 = 0
25-34 2.64 X 0.155 = 0.409 0 X 0.155 = 0
35-44 7.52 X 0.138 = 1.038 23.43 X 0.138 = 3.233
45-54 19.19 X 0.114 = 2.188 0 X 0.114 = 0
55-64 49.27 X 0.083 = 4.089 16.71 X 0.083 = 1.387
65-74 116.14 X 0.052 = 6.039 185.01 X 0.052 = 9.621
75-84 232.31 X 0.024 = 5.575 146.85 X 0.024 = 3.524
85 + 446.41 X 0.006 = 2.678 189.45 X 0.006 = 1.137
107
All Ages 22.095 18.902
STATE A STATE B
Age Age- WHO Age Age- WHO Age
Group Specific Standard Adjusted Specific Standard Adjusted
(years) Rate Pop Rate Rate Pop Rate
Weight Weight
Under 1 0 X 0.018 = 0 0 X 0.018 = 0
1-4 0 X 0.07 = 0 0 X 0.07 = 0
5-14 0.24 X 0.173 = 0.042 0 X 0.173 = 0
15-24 0.22 X 0.167 = 0.037 0 X 0.167 = 0
25-34 2.64 X 0.155 = 0.409 0 X 0.155 = 0
35-44 7.52 X 0.138 = 1.038 23.43 X 0.138 = 3.233
45-54 19.19 X 0.114 = 2.188 0 X 0.114 = 0
55-64 49.27 X 0.083 = 4.089 16.71 X 0.083 = 1.387
65-74 116.14 X 0.052 = 6.039 185.01 X 0.052 = 9.621
75-84 232.31 X 0.024 = 5.575 146.85 X 0.024 = 3.524
85 + 446.41 X 0.006 = 2.678 189.45 X 0.006 = 1.137
108
All Ages 22.095 18.902
Analysis
Crude Rates of Vital Statistics Data
32.75 53.72
Review: Direct Age-Adjustment
1. Need standard population weights
2. Calculate age-specific rate for each age group
3. Multiply age-specific rate for each age group by

weight
4. Sum the products
109

Standardized Mortality Ratio
(Indirect Age-adjusted Death Rate)
 To compare the death rates of a study population with
those of a standard population
 Averages specific rates in a standard population,

weighted by the age distribution of the study population
– Need:
• Age-specific death rates for a standard population
• Age distribution of study population
 Useful when age-specific # of deaths in the study

population are unavailable or small (< 25)
110

Calculating a
Standardized Mortality Ratio
1. Calculate # of expected deaths in population:
Σ (Standard age-specific death rate) X (Study age-specific pop weight)
2. Calculate the standardized mortality ratio

# observed deaths in population X 100
# expected deaths (step 1)
111

Exercise - Calculate:
Standardized Mortality Ratio (SMR)

for District A
using 2004 National death rates
as the standard for comparison
59,153 deaths were observed in District A in 2004

112

1. Calculate # of expected
deaths in population
Σ (Standard age-specific death rate) X (Study age-specific pop weight)
113

Example of Calculating Expected Deaths in a Population
Age Group National District A Expected
(Standard) Population Deaths
Population (#) (rounded)
Death Rate
per 100,000
0 5.3 154,585
1-4 25.6 607,984
5-14 14.1 1,585,503
15-24 69.2 1,440,136
25-34 83.6 1,528,427
35-44 156.5 1,616,982
45-54 373.2 1,337,298
55-64 770.5 872,216
65-74 1,822.1 527,629
75-84 4,626.5 365,602
85+ 11,873.4 138,471
All Ages 114

Death Rate
per 100,000
0 5.3 X 154,585 / 100,000 = 8
1-4 25.6 607,984
5-14 14.1 1,585,503
15-24 69.2 1,440,136
25-34 83.6 1,528,427
35-44 156.5 1,616,982
45-54 373.2 1,337,298
55-64 770.5 872,216
65-74 1,822.1 527,629
75-84 4,626.5 365,602
85+ 11,873.4 138,471
All Ages 115

Death Rate
per 100,000
0 5.3 X 154,585 / 100,000 = 8
1-4 25.6 X 607,984 / 100,000 = 156
5-14 14.1 X 1,585,503 / 100,000 = 224
15-24 69.2 X 1,440,136 / 100,000 = 997
25-34 83.6 X 1,528,427 / 100,000 = 1,278
35-44 156.5 X 1,616,982 / 100,000 = 2,531
45-54 373.2 X 1,337,298 / 100,000 = 4,991
55-64 770.5 X 872,216 / 100,000 = 6,720
65-74 1,822.1 X 527,629 / 100,000 = 9,614
75-84 4,626.5 X 365,602 / 100,000 = 16,915
85+ 11,873.4 X 138,471 / 100,000 = 16,441
All Ages 116

Death Rate
per 100,000
0 5.3 X 154,585 / 100,000 = 8
1-4 25.6 X 607,984 / 100,000 = 156
5-14 14.1 X 1,585,503 / 100,000 = 224
15-24 69.2 X 1,440,136 / 100,000 = 997
25-34 83.6 X 1,528,427 / 100,000 = 1,278
35-44 156.5 X 1,616,982 / 100,000 = 2,531
45-54 373.2 X 1,337,298 / 100,000 = 4,991
55-64 770.5 X 872,216 / 100,000 = 6,720
65-74 1,822.1 X 527,629 / 100,000 = 9,614
75-84 4,626.5 X 365,602 / 100,000 = 16,915
85+ 11,873.4 X 138,471 / 100,000 = 16,441
All Ages 59,875 117


------ observed deaths (given) X 100 = ____

------ expected deaths (step 1)
SMR = _____ deaths per 100,000

118


59,153 observed deaths (given) X 100 = 98.8

59,875 expected deaths (step 1)
SMR = 98.8 deaths per 100,000

119

How to interpret an SMR
Comparing deaths in study population (District A) to what

would be expected if the study population had the same
probability of dying as the standard population (National)
 SMR > 100.0

# of observed deaths is greater than what would be expected
 SMR < 100.0

# of observed deaths is less than what would be expected
120

Review: Age Adjusting
 Why we adjust
 Direct age adjustment

– Uses standard population age distributions
 Indirect age adjustment

– Uses standard population age-specific
death rate
121

Mortality Statistics
What types of mortality statistics are

produced/used in your country?
122

Cause of Death Tabulations
 Cause of death lists are basis for:
– Leading causes of death
– National cause of death tabulations
 WHO death tables by country as a resource:

http://www.who.int/healthinfo/statistics/mortality/en/index.html
 Each country should develop national cause

of death tabulation list to meet specific needs
123
SOURCES: WHO Health Statistics and Health Information

Analysis of Vital Statistics Data Systems, Mortality Data:
http://www.who.int/healthinfo/statistics/mortality/en/index.html
Cause-Specific Mortality Tabulations
ICD Recommendations
 Coding – various levels of detail available (diagnosis,
location of event, contributing conditions, etc.)
 Age classifications (vary by indicator)
< 1 yr < 1 yr ,< 1 y<< 1 yr
1 yr 1-4 yrs 1-14 yrs
2 yrs 5-14 yrs 15-44 yrs
3 yrs 15-24 yrs 45-64 yrs
4 yrs 25-34 yrs > 65 yrs
5-yr groups from 5-84 yrs 35-44 yrs
> 85 yrs 45-54 yrs
55-64 yrs
65-74 yrs
> 75 yrs 124
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5; NCHS,
Unit 17.
Recommended
Age Classifications
125
Analysis of Vital Statistics Data SOURCES: NVSS Deaths, p 77.

Cause-Specific
Mortality Tabulations
ICD Recommendations (continued):
 Area classifications
– Major civil division (state, province, region, country, etc.)
– Town or conurbation of ≥ 1 million, otherwise largest town
with population ≥ 100,000
– National aggregate of urban areas (≥ 100,000 population)
– National aggregate of urban areas (< 100,000 population)
– National aggregate of rural areas
* Include definitions of urban and rural

* Where medical certification of COD is limited to certain
areas, separate figures for deaths not medically certified 126
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5.

Cause-Specific
ICD Tabulation Lists:
 Lists of causes of mortality
 Adopted by World Health Assembly in 1990
 4 lists:
–General mortality, condensed list (103 causes)
–General mortality, selected list (80 causes)
–Infant & child mortality, condensed list (67 causes)
–Infant & child mortality, selected list (51 causes)
127
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 1, p 1205-20,

Volume 2, Chapter 5.
Cause-Specific
ICD Tabulation Lists (continued):
• Which list to use?
– Condensed: Condense full range of ICD (3
character) categories
– Selected: Items significant for monitoring
population health status at sub-national, national,
and international levels
– Customize for local use (if no international
comparison)
128
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 1, p 1205-20, Volume
2, Chapter 5.
Mortality Statistics:
Uses:
Tabulations & Figures
 To identify population group with highest
number/percentage of deaths
 To rank causes of death, by main groups &

underlying cause
Time Inc., 2012 129

Crude and Age-adjusted Death Rates
130

% Distribution of Deaths by Sex and Year of Death
131
Analysis of Vital Statistics Data SOURCES: Statistics SA, p 14.

% Distribution of Deaths by Age and Sex, 2008
132

Age-adjusted Death Rates by Sub-population
133

10 Leading Natural Causes of Death
134

Age-adjusted Death Rates for Leading Causes of Death
135
Analysis of Vital Statistics Data SOURCES: NVSS Death, p 22.

% Distribution of Natural & Non-natural
Causes of Death by Year of Death
136

Exercise: Natural versus
External Causes of Death
137
Analysis of Vital Statistics Data SOURCES: MRC, p 9.

Exercise: Natural versus
External Causes of Death
138

Exercise: Natural versus External Causes of Death
139

SOURCES: MRC, p 9.
Distribution of Deaths
by Place of Death
140

Infant, Neonatal, &
Postneonatal Mortality Rates
141

Life Expectancy Differential
by Sex and Race
142

HIV Deaths by Age
143

TB Deaths by Age
144

HIV & TB Deaths by Age
 In more recent
years, TB death
patterns look more
like HIV/AIDS death
patterns
 “TB deaths” are

more likely deaths
due to HIV/AIDS,
complicated by
TB
145

SOURCES: MRC, p 11.
Natural Deaths Due to Ill-defined Causes
146

Analysis Points to Remember
 Always specify rate/ratio denominator (e.g.
live births)
 Analysis of population subgroups must

consider size of subgroup
– Use broader groups
• Disease classification
• Age categories
– Aggregate data over a longer period of time
147
Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5.

Analysis Points to Remember
 Small area analysis
– Produce and use statistics in areas with

good coverage
– Data more accurate than survey data
– Data used to show usefulness to

government
148

Discuss
What would be reasonable goals for collection

and compilation of vital statistics?
149

Matching/Linking Vital Records
 Example: Matching a birth record with a
corresponding death record
 Purpose
– Statistical / Reporting
• Richer data set
• Outside users
– Administrative
• Improve quality of information
• Prevent fraud 150
Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter III.E.10-11; Freedman, p 5-6.
Discuss
What are some non-statistical &

statistical uses of record linkage?
151

Evaluating the
Quality of Information
 Coverage
– Representativeness
– Delays in reporting
 Accuracy & completeness
 Sufficient detail to reveal relationships
 Timeliness
– Availability of information
– Date of event versus date event was registered
 Geographic reference
– Place of event versus place of usual residence 152
Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter II.H.3.

Discuss
What leads to late registration?
What can be done to eliminate late registration?
153

References
 (Freedman) Freedman, MA. Improving Civil Registration and Vital Statistics. The World Bank. 2003.
 (Kenya) Republic of Kenya. Annual Health Sector Statistics Report, 2008. Division of Health Management
Information Systems. July 2009.
 (MRC) Medical Research Council. Cause of death statistics for South Africa: Challenges and possibilities
for improvement. Burden of Disease Research Unit. Nov 2010.
 (NAPHSIS) National Association for Public Health Statistics and Information Systems. Statistical
Measures and Definitions.
 (NCHS) National Center for Health Statistics. Methods of Civil Registration: Modular Course of Instruction.
 (NVSS Births) National Vital Statistics Reports. Births: Final Data for 2006. 57(7). 7 Jan 2009.
 (NVSS Deaths) National Vital Statistics Reports. Deaths Final Data for 2008. 59(10) 7 Dec 2011.
 (PRVSS2) UN. Principles and Recommendations for a Vital Statistics System, Revision 2. New York. 2001.
 (Statistics SA) Statistics South Africa. Mortality and causes of death in South Africa, 2008: Findings from
death notification. Statistical release P0309.3. Nov 2010.
 (UN Handbook) UN. Handbook on Training in Civil Registration and Vital Statistics Systems. Studies in
Methods, Series F, No. 84. UN: New York. 2002.
 (WHO ICD-10) WHO. ICD-10, Tenth Revision, Volumes 1 and 2. 1993.
 (WHOSIS) WHO Statistical Information Systems. Indicator definitions and metadata, 2008. Age-
standardized mortality rates by cause. 154

Activity
 In small groups, based on the data sheet handout, compute
and interpret the following summary statistics and rates for
(if using South Africa example, use data for 2009):
 Crude birth rate  Neonatal mortality rate
 Sex ratio at birth  Post-neonatal mort. rate
 Percent of premature  Age-specific death rate
births  Age-adjusted death rate
 Crude death rate (using either direct or
 Infant mortality rate indirect method ― see
worksheet)
 Discuss how the various defects in basic data would affect
the computed statistics.
155

Activity
 In small groups, draft statistical “dummy”
tables that you would publish in an annual
CRVS report for your country.
– Consider the number/type of categories or
groups to be used in the tables
– Consider the types of measures you would
present
 Share with the class.
156

Activity
Select
subgroups &
Label headings
label categories
TOTAL
TOTAL
Make sure all
column and row
totals are summed
correctly 157

Overall Review
1.Vital statistics (can / cannot) be used for planning

human development.
2.Vital statistics are (one of many / the only) nationally
representative source(s) of mortality by cause of
death.
3.Useable statistics have (complex / simple)
definitions.
4.Useable statistics are (able / not able) to be adapted.
5.Absolute counts (are / are not) comparable over
time/geography. 158

Overall Review
6. (Absolute / Relative) numbers must have denominator

information.
7. In a ratio, the numerator (does / does not) have to be part of

denominator.
8. Final tabulations should be calculated by date of

(occurrence / registration) of the event.
9. Final tabulations should be calculated by place of (usual

residence / occurrence of event).
10.Small area analysis data are (less / more) accurate than

survey data. 159

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U.S.

Centers for Disease Control and Prevention

Analysis of Vital Statistics Data

 Uses, general principles, & standardization of

 Types of vital statistics measures

 Visualizing data (general)

Analysis of Vital Statistics Data

 Population growth dynamics Population Pyramid,

 Monitoring & evaluating interventions 3

 Provision of services for vulnerable

 Regional & urban/rural comparisons

 Allocation of resources (i.e. health care,

Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter I.B.

 Risks of premature death

CDC, NVSS, 2007

 Cause-specific risk of dying trends 5

Analysis of Vital Statistics Data SOURCES: PRVSS2, Chapter I.B.

 Ideal source for international comparison

Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5;

Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5;

 Necessary for international

Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 1, p 1233-1238;

Analysis of Vital Statistics Data PAHO, 2009

How are causes of death classified in your

How often are the ICD codes revised? What

If ICD10 is in use, what edition of that revision is

Analysis of Vital Statistics Data

Analysis of Vital Statistics Data SOURCES: NAPHSIS; NCHS, Unit 17.

Analysis of Vital Statistics Data Source: NAPHSIS; NCHS, Unit 17.

 Numerator does NOT have to be part of denominator

 Example: Sex Ratio at Birth

= number of male live births per 100 (or 1,000) female

Analysis of Vital Statistics Data SOURCES: NAPHSIS; NCHS, Unit 17.

 Example: infant mortality rate

 Two types of rates

Analysis of Vital Statistics Data SOURCES: NAPHSIS; NCHS, Unit 17.

Analysis of Vital Statistics Data SOURCES: NAPHSIS; NCHS, Unit 17.

How will percentages help you to summarize

Analysis of Vital Statistics Data

 Absolute versus relative

Analysis of Vital Statistics Data

 Column and row totals should add up correctly 21

Analysis of Vital Statistics Data

 By date of occurrence of event

Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5; UN

 May focus on areas of known coverage

Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5; UN

 By place of usual residence

Analysis of Vital Statistics Data SOURCES: WHO ICD-10, Volume 2, Chapter 5; UN

• Customize for local

• Use to expand data

• Use to explain/justify needs to stakeholders

Analysis of Vital Statistics Data

 Charts, graphs, & figures

Analysis of Vital Statistics Data

 Age specific rates

Analysis of Vital Statistics Data SOURCES: NAPHSIS

Total resident live births X 1,000

Analysis of Vital Statistics Data SOURCES: NAPHSIS