Drugs, Death, and Data

The epidemic of drug-related overdose deaths America is a serious public health issue. To help address this crisis, experts need accurate and timely information that can help them make the best decisions to protect people’s health. One means of collecting that important information is via mortality data from death certificates. When viewed collectively, data from death certificates tell a broader story about the health of our country and our communities. These data are used routinely by public health experts to uncover health disparities, inform policy and funding decisions, and improve outbreak and disaster response efforts, as well as to tackle health emergencies, like the opioid epidemic.

Because mortality data can help support public health strategies in so many ways, finding tools and methods to better collect that information and exchange it more easily is a priority. The process is complex, however, and relies on experts from multiple disciplines and at multiple level of public health.

The flow of mortality data matters to public health – and to the opioid emergency

To get the full picture of how death data moves through and informs public health at multiple levels, it’s important to understand how that data flows from the local level to the national level and back again.

Drug overdose deaths, for example, are investigated by medical examiners or coroners, who determine cause and manner of death, certify the death certificate, and send that certificate to the local, state or territorial vital records office to register the death. Information from death certificates showing all causes of death from across the country—about 2.6 million per year—are then collected though the National Vital Statistics System (NVSS) and processed by the Division of Vital Statistics in CDC’s National Center for Health Statistics (NCHS).  Experts at NCHS interpret the textual information on the death certificates to assign codes, determine the appropriate underlying cause of death, and share these codes back with the states and territories. These coded data help trigger public health actions.

Death records become a rapid-response tool

In recent years, significant progress has been made to turn state-based death registries and other collections of vital statistics data from historical repositories into more real-time data feeds that can be used to support public health surveillance and response across the board, including for drug deaths. For example, death data reporting systems, including the various Electronic Death Reporting Systems (EDRS) that allow states to share death data electronically, are being upgraded and integrated. This means it’s easier to share data automatically or in an electronic environment. There’s also been a reduction in the time it takes for finalized death data from the NVSS to be publically available. This more timely data sharing has allowed production of quarterly provisional estimates for major causes of death as well as monthly provisional counts of deaths from drug overdose. Data quality has been improved as well, thanks to collaborations with medical examiners and coroners. For example, the percentage of drug overdose deaths that identified the specific drugs involved has continued to increase over time, with ranges of 75%–79% from 1999 to 2013 increasing to 85-87% for the first quarters of 2017.

Pushing for further improvements

Even with this improved reporting, however, drug overdose deaths are more complex and present challenges to improving the overall timeliness and accuracy of NVSS mortality data. In the case of drug overdose and other traumatic deaths, determination of a cause of death may have to wait until toxicology or other lab results are finalized. This means that these types of deaths tend to have longer reporting lags. It also means more work needs be done to improve how we collect and share mortality data, especially for these types of deaths.

To this end, NCHS received funding through the Patient Centered Outcomes Research Trust Fund for a project designed to improve mortality data quality and timeliness entitled Modernizing the Infrastructure for Capturing Drug Death Data and Enhancing Research on Opioid Poisoning using Death Certificates’ Literal Text Field. This project includes an Implementer’s Workgroup that was created to develop, test, pilot, and track the progress of new and more interoperable approaches to sharing important data on mortality. As the participants make progress toward their strategic goals, their work could help improve the data needed to save more lives from drug overdoses—and, potentially, help improve the overall health surveillance that can help experts tackle other public health challenges, too.

To learn more about the project, visit the National Vital Statistics System Modernization Community of Practice page.