240367 Usefulness of death certificates for influenza surveillance

Tuesday, November 1, 2011: 3:05 PM

Elizabeth Bancroft, MD, SM , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Sun Lee, MPH , Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, CA
Background: Surveillance for influenza fatalities has long been part of the national system to gage the severity of an influenza “season.” Traditional surveillance, relying on individual case reports (ICR) from hospitals, physicians, and coroners can be slow and resource intensive. Surveillance using data from death certificates may provide more timely data and be less resource intensive which is important in a pandemic. Death certificates in Los Angeles County must be reported via the electronic death record system (EDRS). Reports are analyzed weekly for any case with “influenza” listed as a cause of death. Methods: We compared the cases of influenza fatalities reported by EDRS versus the fatalities reported by ICR during August 30, 2009-April 30, 2010. We compared the demographic variables and calculated the sensitivity and the positive predictive value of EDRS reported fatalities. Results: there were 102 fatalities reported by ICR versus 85 by EDRS. The % female (53, 54), % Hispanic (51, 56) and median age (47,49), respectively, were similar. However, only 48% of the EDRS records reported any secondary condition or risk factor for acquiring influenza versus 90% by ICR. Only 60 of the 85 EDRS reports were determined to be due to laboratory confirmed influenza. The sensitivity of EDRS was 41% versus traditional reporting and the positive predictive was 71%. EDRS identified 18 additional cases that had not been reported by ICR. Conclusions: EDRS provided a timely, automated method of tracking influenza deaths. However, it lacked sensitivity and cannot fully replace traditional surveillance methods.

Learning Areas:
Public health or related research

Learning Objectives:
Describe the pros and cons of using death certificates for influenza surveillance.

Keywords: Infectious Diseases, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been head of the flu surveillance unit at Los Angeles County for 5 years, I am a medical epidemiologist, and I participated in the collection, cleaning, and analysis of the data I am going to present.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.