Death registry systems across political borders: Assessment of the coroner system

Background: Data collection from death certificates is critical to public health surveillance. Mortality data are collected with different systems at the local, county, state, and national level, even while compatibility across borders is desirable. One study of rural Nevada suicides found local discrepancies with the state-level figures. Recent policy changes further impact data collection. In mid-2006 Nevada began an electronic death registry system. Beginning in 2008 Nevada will use the new CDC death certificate form that requests much more data in greater detail. The transition to a new form and a new electronic system provide an experiment for assessing local-level data collection and public health surveillance via the coroner system.

Objective: To examine the mortality data process and assess data accuracy and transfer from the local to national level with a special focus on three causes or manner of death often problematic for record-keeping: suicide, occupational injury, and “ill-defined causes.”

Methods: Multiple methods to assess the quality of local and state vital statistics and mortality data, including interviews with key community-level participants in the coroner system.

Results: We find many barriers to accurate coding and to implementing the electronic system. We predict missing data and continued discrepancy between political levels. We predict the numbers of deaths from ill-defined and unknown causes will be disproportionate among some populations, revealing further inequities and the specter of unregistered deaths. We predict there are barriers to assessing the quality of the occupational injury category of deaths. We predict suicides to be inconsistently reported with the electronic systems, similar to experiences with the paper systems.

Conclusion: Whether by electronic means or not, political decisions, political boundaries, and public policy processes influence the quality of surveillance over causes of death. Registry systems should be compatible from the local community level to the national and international level.