A New Model Law for A New Model Law for Vital StatisticsVital Statistics

National Center for Health Statistics

Division of Vital Statistics

Model law revisionModel law revision

Model State Vital Statistics Act and Regulations:

• Provides detailed guidance to States that are considering revision of their own State vital statistics laws and regulations.

• Promotes uniformity among states in definitions, registration practices, disclosure and issuance procedures, and in the many other functions that comprise a state system of vital statistics.

• Initially established in 1907, has been revised in 1941, 1959, 1977, 1992

http://www.cdc.gov/nchs/nvss/model_law_revision.htm

Why update?Why update?

• Security

• Electronic environment

• Assisted reproduction

• Confidentiality and disclosure

• Establishing new records of live birth

• Same-sex marriage

• COOP (Continuity of Operations Planning)

Model law revision work groupModel law revision work group

Chairperson• Alvin T. Onaka, Ph.D., Hawaii Department of Health

Members

• Catherine Molchan Donald, Alabama Department of Public Health

• Karen R. Hampton, J.D., Oregon Department of Human Services

• Ronald Hyman, Colorado Department of Public Health and Environment

• Wilfredo Lopez, J.D., General Counsel Emeritus, New York City Department of Health and Mental Hygiene

• Patricia W. Potrzebowski, Ph.D., Formerly, Pennsylvania Department of Health; Executive Director, NAPHSIS

• Steven Schwartz, Ph.D., New York City Department of Health and Mental Hygiene

• Linette T. Scott, M.D., M.P.H., California Department of Public Health

Model law revision work groupModel law revision work group

Centers for Disease Control and Prevention National Center for Health Statistics, Division of Vital Statistics, Registration Methods Staff

• Judy M. Barnes

• Julia L. Kowaleski

• George C. Tolson

• Dewey LaRochelle

Centers for Disease Control and Prevention

• Deborah Tress, J.D.Office of General Counsel

Functional focus areasFunctional focus areas

• Registration

• Issuance

• Preservation

• Dissemination

• Security

• Authorities

• Fees

• Penalties

Cathy Molchan Donald

Karen Hampton

Ron Hyman

Trish Potrzebowski

Linette Scott

Alvin Onaka

Steve Schwartz

Wilfredo Lopez

The Model Act and Regulations were divided by functional focus areas with a Work Group member assigned as lead for

each area

ObjectivesObjectives

• Implementation of revised Model Law and Regulations in jurisdictions

• Improved uniformity of process

• Use as a resource to support justifications for actions in the jurisdictions regarding the vital records system

Legislative researchLegislative research

• Assisted reproductive technology

• Adoption laws

• Electronic records and signatures

• Aspect of breach of confidentiality

• Same-sex parentage

Accomplishments Accomplishments Surveys of NAPHSIS Membership developed by the Workgroup

• Model Law Survey – 32 states responded

• Issuance Survey – 35 states responded

Other Surveys of NAPHSIS Membership used by the Workgroup:

• Fees Charged

• Fee Retention

• Levying Fines

• Verification Charges

Accomplishments Accomplishments

Solicitation of Comments on NCHS web site

• Received feedback from NAPHSIS Members• National Archives and Records Administration• CSTE Subcommittee on Tribal Epidemiology• US Department of Justice, Witness Security Division• Vermont Notary Public• West VA Funeral Directors Association• American College of Nurse Midwives• National Funeral Directors Association• Lambda Legal• ACLU LGBT Rights Project• National Center for Lesbian Rights• Gay and Lesbian Advocates and Defenders• Others

Accomplishments Accomplishments

2009/2010 NAPHSIS/VSCP Joint Meetings

• Presentations

• Roundtables

• Town Hall

Workgroup Meetings began in 2009

• April, July, September, November 2009

• January, April , July, September, November 2010

• March, May 2011

Accomplishments Accomplishments

October/November 2010 Workgroup Webinars

•Total of 8

•December 23, 2010 – Draft Model Law sent to NAPHSIS Membership

Accomplishments Accomplishments

January Webinars with NAPHSIS–Purpose

•Provided background on development process for Draft Model Law & Regulations

•Provided overview of changes

•Answered clarifying questions

Comments on draft were due from NAPHSIS Members February 11, 2011

Statistical Uses of Vital Records Statistical Uses of Vital Records DataData

• Identifying and measuring public health problems

•Planning and evaluating programs at local, State, national, and international levels

•Providing baseline data for city, county, state, and U.S. comparisons

Statistical uses of the data Statistical uses of the data

Uses of natality dataUses of natality data

Population composition and growth

•Estimate size of population and project increases and decreases

•Influence on economic and social institutions (schools, labor market, commercial uses)

•Life expectancy

•Teenage birth rates

•Births to unmarried mothers

Uses of natality data Uses of natality data

•Adverse birth outcomes

•Low birth weight babies

•Racial differentials

•Multiple births

Uses of natality data Uses of natality data

Natality data used to:Natality data used to:

•Determine need for birthing centers and hospitals

•Target prenatal care to certain populations

•Develop educational programs

•Add warning labels to certain products

• Infant mortality

•Teenage suicide

•Deaths due to violence

•Motor vehicle mortality

•Maternal mortality

Uses of mortality dataUses of mortality data

Mortality data used for:Mortality data used for:

•Allocation of health facilities

•Epidemiological research

•Discovery of emerging problems

Latest available NCHS dataLatest available NCHS data

•Final Birth–2008

•Preliminary Birth–2009

•Final Death–2008

•Preliminary Death-2009

0

520

1040

1560

2080

2600

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 20000

20

40

60

80

Ag

e in

ye

ars

NOTE: Prior to 1933, data are for death-registration States only.

Death

s p

er

100,0

00 s

tan

dard

popula

tion

2008

Life expectancy and age-Life expectancy and age-adjusted death rates: U.S., adjusted death rates: U.S.,

1900-20081900-2008

Life expectancy

Age-adjusted death rates

0

20

40

60

80

100

120

140

160

180

200

0

1

2

3

4

5

1930 1940 1950 1960 1970 1980 1990 2000 Rat

e p

er 1

,000

wom

en a

ged

15-

44

year

s

Mill

ion

s of

birt

hs

YearNOTES: Beginning with 1959, trend lines are based on registered live births; trend lines for 1930-59 are based on live births adjusted for underregistration.SOURCE: CDC/NCHS, National Vital Statistics System.

2008

Live births and fertility rates: Live births and fertility rates: United States, 1930-2008United States, 1930-2008

Number

Rate

Fertility rates by race and Fertility rates by race and Hispanic origin: United States, Hispanic origin: United States,

1920–20061920–2006

1920

1930

1940

1950

1960

1970

1980

1990

2000

50

Hispanic

Black

White, total

Non-Hispanic White

Asian/PI

NOTE: Data for black women for years prior to 1960 are for women of all races other than white. In 1960, 92% of "all other" births were to black women. Data for 2006 are preliminary.

100

150

200

Bir

ths

per

1,0

00

wom

en

ag

ed

15

-44

in

sp

eci

fied

gro

up

(p

lott

ed

on

a log

sc

ale

)

2006

AmericanIndian

0

10

20

30

40

50

60

1940 1950 1960 1970 1980 1990 2000 2009

Per

cent

unm

arrie

d

0

250

500

750

1000

1250

1500

1750

Number of births

Birth rate

Percent

Number of births, birth rate, and percent of births to unmarried women

Births per 1,000 unmarried women 15-44

Births in 1000’s

SOURCE: National Vital Statistics System, National Center for Health Statistics, CDC.

Percent of births to unmarried Percent of births to unmarried women, women,

US, selected years, 1980–2008US, selected years, 1980–2008

0

5

10

15

20

25

30

35

40

45

SOURCE: Division of Vital Statistics, National Center for Health Statistics,Centers for Disease Control and Prevention

1980 1990 1995 2000 2005 2008

18.4

32.2 33.236.9

40.6

28.0

Perc

ent

Birth rate for unmarried women, Birth rate for unmarried women, selected years, 1980–2008selected years, 1980–2008

0

10

20

30

40

50

60

SOURCE: Division of Vital Statistics, National Center for Health Statistics,Centers for Disease Control and Prevention

1980 1990 1995 2000 2005 2008

29.4

44.3 44.147.5

52.5

43.8

Rates per 1,000 unmarried women aged 15–44

Triplet/+ birth ratesTriplet/+ birth rates

0

20

40

60

80

100

120

140

160

180

200

198019821984198619881990199219941996199820002002200420062008

Per

100

,000

birt

hs

NOTE: Triplet/+ births are births in triplet and higher order multiple deliveries.SOURCE: CDC/NCHS, National Vital Statistics System.

Cesarean delivery by race and Cesarean delivery by race and Hispanic origin of motherHispanic origin of mother

15

20

25

30

35

1993 1995 1997 1999 2001 2003 2005 2007Year

SOURCE: CDC/NCHS, National Vital Statistics System.

Per

cent

Hispanic

Non-Hispanic black

Non-Hispanic white

0

2008

22 2119

2018

2423

21 2220

3533 33

32

29

10

20

30

40 1996 2000 2009

Per

100

birt

hs

NOTE: Data for 2009 are preliminary.SOURCE: CDC/NCHS, National Vital Statistics System.

Race and Hispanic origin

Non-Hispanic black

Hispanic American Indian or

Alaska Native

Asian or Pacific

Islander

Non-Hispanic white

Cesarean delivery rates by race Cesarean delivery rates by race and and

Hispanic origin of motherHispanic origin of mother

0

Twin birth rates by age of mother:Twin birth rates by age of mother: United States, 1990, 2000, and 2008 United States, 1990, 2000, and 2008

Per

1,0

00

NOTE: The twin birth rate is per 1,000 live births. The birth rate for women 45-49 for 1990 is not shown because of the small number of births.

Years of age

0

40

80

120

160

200

15–19

20–24

25–29

30–34

35–39

40–44

45–49

1990 2000 2008

Birth rates for teenagers 15-19 Birth rates for teenagers 15-19 yearsyears

59.961.8 60.3 59.0 58.2

56.053.5

51.3 50.3 48.8 47.745.3

43.0 41.6 41.1 40.5 41.9 42.5 41.539.1

0

20

40

60

80

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

SOURCE: National Vital Statistics System, National Center for Health Statistics, CDC

Rat

es p

er 1

,000

wom

en a

ged

15-1

9 ye

ars

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MDDE

NJ

CT RI

MA

ME

VTNH

AK

HI

DC

Teenage birth rates for 15-19 Teenage birth rates for 15-19 year olds by State, 2009year olds by State, 2009

Significantly higher than the U.S.10 highest

Not significantly different from U.S.Significantly lower than U.S.10 lowest

0

25

50

75

100

125

150

175

1960 1970 1980 1990 2000

NOTE: Data for 2009 are preliminary.SOURCE: CDC/NCHS, National Vital Statistics System.

18-19 years

15-19 years

15-17 years

2009

Birth rate for teenagers by Birth rate for teenagers by ageage

Rat

e pe

r 1,

000

wom

en in

spe

cifie

d ag

e

0

20

40

60

80

100

120

140

All races White * Black * Hispanic AIAN API

Rat

es p

er 1

,000

wom

en a

ged

15-

19 in

sp

ecifi

ed g

rou

p

1991 2005 2007 2009

* Non-HispanicSOURCE: CDC/NCHS, National Vital Statistics System.

Teen birth rates by race and Hispanic origin, Teen birth rates by race and Hispanic origin, final 1991, 2005, 2007, and 2009final 1991, 2005, 2007, and 2009

Number of births and birth rate Number of births and birth rate for teenagers 15-19 yearsfor teenagers 15-19 years

0

10

20

30

40

50

60

70

80

90

100

0

100

200

300

400

500

600

700

800

900

1000

1940 1950 1960 1970 1980 1990 2000 2009

Ra

te p

er

1,0

00

wo

me

n 1

5-1

9 y

ea

rs

Nu

mb

er

of

bir

ths

(in

th

ou

sa

nd

s)

SOURCE: CDC/NCHS, National Vital Statistics System.

Number of births

Birth rate

NOTE: Data for 2009 are preliminary.

Birth rates for teenagers 15-17 years Birth rates for teenagers 15-17 years by race and Hispanic originby race and Hispanic origin

0

20

40

60

80

100

All races White * Black * Hispanic AI/AN API

Ra

tes

pe

r 1

,00

0 w

om

en

ag

ed

15

-17

in s

pe

cifie

d g

rou

p

1991 2005 2007 2009

* Non-HispanicNOTE: Data for 2009 are preliminary.SOURCE: CDC/NCHS, National Vital Statistics System

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MDDE

NJ

CT RI

MA

ME

VTNH

AK

HI

Change in birth rate for women Change in birth rate for women aged 15-17 years by State, 2007 aged 15-17 years by State, 2007

and 2009and 2009

Decreased significantly

Ten largest significant decreases

No significant difference

Increased significantly

NOTE: Data for 2009 are preliminary.SOURCE: CDC/NCHS, National Vital Statistics System.

U.S. teen birth rate for ages 15-17 was 22.1 per 1,000 in 2007 and 20.1 in 2009

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MDDE

NJ

CTRI

MA

ME

VTNH

AK

HI

Change in birth rate for women Change in birth rate for women aged 18-19 years by State, 2007 aged 18-19 years by State, 2007

and 2009and 2009

Decreased significantly

Ten largest significant decreases

No significant difference

NOTE: Data for 2009 are preliminary.SOURCE: CDC/NCHS, National Vital Statistics System.

U.S. teen birth rate for ages 18-19 was 73.9 per 1,000 in 2007 and 66.2 in 2009

5

6

7

8

9

10

11

12

13

14

1981 1985 1990 1995 2000 2006 2009

Per

cen

t

Year

Preterm and low birthweight ratesPreterm and low birthweight rates

Preterm

Low birthweight

0

0

100

200

300

400

500

600

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2008

Rat

e per

100,0

00 s

tandar

d p

opula

tion

Note: Data prior to 1933 contain death-registration States only.

Heart disease

Influenza & Pneumonia

Age-adjusted death rates for heart Age-adjusted death rates for heart disease and influenza and disease and influenza and

pneumoniapneumonia

Leading causes for U.S.Leading causes for U.S.

1900

• Influenza & Pneumonia

• Tuberculosis

• Diarrhea

• Heart disease

• Stroke

2008

• Heart disease

• Cancer

• Stroke

• Chronic lower respiratory diseases

• Accidents (unintentional injuries)

NOTE: Prior to 1933, data are for death-registration States only.

Deaths per 100,000 standard population

1- Diseasesof heart

2- Malignant neoplasms

3- Cerebro-vascular diseases

4- Chronic lower

respiratory diseases

5- Accidents (unintentional

injuries)

Trends in leading causes of Trends in leading causes of death, United States, 2003-death, United States, 2003-

20082008

10

100

1000

10000

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

2008

10-14 years

15-19 years

1-4 years

5-9 years

Childhood death rates by age at Childhood death rates by age at deathdeath

Deaths per 100,000 population

SOURCE: CDC/NCHS: National Vital Statistics System, 1900-2008

Maternal mortality rates, 1915-Maternal mortality rates, 1915-20072007

1

10

100

1000

1915 1920 1930 1940 1950 1960 1970 1980 1990 2000

Dea

ths

per

100,0

00 liv

e bir

ths

NOTE: Prior to 1933, data are for birth-registration States only.

2007

1

10

100

1915 1920 1930 1940 1950 1960 1970 1980 1990 2000 2008

De

ath

s pe

r 1

,00

0 liv

e b

irth

s

Infant

Neonatal

Postneonatal

NOTES: Death registration area complete for 1933-2002.

Infant, neonatal, and postneonatal Infant, neonatal, and postneonatal mortality ratesmortality rates

www.cdc.gov/nchs/www.cdc.gov/nchs/nvss.htmnvss.htm

Vital Statistics Vital Statistics

•Core of our health data system

•Base for public health, social science, economic planning and program development

•Monitor key indicators of health world-wide and at the local, state and national level

•Track progress to goals

• Identify disparities

•Alert to emerging problems

Need for complete and Need for complete and accurate informationaccurate information

Every certificate is important!