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Scientific Data Documentation
Linked Birth/Infant Death File, 1999

1999 Period Linked Birth/Infant Death Data Set

Data Set Names (DSNs)
     CC36.NATAL99.DENOM     ( U.S. Denominator File)
     CC36.NATAL99.DENOM.PS  ( Territories Denominator File)
     CC36.NATAL99.LINK	    ( U.S. Linked File - aka U.S. Numerator File ) 
     CC36.NATAL99.LINK.PS   ( Territories Linked File - aka Territories Numerator File )
     CC36.NATAL99.UNLINK    ( U.S. Unlinked File )
     CC36.NATAL99.UNLINK.PS ( Territories Unlinked File )

Contents

  1. Introduction, Methodology, and Classification of Data.
  2. Machine and data file characteristics.
  3. List of data elements and locations.
  4. Record layout and definition of items and codes.
  5. Technical Appendix for the 1999 Natality file.(PDF File)
  6. 1999 Mortality Technical notes.(PDF File)
Symbols Used In Tables


     Symbol         Explanation

     ---            Data not available
     ...            Category not applicable
      -             Quantity zero
     0.0            Quantity more than 0 but less than 0.05
      *             Figure does not meet standards of reliability or precision 


Acknowledgments


This tape documentation was prepared in the Division of Vital Statistics.  TJ
Mathews and Marian MacDorman of the Reproductive Statistics Branch, wrote the
tape documentation.  Sherry Murphy, Mortality Statistics Branch, coordinated
preparation of the 1999 Mortality Technical Notes.  Melissa Park and Brady
Hamilton, Reproductive Statistics Branch, coordinated preparation of the 1999
Natality Technical Appendix.  The Registration Methods Branch provided
consultation to State vital statistics offices regarding collection of birth
and death certificate data.  Ronald F Chamblee, Connie M. Gentry, Brenda A.
Green, Christina K. Jarman, Millie B. Johnson, David W. Justice, Virginia J.
Justice, Susan L. McBroom, Adrienne L. Rouse, Pam Stephenson, Mary M. Trotter,
Teresa M. Watkins, Faye L. Webster, Mary Whitley, Dora B. Wilkerson, and
Francine D. Winter of the Technical Services Branch processed computer edits,
reviewed data, and were responsible for receipt and processing of the basic
data file.  Gail Parr, Steven Steimel, Bonita Gross, and Vanetta Harrington of
the Systems Programming and Statistical Resources Branch (SPSRB) each produced
portions of the tape documentation. 

Introduction                                                                   
                                                                      
The linked birth/infant death data set (linked file) is released in two
different formats - period data and birth cohort data.  This documentation is
for the 1999 period linked file. Beginning with 1995 data, the period linked
files have formed the basis for all official NCHS linked file statistics
(except for special cohort studies).  Differences between period and birth
cohort data are outlined below. 

Period data  - The numerator for the 1999 period linked file consists of all
infant deaths occurring in 1999 linked to their corresponding birth
certificates, whether the birth occurred in 1999 or 1998.  The denominator
file for this data set is the 1999 natality file, that is, all births
occurring in 1999.

Birth cohort data  - The numerator for the 1999 birth cohort linked file
consists of deaths to infants born in 1999 whether the death occurred in 1999
or 2000. The denominator file is the 1999 natality file, that is, all births
occurring in 1999.  

While the birth cohort format has methodological advantages, it creates
substantial delays in data availability, since it is necessary to wait until
the close of the following data year to include all infant deaths to the birth
cohort. 

The 1999 period linked birth/infant death data set includes several data
files.  The first file includes all US infant deaths which occurred in the
1999 data year linked to their corresponding birth certificates, whether the
birth occurred in 1999 or in 1998 - referred to as the numerator file. The
second file contains information from the death certificate for all US infant
death records, which could not be linked to their corresponding birth
certificates - referred to as the unlinked death file.  The third file is the
1999 NCHS natality file for the US in compressed format, which is used to
provide denominators for rate computations.  These same three data files are
also available for Puerto Rico, the Virgin Islands, and Guam.

Changes Beginning with the 1995 Data Year         

In part to correct for known biases in the data, changes were made to the
linked file beginning with the 1995 data year, and these changes are also
effective for 1999 data.  A weight has been added to the linked numerator file
to correct in part for biases in percent of records linked by major
characteristics (see section on Percent of records linked below). The number
of infant deaths in the linked file are weighted to equal the sum of the
linked plus unlinked infant deaths by age at death and state.  The formula for
computing the weights is as follows: 

number of linked infant deaths + number of unlinked infant deaths
                 number of linked infant deaths.                            

A separate weight is computed for each State of residence of birth and each
age at death category (<1 day, 1-27 days, 28 days-1year). Thus, weights are
1.0 for states, which link all of their infant deaths.  The denominator file
is not weighted.  Weights have not been computed for the Puerto Rico, Virgin
Islands, and Guam file. 

An imputation for not-stated birthweight has been added to the data set, to
reduce potential bias in the computation of birthweight-specific infant
mortality rates.  Basically, if birthweight is not-stated and the period of
gestation is known, birthweight is assigned the value from the previous record
with the same period of gestation, race, sex, and plurality.  Imputed values
are flagged.  The addition of this imputation has reduced the percent of not-
stated responses for birthweight from 3.81% to 1.42% in the numerator file,
and from 0.12% to 0.06% in the denominator file, thus reducing (but not
eliminating) the potential for underestimation when computing birthweight-
specific infant mortality rates.  The change from a birth cohort to a period
format was discussed in detail on page one. 

Comparisons of infant mortality data from the linked file with infant
mortality data from the vital statistics mortality file

Although the time periods are the same, numbers of infant deaths and infant
mortality rates by characteristics are not identical between the 1999 period
linked file and the 1999 vital statistics mortality file.  The differences
can be traced to three different causes: 1) geographic differences; 2)
additional quality control; and 3) weighting. 

Geographic differences - To be included in the linked file for the 50 States
and D.C., the birth and death must both occur inside the 50 States and D.C. 
In contrast, for the vital statistics mortality file, deaths which occur in
the 50 States and D.C. to infants born inside and outside of the 50 States and
D.C. are included.  Similarly, to be included in the linked data file for
Puerto Rico, the Virgin Islands, and Guam, the birth and death must both occur
in Puerto Rico, the Virgin Islands or Guam.  In contrast, for the vital
statistics mortality file, deaths which occurred 
in Puerto Rico, the Virgin Islands, and Guam to infants born inside and
outside of Puerto Rico, the Virgin Islands and Guam are included.  

Additional quality control - The second reason for differences between the two
files is that the linkage process subjects infant death records to an
additional round of quality control review.  Every year, a few records are
voided from the file at this stage because they are found to be fetal deaths,
deaths at ages greater than 1 year, or duplicate death certificates.  

Weighting - Beginning with 1995 data, linked file records are now weighted to
compensate for the 2-3 percent of infant death records which could not be
linked to their corresponding birth certificates.  Although every effort has
been made to design weights which will accurately reflect the distribution of
deaths by characteristics, weighting may contribute to small differences in
numbers and rates by specific variables between the linked file and the vital
statistics mortality files. 

In most cases, differences between numbers of infant deaths and infant
mortality rates between the linked file and those computed from the vital
statistics mortality file are negligible.  
                                     
Methodology

The methodology used to create the national file of linked birth and infant
death records takes advantage of two existing data sources:  

1. State linked files for the identification of linked birth and infant
   death certificates; and 

2. NCHS natality and mortality computerized statistical files, the source of
   computer records for the two linked certificates.  

Virtually all States routinely link infant death certificates to their
corresponding birth certificates for legal and statistical purposes.  When the
birth and death of an infant occur in different States, copies of the records
are exchanged by the State of death and State of birth in order to effect a
link.  In addition, if a third State is identified as the State of residence
at the time of birth or death, that State is also sent a copy of the
appropriate certificate by the State where the birth or death occurred.

The NCHS natality and mortality files, produced annually, include statistical
data from birth and death certificates that are provided to NCHS by States
under the Vital Statistics Cooperative Program (VSCP).  The data have been
coded according to uniform coding specifications, have passed rigid quality
control standards, have been edited and reviewed, and are the basis for 
official U.S. birth and death statistics. 
To initiate processing, NCHS obtained matching birth certificate numbers from
States for all infant deaths that occurred in their jurisdiction.  We used
this information to extract final, edited mortality and natality data from the
NCHS natality and mortality statistical files.  Individual birth and death
records were selected from their respective files and linked into a single
statistical record, thereby establishing a national linked record file.  

After the initial linkage, NCHS returned to the States where the death
occurred computer lists of unlinked infant death certificates for follow up
linking.  If the birth occurred in a State different from the State of death,
the State of birth identified on the death certificate was contacted to obtain
the linking birth certificate.  State additions and corrections were
incorporated, and a final, national linked file was produced.  Characteristics
of the natality and mortality data from which the linked file is constructed
are described in detail in the Technical Appendices and Addenda included in
this document.

Characteristics of Unlinked File

For the 1999 linked file 633, or 2.3% of all infant death records could not be
linked to their corresponding birth certificates. Unlinked records are
included in a separate data file in this data set.  The unlinked record file
uses the same record layout as the numerator file of linked birth and infant
death records.  However, except as noted below, tape locations 1-210, reserved
for information from the matching birth certificate, are blank since no
matching birth certificate could be found for these records.  The sex field
(tape location 79) contains the sex of infant as reported on the death
certificate, rather than the sex of infant from the birth certificate, which
is not available.  The race field (tape location 36-37) contains the race of
the decedent as reported on the death certificate rather than the race of
mother as reported on the birth certificate as is the case with the linked
record file.  The race of mother on the birth certificate is generally
considered to be more accurate than the race information from the death
certificate (see section on Comparison of race data from birth and death
certificates in the Mortality Technical Appendix included in this
documentation).  Also, date of birth as reported on the death certificate is
used to generate age at death.  This information is used in place of date of
birth from the birth certificate, which is not available. 

Documentation table 6 shows counts of unlinked records by race and age at
death for each State of residence.  The user is cautioned in using table 6
that the race and residence items are based on information reported on the
death certificate; whereas, tables 15 present data from the linked file in
which the race and residence items are based on information reported on the
birth certificate.  (see section on Comparison of race data from birth and
death certificates in the Mortality Technical Appendix included in this
documentation). 

Percent of Records Linked

The 1999 linked file includes 27,281 linked infant death records and 633
unlinked infant death records.  The linked file is weighted to the sum of
linked plus unlinked records, thus the total number of weighted infant deaths
by place of occurrence is 27,914.  While the overall percent linked for infant
deaths in the 1999 file is 97.7%, there are differences in percent linked by
certain variables.  These differences have important implications for how the
data is analyzed.

Table 1 shows the percent of infant deaths linked by State of occurrence of
death.  While most States link a high percentage of infant deaths, linkage
rates for some States are well below the national average.  Note in particular
the percent linked for New Mexico (91.8%), Ohio (91.0%), and Oklahoma (91.0%). 
When a high percentage of deaths remain unlinked, unweighted infant mortality
rates computed for these States are underestimated.  It is for this reason
that weights were added to the file to correct for biases in the data due to
poor data linkage for particular states.  

The percent of infant deaths linked by race and age at death is shown in Table
2.  In general, a slightly higher percentage of postneonatal (98.3%) than
neonatal (97.5%) deaths were linked.  Variations in percent linked by
underlying cause of death have also been noted (data not shown). While the
weighting protocol has been designed to correct for possible bias due to
variations in match rates by characteristics, no statistical method can
correct perfectly for data limitations.  Therefore, variations in the percent
of records linked should be taken into consideration when comparing infant
mortality rates by detailed characteristics.  

Geographic Classification

Geographic codes in this data set are based on the results of the 1990 census. 
Because of confidentiality concerns, only those counties and cities with a
population size of 250,000 or more are separately identified in this data set. 
 Users should refer to the geographic code outline in this document for the
list of available areas and codes.
For events to be included in the linked file, both the birth and death must
occur inside the 50 States and D.C. in the case of the 50 States and D.C.
file; or in Puerto Rico, the Virgin Islands or Guam in the case of the Puerto
Rico, Virgin Islands and Guam file.  In tabulations of linked data and
denominator data events occurring in each of the respective areas to
nonresidents are included in tabulations that are by place of occurrence, and
excluded from tabulations by place of residence. These exclusions are based on
the usual place of residence of the mother.  This item is 
contained in both the denominator file and the birth section of the numerator
(linked) file.  Nonresidents are identified by a code 4 in location 11 of
these files.


Table 1. Percent of infant deaths linked by state of occurrence of death: 
United States, 1999 linked file

United States              97.8%        Nebraska               99.4%
Alabama                   100.0%        Nevada                 97.4% 
Alaska                     98.0%        New Hampshire         100.0%
Arizona                    98.4%        New Jersey             96.2%
Arkansas                   98.5%        New Mexico             91.8%
California                 97.1%        New York State         95.7%
Colorado                   99.1%        New York City          97.3%
Connecticut               100.0%        North Carolina         99.8%
Delaware                   99.1%        North Dakota           98.3%
District of Columbia       94.8%        Ohio                   91.0%
Florida                    99.2%        Oklahoma               91.0%
Georgia                    99.9%        Oregon                 99.6%
Hawaii                     96.7%        Pennsylvania           97.8%  
Idaho                      99.1%        Rhode Island           00.0%
Illinois                   97.5%        South Carolina         99.8%
Indiana                    98.6%        South Dakota          100.0% 
Iowa                      100.0%        Tennessee             100.0%
Kansas                     98.3%        Texas                  97.3%
Kentucky                   98.6%        Utah                   96.3%
Louisiana                  97.6%        Vermont               100.0%
Maine                      98.4%        Virginia               98.5%
Maryland                   99.4%        Washington             99.0%
Massachusetts              97.1%        West Virginia          98.8%
Michigan                   97.3%        Wisconsin             100.0% 
Minnesota                 100.0%        Wyoming               100.0%
Mississippi               100.0%        Puerto Rico            99.4%
Missouri                   98.7%        Virgin Islands        100.0%
Montana                    98.5%        Guam                  100.0%


Table 2. Percent of infant deaths linked by age at death: United States, 1999
linked file (Infant deaths are under 1 year; neonatal, under 28 days, and
postneonatal, 28 days-under 1 year)

Infant                    97.7%         
Neonatal                  97.5%         
Postneonatal              98.3%    


Demographic and Medical Classification

The documents listed below describe in detail the procedures employed for
demographic classification on both the birth and death records and medical
classification on death records.  These documents, while not absolutely
essential to the proper interpretation of the data for a number of general
applications, should nevertheless be studied carefully prior to any detailed
analysis of demographic or medical data variables. In particular, there are a
number of exceptions to the ICD rules in multiple cause-of-death coding which,
if not treated properly, may result in faulty analysis of the data. Volumes 1,
2 and 3 of the ICD-10 may be purchased from the World Health Organization
(WHO) Publication Center USA, 49 Sheridan Avenue, Albany, New York, 12210 (
http://www.who.int/whosis/icd10/index.html).  Many of the instruction manuals
listed below are available electronically on the NCHS website at:  
http://www.cdc.gov/nchs/about/major/dvs/im.htm.  In addition, users who do not
already have access to these documents may request them from the Chief,
Mortality Medical Classification Branch, Division of Vital Statistics,
National Center for Health Statistics, 4105 Hopson Road, Research Triangle
Park, North Carolina  27709.  The technical appendices for natality and
mortality included in this document also provide information on the source of
data, coding procedures, quality of the data, etc.

National Center for Health Statistics. Vital statistics, Instructions for
Classifying the Underlying Cause-of-Death, 1999. NCHS Instruction
Manual, Part 2a. Hyattsville, Maryland: Public Health Service.
     
National Center for Health Statistics. Vital statistics, Instructions for
Classifying Multiple Cause-of-Death, 1999. NCHS Instruction Manual, Part
2b. Hyattsville, Maryland: Public Health Service.
     
National Center for Health Statistics. Vital statistics, ICD-10 ACME Decision
Tables for Classifying Underlying Causes-of-Death, 1999. NCHS
Instruction Manual, Part 2c. Hyattsville, Maryland: Public Health
Service.
     
National Center for Health Statistics. Vital statistics, NCHS Procedures for
Mortality Medical Data System File Preparation and Maintenance,
Effective 1999. NCHS Instruction Manual, Part 2d. Hyattsville, Maryland:
Public Health Service.
    
National Center for Health Statistics. Vital statistics, ICD-10 TRANSAX
Disease Reference Tables for Classifying Multiple Causes-of-Death, 1999.
NCHS Instruction Manual, Part 2f. Hyattsville, Maryland: Public Health
Service.
     
National Center for Health Statistics.  Vital statistics, Classification and
Coding Instructions for Live Birth Records, 1999.  NCHS Instruction
Manual, Part 3a.  Hyattsville, Maryland: Public Health Service. 
National Center for Health Statistics. Vital statistics, Demographic
Classification and Coding Instructions for Death Records, 1999. NCHS
Instruction Manual, Part 4. Hyattsville, Maryland: Public Health
Service.

National Center for Health Statistics.  Vital statistics, Computer Edits for
Natality Data, Effective 1993.  NCHS Instruction Manual Part 12. 
Hyattsville, Maryland:  Public Health Service.
     
National Center for Health Statistics.  Vital statistics, Computer Edits for
Mortality Data, Effective 1999. NCHS Instruction Manual Part 11.
Hyattsville, Maryland: Public Health Service.
     
Change in Cause-of-Death Classification  
     
For data year 1999, a new classification system for coding causes of death was
implemented in the United States: the Tenth Revision of the
International Classification of Diseases (ICD-10), developed by the
World Health Organization (WHO).  Information about the new system can
be obtained at the following address:
http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm
     
Underlying Cause of Death Data
     
Mortality statistics by cause of death are compiled from entries on the
medical certification portion of the death certificate.  The U.S.
Standard Certificate of Death is shown in the Mortality Technical
Appendix which is included in this documentation.  Causes of death
include "all those diseases, morbid conditions or injuries which either
resulted in or contributed to death and the circumstances of the
accident or violence which produced these injuries".  The medical
certification of death is divided into two sections.  In Part I, the
physician is asked to provide the causal chain of morbid conditions that
led to death, beginning with the condition most proximate to death on
line (a) and working backwards to the initiating condition.  The lines
(a) through (d) in Part I are connected by the phrase "due to, or as a
consequence of."  They were designed to encourage the physician to
provide the causally related sequence of medical conditions that
resulted in death.  Thus, the condition on line (a) should be due to the
condition on line (b), and the condition on line (b) should be a
consequence of the condition on line (c), etc., until the full sequence
is described back to the originating or initiating condition.  If only
one step in the chain of morbid events is recorded, a single entry on
line (a) is adequate.  Part I of the medical certification is designed
to facilitate the selection of the underlying cause of death when two or
more causes are recorded on the certificate.  The underlying cause of
death is defined by the WHO in the ICD-10 as  "(a) the disease or injury
which initiated the chain of morbid events leading directly to death, or
(b) the circumstances of the accident or violence that produced the
fatal injury" and is generally considered the most useful cause from a
public health standpoint.  Part II of the cause-of-death section of the
death certificate solicits other conditions that the certifier believed
contributed to death, but were not in the causal chain.   While some
details of the death certificate vary by State, all States use the same
general format for medical certification outlined in the U.S. Standard
Certificate.  The U.S. Standard Certificate, in turn, closely follows
the format recommended by the WHO.
     
If the death certificate is properly completed, the disease or condition
listed on the lowest used line in Part I is usually accepted as the
underlying cause of death.  This is an application of "The General
Principle."  The General Principle is applied unless it is highly
improbable that the condition on the lowest line used could have given
rise to all of the diseases or conditions listed above it.  In some
cases, the sequence of morbid events entered on the death certificate is
not specified correctly.  A variety of errors may occur in completing
the medical certification of death.  Common problems include the
following: The causal chain may be listed in reverse order; the
distinction between Part I and Part II may have been ignored so that the
causal sequence in Part I is simply extended unbroken into Part II; or
the reported underlying cause is unlikely, in an etiological sense, to
have caused the condition listed above it.  In addition, sometimes the
certifier attributes the death to uninformative causes such as cardiac
arrest or pulmonary arrest.
    
To resolve the problems of incorrect or implausible cause-of-death statements,
the WHO designed standardized rules to select an underlying cause of
death from the information available on the death certificate that is
most informative from a public health perspective.  The rules for the
Tenth Revision as updated by WHO since the publication of ICD-10 are
described in NCHS instruction manual Part 2A.  Coding rules beyond the
General Principle are invoked if the cause-of-death section is completed
incorrectly or if their application can improve the specificity and
characterization of the cause of death in a manner consistent with the
ICD.  The rules are applied in two steps:  selection of a tentative
underlying cause of death, and modification of the tentative underlying
cause in view of the other conditions reported on the certificate in
either Part I or Part II.  Modification involves several considerations
by the medical coder: determining whether conditions in Part II could
have given rise to the underlying cause, giving preference to specific
terms over generalized terms, and creating linkages of conditions that
are consistent with the terminology of the ICD.
     
For a given death, the underlying cause is selected from the condition or
conditions recorded by the certifier in the cause-of-death section of
the death certificate.  NCHS is bound by international agreement to make
the selection of the underlying cause through the use of the ICD-10
classification structure, and the selection and modification rules
contained in this revision of the ICD.  These rules are contained in a
computer software program called ACME (Automated Classification of
Medical Entities). ACME does exactly what a coder would do to select the
underlying cause of death.  The ACME program has been used for final
mortality data since 1968.
     
The WHO selection rules take into account the certifier's ordering of
conditions and their causal relationships to systematically identify the
underlying cause of death. The intent of these rules is to improve the
usefulness of mortality statistics by giving preference to certain
classification categories over others and consolidating two or more
conditions on the certificate into a single classification category.
     
Multiple Cause of Death Data
     
The limitations of the underlying cause concept and the need for more
comprehensive data suggested the need for coding and tabulating all
conditions listed on the death certificate.  Coding all listed
conditions on the death certificate was designed with two objectives in
mind. First, to facilitate studies of the relationships among conditions
reported on the death certificate, which require presenting each
condition and its location on the death certificate in the exact manner
given by the certifier. Secondly, the coding needed to be carried out in
a manner by which the underlying cause-of-death could be assigned using
the WHO coding rules. Thus, the approach in developing multiple cause
data was to provide two fields: 1) entity axis and 2) record axis.  For
entity axis, NCHS suspends the provisions of the ICD that create
linkages between conditions for the purpose of coding each individual
condition, or entity, with minimum regard to other conditions present on
the death certificate.  
     
Record axis is designed for the generation of person-based multiple cause
statistics. Person-based analysis requires that each condition be coded
within the context of every other condition on the same death
certificate and modified or linked to such conditions as provided by
ICD-10. By definition, the entity data cannot meet this requirement
since the linkage provisions modify the character and placement of the
information originally recorded by the certifier. Essentially, the axis
of the classification has been converted from a entity basis to a record
(or person) basis. The record axis codes are assigned in terms of the
set of codes that best describe the overall medical certification
portion of the death certificate. 
     
This translation is accomplished by a computer system called TRANSAX
(Translation of Axis).  TRANSAX selectively uses the traditional linkage
and modification rules for mortality coding. Underlying cause linkages
which simply prefer one code over another for purposes of underlying
cause selection are not included. Each entity code on the record is
examined and modified or deleted as necessary to create a set of codes
that are free of contradictions and are the most precise within the
constraints of ICD-10 and medical information on the record. Repetitive
codes are deleted. The process may 1) combine two entity axis categories
together to a new category thereby eliminating a contradiction or
standardizing the data; or 2) eliminate one category in favor of another
to promote specificity of the data or resolve contradictions. The
following examples from ICD-10 illustrate the effect of this
translation:
     
Case 1: When reported on the same record as separate entities, cirrhosis
        of liver and alcoholism are coded to K74.6 (Other and unspecified
        cirrhosis of liver) and F10.2 (Mental and behavioral disorders due
        to use of alcohol; dependence syndrome), respectively. Tabulation
        of records with K74.6 would imply that such records had no mention
        of alcohol. A preferable code would be K70.3 (Alcoholic cirrhosis
        of liver) in lieu of both K74.6 and F10.2.

Case 2: If "gastric ulcer" and "bleeding gastric ulcer" are reported on a
        record they are coded to K25.9 (Gastric ulcer, unspecified as
        acute or chronic, without mention of hemorrhage or perforation)
        and K25.4 (Gastric ulcer, chronic or unspecified with hemorrhage),
        respectively. A more concise code is K25.4 which shows both the
        gastric ulcer and the bleeding.

Entity Axis Codes

The original conditions coded for selection of the underlying cause-of-death
are reformatted and edited prior to creating the public-use data file. The
following paragraphs describe the format and application of entity axis data. 

1. Format. Each entity-axis code is displayed as an overall seven byte code
   with subcomponents as follows:

     1. Line indicator: The first byte represents the line of the death
        certificate on which the code appears. Six lines (1-6)
        are allowable with the fourth and fifth denoting one
        or two written in "due to"s beyond the three lines
        provided in Part I of the U.S. standard death
        certificate. Line "6" represents Part II of the death
        certificate.

     2. Position indicator: The next byte indicates the position of
        the code on the line, i.e., it is the first (1),
        second (2), third (3) .... eighth (8) code on the
        line.

     3. Cause category: The next four bytes represent the ICD-10 cause
        code.

     4. The last byte is blank. 

A maximum of 20 of these seven byte codes are captured on a record for
multiple cause purposes. This may consist of a maximum of 8 codes on any given
line with up to 20 codes distributed across three or more lines depending on
where the subject conditions are located on the certificate. Codes may be
omitted from one or more lines, e.g., line 1 with one or more codes, line 2
with no codes, line 3 with one or more codes. 

In writing out these codes, they are ordered as follows: line 1 first code,
line 1 second code, etc. ----- line 2 first code, line 2 second code, etc. ---
-- line 3 ---- line 4 ----- line 5 ----- line 6. Any space remaining in the
field is left blank. The specifics of locations are contained in the record
layout given later in this document.

2. Edit.  The original conditions are edited to remove invalid codes, reverify
   the coding of certain rare causes of death, and assure age/cause and sex/cause
   compatibility. Detailed information relating to the edit criteria and the sets
   of cause codes which are valid to underlying cause coding and multiple cause
   coding are provided in NCHS Instruction Manual Part 11.

3. Entity Axis Applications.  The entity axis multiple cause data file is
   appropriate for analyses that require that each condition be coded as a stand
   alone entity without linkage to other conditions and/or require information on
   the placement of such conditions in the death certificate. Within this
   framework, the entity data are appropriate to examine relationships among
   conditions and the validity of traditional assumptions in underlying cause
   selection. Additionally, the entity data provide in certain categories a more
   detailed code assignment that could be excluded in creating record axis data.
   Where such detail is needed for a study, the user should use entity data.
   Finally, the researcher may not wish to be bound by the assumptions used in
   the axis translation process. 

The main limitation of entity axis data is that it does not necessarily
reflect the best code for a condition when considered within the context of
the medical certification as a whole. As a result, certain entity codes can be
misleading or even contradict other codes in the record. For example, category
K80.2 is titled "Calculus of gallbladder without cholecystitis." Within the
framework of entity codes this is interpreted to mean that the codable entity
itself contained no mention of cholecystitis rather than that cholecystitis
was not mentioned anywhere on the record. Tabulation of records with a "K80.2"
as a count of persons having Calculus of gallbladder without cholecystitis
would therefore be erroneous. This illustrates the fact that under entity
coding the ICD-10 titles cannot be taken literally. The user should study the
rules for entity coding as they relate to his/her research prior to use of
entity data. The user is further cautioned that the inclusion notes in ICD-10
that relate to modifying and combining categories are seldom applicable to
entity coding (except where provided NCHS Instruction Manual Part 2b). 

In tabulating the entity axis data, one may count codes with an individual
code representing the number of times the condition(s) appears in the file. In
this kind of tabulation of morbid conditions, the counts among categories may
be added together to produce counts for groups of codes. Alternatively,
subject to the limitations given above, one may count persons having mention
of the disease represented by a code or codes. In this instance it is not
correct to add counts for individual codes to create person counts for groups
of codes. Since more than one code in the researcher's interest may appear
together on the certificate, totaling must account for higher order
interactions among codes. Up to 20 codes may be assigned on a record;
therefore, a 20-way interaction is theoretically possible. All totaling must
be based on mention of one or more of the categories under investigation.

Record Axis Codes

The following paragraphs describe the format and application of record-axis
data. Part 2f of the Instruction Manual Series (ICD-10 TRANSAX Disease
Reference Tables for classifying Multiple Causes-of-Death, 1999) describes the
TRANSAX process for creating record axis data from entity axis data.

1. Format.  Each record (or person) axis code is displayed in five bytes.
   Location information is not relevant. The Code consists of the following
   components: 

     1. Cause category: The first four bytes represent the ICD-10 cause
        code.

     2. The last byte is blank.

Again, a maximum of 20 codes are captured on a record for multiple cause
purposes. The codes are written in a 100-byte field in ascending code number
(5 bytes) order with any unused bytes left blank. 

2. Edit.  The record axis codes are edited for rare causes and age/cause and
   sex/cause compatibility. Likewise, individual code validity is checked. The
   valid code set for record axis coding is the same as that for entity coding.

3. Record Axis Applications.  The record axis multiple cause data are the
   basis for NCHS core multiple cause tabulations. Location of codes is not
   relevant to this data, and conditions have been linked into the most
   meaningful categories for the certification. The most immediate consequence
   for the user is that the codes on the record already represent mention of a
   disease assignable to that particular ICD-10 category. This is in contrast to
   the entity code which is assigned each time such a disease is reported on
   different lines of the certification. Secondly, the linkage implies that
   within the constraints of ICD-10 the most meaningful code has been assigned.
   The translation process creates for the user a data file that is edited for
   contradictions, duplicate codes, and imprecisions. In contrast to entity axis
   data, record axis data are classified in a manner comparable to underlying
   cause of death classification thereby facilitating joint analysis of these
   variables. A potential disadvantage of record axis data is that some detail is
   sacrificed in a number of the linkages. 

The user can take the record axis codes as literally representing the
information conveyed in ICD-10 category titles. While knowledge of the rules
for combining and linking and coding conditions is useful, it is not a
prerequisite to meaningful analysis of the data as long as one is willing to
accept the assumptions of the axis translation process. The user is cautioned,
however, that due to special rules in mortality coding, not all linkage notes
in ICD-10 are used. (NCHS Instruction Manual Part 2f). 

The user should proceed with caution in using record axis data to count
conditions as opposed to people with conditions, since linkages have been
invoked and duplicate codes have been eliminated. As with entity data, person-
based tabulations that combine individual cause categories must take into
account the possible interaction of up to 20 codes on a single certificate. 

Additional Information

In using the NCHS multiple cause data files, the user is urged to review the
information in this document and its references. The instructional material
does change from year to year and ICD revision to ICD revision. The user is
cautioned that coding of specific ICD-10 categories should be checked in the
appropriate instruction manual. What may appear on the surface to be the
correct code by ICD-10 may in fact not be correct as given in the instruction
manuals. 

If on the surface it is not obvious whether entity axis or record axis data
should be employed in a given application, detailed examination of NCHS
Instruction Manual Part 2f and its attachments will probably provide the
necessary information to make a decision. It allows the user to determine the
extent of the trade-offs between the two sets of data in terms of specific
categories and the assumption of axis translation. In certain situations, a
combination of entity and record axis data may be the more appropriate
alternative. 
1999 Period Linked Birth/Infant Death Data Set

Data File Characteristics:


     The data were processed using the SAS language on an IBM 9672.
     The data are recorded in IBM/EBCDIC 8-bit code for each character.
     Codes may be numeric, alphabets, or blank.
     The record type is blocked, fixed format.
     The last block for the data year may be a short block.

 
I.   Denominator File:

     United States Data Set 
     A.  File Organization:                          One file, multiple tapes
     B.  Record count:                                              3,963,465
     C.  Record length:                                                   210  
     D.  Blocksize:                                                     32130
     E.  Data counts:                   a. By occurrence:           3,963,465 
                                        b. By residence:            3,959,417
                                        c. To foreign residents:        4,048  
         
     Territories Data Set
     A.  File Organization:             One file, one tape
     B.  Record count:                  65,493
     C.  Record length:                 210  
     D.  Blocksize:                     32130

     Puerto Rico              
     Data counts:                       a. By occurrence:              59,684
                                        b. By occurrence and
                                           residence:                  59,563
                                        c. To foreign residents:          121

     Virgin Islands
     Data counts:                       a. By occurrence:               1,772
                                        b. By occurrence and
                                           residence:                   1,671 
                                        c. To foreign residents:          101    
     Guam
     Data counts:                       a. By occurrence:               4,037
                                        b. By occurrence and
                                           residence:                   4,021                                                                                        c. To foreign residents:           16

II. Numerator File:

     United States Data Set 
     A.  File Organization:                   One of multiple files on a tape
     B.  Record count:                                                 27,281
     C.  Record length:                                                   535  
     D.  Blocksize:                                                     32635
     E.  Data counts:                   a. By occurrence:              27,281
                                        b. By residence:               27,261
                                        c. To foreign residents:           20
         
     Territories Data Set
     A.  File Organization:                   One of multiple files on a tape
     B.  Record count:                                                    678
     C.  Record length:                                                   535  
     D.  Blocksize:                                                     32635

     Puerto Rico
     Data counts:                       a. By occurrence:                 627
                                        b. By occurrence and
                                           residence:                     627      
                                        c. To foreign residents:            0
     Virgin Islands
     Data counts:                       a. By occurrence:                  16  
                                        b. By occurrence and residence:    16    
                                        c. To foreign residents:            0
     Guam
     Data counts:                       a. By occurrence:                  35
                                        b. By occurrence and residence:    35  
                                        c. To foreign residents:            0

III. Unlinked  File:

     United States Data Set 
     A.  File Organization:              one file of multiple files on a tape 
     B.  Record count:                                                    633
     C.  Record length:                                                   535  
     D.  Blocksize:                                                     32635
     E.  Data counts:                   a. By occurrence:                 633
                                        b. By residence:                  627
                                        c. To foreign residents:            6  
         
     Territories Data Set
     A.  File Organization:              one file of multiple files on a tape
     B.  Record count:                                                      4
     C.  Record length:                                                   535  
     D.  Blocksize:                                                     32635

     Puerto Rico
     Data counts:                       a. By occurrence:                    4
                                        b. By occurrence and residence:      2 
                                        c. To foreign residents:             2
     Virgin Islands
     Data counts:                       a. By occurrence:                    0
                                        b. By occurrence and residence:      0 
                                        c. To foreign residents:             0    
     Guam
     Data counts:                       a. By occurrence:                    0                                    
                                        b. By occurrence and residence:      0 
                                        c. To foreign residents:             0   

1999 Period Linked Birth/Infant Death Data Set 
List of Data Elements and Locations


                                        Denominator         Numerator      File           Unlinked
Data Items                              File                Birth          Death          File

1.   General                  
     a. Year of birth                   7-10                7-10           --             --
     b. Year of death                   --                  --             524-527        524-527
     c.  Resident status                11                  11             505            505
     d.  Record weight                  --                  --             223-230        --
     e.  Flag for records included in 210                   --             --             --     
         both numerator and denominator  

2.   Occurrence          
     a.   FIPS state                    14-15               14-15          508-509        508-509
     b.   FIPS county                   16-18               16-18          510-512        510-512

3.   Residence      
     a.   FIPS state                    19-20               19-20          513-514        513-514
     b.   FIPS county                   21-23               21-23          515-517        515-517
     c.   FIPS place                    24-28               24-28          518-522        518-522
     d.   NCHS state                    12-13               12-13          506-507        506-507 

4.   Infant
     a.   Age                           --                  --             211-214        211-214+
     b.   Race                          --                  --             --             35-38*
     c.   Sex                           78-79               78-79          --             78-79*
     d.   Gestation                     70-77               70-77          --             --
     e.   Birthweight                   80-87               80-87          --             --
     f.   Plurality                     88-89               88-89          --             --
     g.   Apgar score                   90-91               90-91          --             --
     h.   Day of week of birth/death    209                 209            532            532     
     i.   Month of birth/death          205-206             205-206        528-529        528-529

5.   Mother
     a.   Age                           29-32               29-32          --             --
     b.   Race                          35-38               35-38          --             --
     c.   Education                     39-41               39-41          --             --
     d.   Marital status                42-43               42-43          --             --
     e.   Place of birth                44-46               44-46          --             --
     f.    Hispanic origin              33-34               33-34          --             --
     

6.   Father
     a.   Age                           60-62               60-62          --             --
     b.   Race                          65-66               65-66          --             --
     c.   Hispanic origin               63-64               63-64          --             --


7.   Pregnancy items
     a.   Month prenatal care began     51-53               51-53          --             --
     b.   Number of prenatal visits     54-55               54-55          --             --
     c.   Adequacy of care recode       56                  56             --             --
     d.   Total birth order             47-48               47-48          --             --
     e.   Live birth order              49-50               49-50          --             --
          
8.   Medical and Health Data
     a.   Method of delivery            92-99               92-99          --             --     
     b.   Medical risk factors          100-117             100-117        --             --
     c.   Other risk factors          
          Tobacco                       118-121             118-121        --             --
          Alcohol                       122-125             122-125        --             --
          Weight gain during pregnancy  126-128             126-128        --             --
     d.   Obstetric procedures          129-136             129-136        --             --
     e.   Complications of labor and/or
          delivery                      137-153             137-153        --             --
     f.   Abnormal conditions of the      
          newborn                       154-163             154-163        --             --
     g.   Congenital anomalies          164-186             164-186        --             --
     h.   Underlying cause of death                         216-219        216-219
     i.   130 Infant cause recode                           220-222        220-222
     j.   Multiple conditions                               261-504        261-504    

9.   Other items       
     a.   Place of delivery             67                  67             --             --
     b.   Attendant at birth            68                  68             --             --
     c.   Hospital and patient status   --                  --             523  523   
     e.   Place of accident             --                  --             215            215
     f.   Residence reporting flags     187-203             187-203        --             --

+       For the unlinked file, date of birth as reported on the death certificate
is used to generate age at death.  See section on Changes Beginning with the 1995
Data Year for explanation.    

*       For the unlinked file, these items are from the death certificate.  See
section on Changes Beginning with the 1995 Data Year for explanation. 


Denominator Record and Natality Section of Numerator (Linked) Record
   
Locations 7-210 of the linked file contain data from the Birth Certificate.
Locations 211-535 of linked file contain data from the Death Certificate.

Residence items in the Denominator Record and in the natality section of the
Numerator (linked) Record refer to the usual place of residence of the Mother;
whereas in the mortality section of the Numerator (Linked) Record, these items
refer to the residence of the Decedent.

Item           Item           Variable Name,
Location       Length         Item and Code Outline

1-6            6              R0
                              Reserved Positions

7-10           4              BIRYR
                              Year of Birth

                              1998    ...  Born in 1998 (This code valid
                                           for numerator (linked) file
                                           file only).
                              1999    ...  Born in 1999
     
11             1              RESSTATB
                              Resident Status - Birth
                                     
                              United States Occurrence 
                              1  ...  RESIDENTS:  State and county of
                                      occurrence and residence are the same.
                              2  ...  INTRASTATE NONRESIDENTS:  State of
                                      occurrence and residence are the same, but
                                      county is different.
                              3  ...  INTERSTATE NONRESIDENTS:  State of
                                      occurrence and residence are different, but
                                      both are in the 50 States and D.C.
                              4  ...  FOREIGN RESIDENTS:  State of
                                      occurrence is one of
                                      the 50 States or the District of
                                      Columbia, but place of
                                      residence of mother is outside of
                                      the 50 States and D.C.

                              Puerto Rico Occurrence                  
                              1  ...  RESIDENTS: State and county of
                                      occurrence and residence are the same.
                              2  ...  INTRASTATE NONRESIDENTS:  State of
                                      occurrence and residence are the same, but
                                      county is different.
                              4  ...  FOREIGN RESIDENTS: Occurred in
                                      Puerto Rico to a
                                      resident of any other place.
      
                              Virgin Islands Occurrence
                              1  ...  RESIDENTS: State and county of
                                      occurrence and residence are the same.
                              2  ...  INTRASTATE NONRESIDENTS:  State of
                                      occurrence and residence are the same, but
                                      county is different.
                              4  ...  FOREIGN RESIDENTS:  Occurred in the
                                      Virgin Islands to a
                                      resident of any other place.

                              Guam Occurrence
                              1  ...  RESIDENTS: Occurred in Guam to a
                                      resident of Guam or to a resident of
                                      the U.S.
                              4  ...  FOREIGN RESIDENTS:  Occurred in Guam
                                      to a resident of any place other
                                      than Guam or the U.S.

12-13          2              BRSTATE
                              Expanded State of Residence - NCHS Codes - Birth

                              This item is designed to separately identify
                              New York City records from other New York State
                              records.                                                    
     
                              United States Occurrence    
                              01 ...  Alabama                  
                              02 ...  Alaska
                              03 ...  Arizona
                              04 ...  Arkansas
                              05 ...  California
                              06 ...  Colorado
                              07 ...  Connecticut
                              08 ...  Delaware
                              09 ...  District of Columbia
                              10 ...  Florida
                              11 ...  Georgia
                              12 ...  Hawaii
                              13 ...  Idaho
                              14 ...  Illinois
                              15 ...  Indiana
                              16 ...  Iowa
                              17 ...  Kansas
                              18 ...  Kentucky
                              19 ...  Louisiana
                              20 ...  Maine
                              21 ...  Maryland
                              22 ...  Massachusetts
                              23 ...  Michigan
                              24 ...  Minnesota
                              25 ...  Mississippi
                              26 ...  Missouri
                              27 ...  Montana
                              28 ...  Nebraska
                              29 ...  Nevada
                              30 ...  New Hampshire
                              31 ...  New Jersey
                              32 ...  New Mexico
                              33 ...  New York
                              34 ...  New York city
                              35 ...  North Carolina
                              36 ...  North Dakota
                              37 ...  Ohio
                              38 ...  Oklahoma
                              39 ...  Oregon
                              40 ...  Pennsylvania
                              41 ...  Rhode Island
                              42 ...  South Carolina
                              43 ...  South Dakota
                              44 ...  Tennessee
                              45 ...  Texas
                              46 ...  Utah
                            
12-13          2              BRSTATE
                              Expanded State of Residence - NCHS Codes - Birth
                              (Cont'd)

                              This item is designed to separately identify
                              New York City records from other New York State
                              records.                            
                              
                              United States Occurrence    
                              47 ...  Vermont
                              48 ...  Virginia
                              49 ...  Washington
                              50 ...  West Virginia
                              51 ...  Wisconsin
                              52 ...  Wyoming
                              53-58,
                              60 ...  Foreign Residents
                              53 ...  Puerto Rico
                              54 ...  Virgin Islands
                              55 ...  Guam
                              56 ...  Canada
                              57 ...  Cuba
                              58 ...  Mexico
                              60 ...  Remainder of the World

                              Puerto Rico Occurrence 
                              53 ...  Puerto Rico
                              01-52,54-58,
                              60 ...  Foreign Residents: 
                                      Refer to U.S. for specific code
                                      structure.

                              Virgin Islands Occurrence 
                              54 ...  Virgin Islands
                              01-53,55-58,
                              60 ...  Foreign Residents: 
                                      Refer to U.S. for specific code
                                      structure.     
          
                              Guam Occurrence 
                              55 ...  Guam
                              01-52...U.S. resident is also
                                      considered a resident of
                                      Guam.
                              53,54,58,
                              60 ...  Foreign Residents: 
                                      Refer to U.S. for specific code
                                      structure.     

                              FIPSOCCB
                              Federal Information Processing Standards 
                              (FIPS) Geographic Codes (Occurrence) - Birth
                              Refer to the Geographic Code Outline further
                              back  in this document for a
                              detailed list of areas and  codes.  For an
                              explanation of FIPS codes, reference
                              should be made to various National Institute of
                              Standards and Technology (NIST) publications.


14-15          2              STOCCFIPB
                              State of Occurrence (FIPS) - Birth 
                              
                              United States 
                              01      ...  Alabama
                              02      ...  Alaska
                              04      ...  Arizona
                              05      ...  Arkansas
                              06      ...  California
                              08      ...  Colorado
                              09      ...  Connecticut
                              10      ...  Delaware
                              11      ...  District of Columbia
                              12      ...  Florida
                              13      ...  Georgia
                              15      ...  Hawaii
                              16      ...  Idaho
                              17      ...  Illinois
                              18      ...  Indiana
                              19      ...  Iowa
                              20      ...  Kansas
                              21      ...  Kentucky
                              22      ...  Louisiana
                              23      ...  Maine
                              24      ...  Maryland
                              25      ...  Massachusetts
                              26      ...  Michigan
                              27      ...  Minnesota
                              28      ...  Mississippi
                              29      ...  Missouri
                              30      ...  Montana
                              31      ...  Nebraska
                              32      ...  Nevada
                              33      ...  New Hampshire
                              34      ...  New Jersey
                              35      ...  New Mexico
                              36      ...  New York
                              37      ...  North Carolina
                              38      ...  North Dakota
                              39      ...  Ohio
                              40      ...  Oklahoma
                              41      ...  Oregon
                              42      ...  Pennsylvania
                              44      ...  Rhode Island
                              45      ...  South Carolina
                              46      ...  South Dakota
                              47      ...  Tennessee
                              48      ...  Texas


14-15          2              STOCCFIPB
                              State of Occurrence (FIPS) - Birth (Cont'd) 
                              
                              United States 
                              49      ...  Utah
                              50      ...  Vermont
                              51      ...  Virginia  
                              53      ...  Washington
                              54      ...  West Virginia
                              55      ...  Wisconsin
                              56      ...  Wyoming

                              Puerto Rico         
                              72      ...  Puerto Rico

                              Virgin Islands 
                              78      ...  Virgin Islands

                              Guam
                              66      ...  Guam

16-18          3              CNTOCFIPB
                              County of Occurrence (FIPS) - Birth

                              001-nnn  ... Counties and county
                                           equivalents (independent and
                                           coextensive cities) are
                                           numbered alphabetically within
                                           each State. (Note:  To
                                           uniquely identify a county,
                                           both the State and county
                                           codes must be used.)
                              999     ...  County with less than 250,000
                                           population


19-23          5              FIPSRESB
                              Federal Information Processing Standards (FIPS)
                              Geographic Codes (Residence) - Birth
                              Refer to the Geographic Code Outline further
                              back in this document for a
                              detailed list of areas and codes.  For an
                              explanation of FIPS codes, reference
                              should be made to various National Institute
                              of Standards and Technology
                              (NIST) publications.


19-20          2              STRESFIPB
                              State of Residence (FIPS) - Birth
                              
                              United States Occurrence 
                              00      ...  Foreign residents
                              01      ...  Alabama
                              02      ...  Alaska
                              04      ...  Arizona
                              05      ...  Arkansas
                              06      ...  California
                              08      ...  Colorado
                              09      ...  Connecticut
                              10      ...  Delaware
                              11      ...  District of Columbia
                              12      ...  Florida
                              13      ...  Georgia
                              15      ...  Hawaii
                              16      ...  Idaho
                              17      ...  Illinois
                              18      ...  Indiana
                              19      ...  Iowa
                              20      ...  Kansas
                              21      ...  Kentucky
                              22      ...  Louisiana
                              23      ...  Maine
                              24      ...  Maryland
                              25      ...  Massachusetts
                              26      ...  Michigan
                              27      ...  Minnesota
                              28      ...  Mississippi
                              29      ...  Missouri
                              30      ...  Montana
                              31      ...  Nebraska
                              32      ...  Nevada
                              33      ...  New Hampshire
                              34      ...  New Jersey
                              35      ...  New Mexico
                              36      ...  New York
                              37      ...  North Carolina
                              38      ...  North Dakota
                              39      ...  Ohio
                              40      ...  Oklahoma
                              41      ...  Oregon
                              42      ...  Pennsylvania
                              44      ...  Rhode Island
                              45      ...  South Carolina
                              46      ...  South Dakota
                              47      ...  Tennessee

                             
19-20          2              STRESFIPB
                              State of Residence (FIPS) - Birth Cont'd)
                              
                              United States Occurrence
                              48      ...  Texas
                              49      ...  Utah
                              50      ...  Vermont
                              51      ...  Virginia
                              53      ...  Washington
                              54      ...  West Virginia
                              55      ...  Wisconsin
                              56      ...  Wyoming

                              Puerto Rico Occurrence 
                              00-56,66,
                              78      ...  Foreign Residents: 
                                           Refer to U.S. for
                                           specific code structure
                              72      ...  Puerto Rico

                              Virgin Islands Occurrence
                              00-56,66,
                              72      ...  Foreign Residents: 
                                           Refer to U.S. for
                                           specific code structure
                              78      ...  Virgin Islands

                              Guam Occurrence
                              00,72,78...  Foreign Residents:  Refer to
                                           U.S. for specific code
                                           structure
                              01-56   ...  U.S. Resident is also
                                           considered a resident of
                                           Guam.  Refer to U.S. for
                                           specific code structure
                              66       ... Guam

21-23          3              CNTYRFPB
                              County of Residence (FIPS) - Birth

                              000     ...  Foreign residents
                              001-nnn ...  Counties and county
                                           equivalents (independent and
                                           coextensive cities) are
                                           numbered alphabetically within
                                           each State (Note:  To uniquely
                                           identify a county, both the
                                           State and county codes must be
                                           used.)
                              999     ...  County with less than 250,000
                                           population

24-28          5              PLRES   
                              Place (City) of Residence (FIPS)
 
                              A complete list of cities is shown in the
                              Geographic Code Outline further back in this
                              document.

                              00000    ...  Foreign residents
                              00001-nnnnn...Code range
                              99999   ...   Balance of
                                            county; or city less than                                        
                                            250,000 population


29             1              MAGEFLG
                              Age of Mother Flag

                              This position is flagged whenever age is
                              imputed or the mother's reported age is used. 
                              The reported age is used, if valid, when computed
                              age derived from the date of birth is not available or
                              when it is outside the 10-54 code range.

                              Blank   ...  Not imputed and reported
                                           age is not used
                              1       ...  Reported age is used
                              2       ...  Age is imputed

30-31          2              DMAGE
                              Age of Mother

                              This item is: a) computed using dates of birth
                              of mother and of delivery; 
                              b) reported; or c) imputed. This is the age
                              item used in NCHS publications.

                              10-54        ...  Age in single years

32             1              MAGER9
                              Age of Mother Recode 9

                              1       ...  Under 15 years
                              2       ...  15 - 19 years
                              3       ...  20 - 24 years
                              4       ...  25 - 29 years
                              5       ...  30 - 34 years
                              6       ...  35 - 39 years
                              7       ...  40 - 44 years
                              8       ...  45 - 49 years
                              9       ...  50 - 54 years

33             1              ORMOTH
                              Hispanic Origin of Mother

                              Hispanic origin is reported for all areas
                              except Puerto Rico.                
                              0       ...  Non-Hispanic
                              1       ...  Mexican
                              2       ...  Puerto Rican
                              3       ...  Cuban
                              4       ...  Central or South American
                              5       ...  Other and unknown Hispanic
                              9       ...  Origin unknown or not stated


34             1              ORRACEM
                              Hispanic Origin and Race of Mother Recode

                              Hispanic origin is reported for all areas
                              except  Puerto Rico.          

                              1       ...  Mexican
                              2       ...  Puerto Rican
                              3       ...  Cuban
                              4       ...  Central or South American
                              5       ...  Other and unknown Hispanic
                              6       ...  Non-Hispanic White
                              7       ...  Non-Hispanic Black
                              8       ...  Non-Hispanic other races
                              9       ...  Origin unknown or not stated

35             1              MRACEIMP
                              Race of Mother Imputation Flag

                              Blank   ...  Race is not imputed
                              1       ...  Race is imputed
                              2       ...  All other races, formerly code
                                           09, is imputed

36-37          2              MRACE
                              Race of Mother - Birth Record or for Unlinked
                              Records Race of Decedent 
                              from Death Record
                              
                              Beginning with 1992 data, some areas started
                              reporting additional Asian or
                              Pacific Islander codes for race.  Codes 18-68
                              replace old code 08 for these
                              areas.  Code 78 replaces old code 08 for all
                              other areas.  For consistency with
                              Census race code 09 (all other races) used
                              prior to 1992 has been imputed.
  
                              United States Occurrence 
                              01          ...  White
                              02          ...  Black
                              03          ...  American Indian (includes
                                               Aleuts and Eskimos)
                              04          ...  Chinese
                              05          ...  Japanese
                              06          ...  Hawaiian (includes part-
                                               Hawaiian)
                              07          ...  Filipino
                              18          ...  Asian Indian
                              28          ...  Korean
                              38          ...  Samoan
                              48          ...  Vietnamese
                              58          ...  Guamanian
                              68          ...  Other Asian or Pacific
                                               Islander in areas reporting
                                               codes 18-58
                              78          ...  Combined other Asian or
                                               Pacific Islander, includes
                                               codes 18-68 for areas that do
                                               not report them
                                               separately


36-37          2              MRACE
                              Race of Mother - Birth Record or for Unlinked
                              Records Race of Decedent 
                              from Death Record (Cond't) 

                         
                              Puerto Rico Occurrence 
                              00           ...  Other races    
                              01      ...  White
                              02      ...  Black
                              
                              Virgin Islands Occurrence 
                              01      ...  White
                              02      ...  Black
                              03      ...  American Indian
                                           (includes Aleuts and Eskimos)
                              04      ...  Chinese
                              05      ...  Japanese
                              06      ...  Hawaiian (includes part-
                                           Hawaiian)
                              07      ...  Filipino
                              08      ...  Other Asian or Pacific
                                           Islander

                              Guam Occurrence 
                              01      ...  White
                              02      ...  Black
                              03      ...  American Indian (includes
                                           Aleuts and Eskimos)
                              04      ...  Chinese
                              05      ...  Japanese
                              06      ...  Hawaiian (includes part-
                                           Hawaiian)
                              07      ...  Filipino
                              08      ...  Other Asian or Pacific
                                           Islander
                              58      ...  Guamanian

38             1              MRACE3
                              Race of Mother Recode

                              1       ...  White
                              2       ...  Races other than White or
                                           Black
                              3       ...  Black



39-40          2              DMEDUC
                              Education of Mother Detail 

                              All areas report education of mother.

                              00      ...  No formal education
                              01-08        ...  Years of elementary
school
                              09      ...  1 year of high school
                              10      ...  2 years of high school
                              11      ...  3 years of high school
                              12      ...  4 years of high school
                              13      ...  1 year of college
                              14      ...  2 years of college
                              15      ...  3 years of college
                              16      ...  4 years of college
                              17      ...  5 or more years of college
                              99      ...  Not stated     

41             1              MEDUC6
                              Education of Mother Recode

                              1       ...  0 - 8 years
                              2       ...  9 - 11 years
                              3       ...  12 years
                              4       ...  13 - 15 years
                              5       ...  16 years and over
                              6       ...  Not stated

42             1              DMARIMP
                              Marital Status of Mother Imputation Flag

                              Blank   ...  Marital status is not
                                           imputed
                              1       ...  Marital status is imputed

43             1              DMAR
                              Marital Status of Mother

                              Marital status is not reported by all
                              areas.  See reporting flags.

                              United States/Virgin Islands/Guam Occurrence
                              1       ...  Married
                              2       ...  Unmarried
                              9       ...  Unknown or not stated

                              Puerto Rico Occurrence
                              1       ...  Married
                              2       ...  Unmarried parents living
                                           together
                              3       ...  Unmarried parents not living
                                           together
                              9       ...  Unknown or not stated          
                                                                 

44-45          2              MPLBIR
                              Place of Birth of Mother

                              01      ...  Alabama
                              02      ...  Alaska
                              03      ...  Arizona
                              04      ...  Arkansas
                              05      ...  California
                              06      ...  Colorado
                              07      ...  Connecticut
                              08      ...  Delaware
                              09      ...  District of Columbia
                              10      ...  Florida
                              11      ...  Georgia
                              12      ...  Hawaii
                              13      ...  Idaho
                              14      ...  Illinois
                              15      ...  Indiana
                              16      ...  Iowa
                              17      ...  Kansas
                              18      ...  Kentucky
                              19      ...  Louisiana
                              20      ...  Maine
                              21      ...  Maryland
                              22      ...  Massachusetts
                              23      ...  Michigan
                              24      ...  Minnesota
                              25      ...  Mississippi
                              26      ...  Missouri
                              27      ...  Montana
                              28      ...  Nebraska
                              29      ...  Nevada
                              30      ...  New Hampshire
                              31      ...  New Jersey
                              32      ...  New Mexico
                              33      ...  New York
                              34      ...  North Carolina
                              35      ...  North Dakota
                              36      ...  Ohio
                              37      ...  Oklahoma
                              38      ...  Oregon
                              39      ...  Pennsylvania
                              40      ...  Rhode Island
                              41      ...  South Carolina
                              42      ...  South Dakota
                              43      ...  Tennessee
                              44      ...  Texas
                              45      ...  Utah
                              46      ...  Vermont
                              47      ...  Virginia
                              48      ...  Washington
                              49      ...  West Virginia

44-45          2              MPLBIR
                              Place of Birth of Mother (Cont'd)

                              50      ...  Wisconsin
                              51      ...  Wyoming
                              52      ...  Puerto Rico
                              53      ...  Virgin Islands
                              54      ...  Guam
                              55      ...  Canada
                              56      ...  Cuba
                              57      ...  Mexico
                              59      ...  Remainder of the World
                              99      ...  Not Classifiable

46             1              MPLBIRR
                              Place of Birth of Mother Recode

                              United States Occurrence
                              1       ...  Born in the 50 States and D.C.
                              2       ...  Born outside the 50 States and
DC 
                              3       ...  Unknown or not stated

                              Puerto Rico/Virgin Island/ Guam Occurrence
                              Blank   ...  This item not recorded

47-48          2              DTOTORD
                              Detail Total Birth Order

                              Sum of live birth order and other terminations
                              of pregnancy.  If either item is
                              unknown, this item is made unknown.

                              01-40   ...  Total number of live
                                           births and other terminations                                    
                                           of  pregnancy
                              99      ...  Unknown 

49-50          2              DLIVORD
                              Detail Live Birth Order
 
                              Sum of live births now living and now dead
                              plus one.  If either item is unknown, this
                              item is made unknown.
                          
                                
                              00-31   ...  Number of children born
                                                alive to mother
                              99      ...  Unknown 


51-52          2              MONPRE
                              Detail Month of Pregnancy Prenatal Care Began

                              00      ...  No prenatal care
                              01      ...  1st month
                              02      ...  2nd month
                              03      ...  3rd month
                              04      ...  4th month
                              05      ...  5th month
                              06      ...  6th month
                              07      ...  7th month
                              08      ...  8th month
                              09      ...  9th month
                              99      ...  Unknown or not stated

53             1              MPRE5
                              Month Prenatal Care Began Recode 5

                              1       ...  1st Trimester (1st-3rd month)
                              2       ...  2nd Trimester (4th-6th month)
                              3       ...  3rd Trimester (7th-9th month)
                              4       ...  No prenatal care
                              5       ...  Unknown or not stated

54-55          2              NPREVIST
                              Total Number of Prenatal Visits

                              00      ...  No prenatal visits
                              01-48   ...  Stated number of visits
                              49      ...  49 or more visits
                              99      ...  Unknown or not stated

56             1              ADEQUACY
                              Adequacy of Care Recode (Kessner Index)

                              This code is based on a modified Kessner
                              criterion. Month Prenatal Care Began, Number of
                              Prenatal Visits, and Gestation are the items used to                  
                              generate this recode.

                              1       ...  Adequate
                              2       ...  Intermediate
                              3       ...  Inadequate
                              4       ...  Unknown
     
57-59          3              R1
                              Reserved Positions

                          

60             1              FAGERFLG
                              Reported Age of Father Used Flag

                              This position is flagged whenever the Father's
                              reported age in years is used. 
                              The reported age is used, if valid, when age
                              derived from date of birth is not
                              available or when it is less than 10.

                              Blank   ...  Reported age is not used
                              1       ...  Reported age is used

61-62          2              DFAGE
                              Age of Father

                              This item is either computed from date of 
                              birth of father and of child or is the reported
                              age.  This is the age item used in NCHS publications.

                              10-98   ...  Age in single years
                              99      ...  Unknown or not stated

63             1              ORFATH
                              Hispanic Origin of Father

                              Hispanic origin is reported for all areas
                              except  Puerto Rico.          

                              0       ...  Non-Hispanic
                              1       ...  Mexican
                              2       ...  Puerto Rican
                              3       ...  Cuban
                              4       ...  Central or South American
                              5       ...  Other and unknown Hispanic
                              9       ...  Origin unknown or not stated


64             1              ORRACEF
                              Hispanic Origin and Race of Father Recode

                              Hispanic origin is reported for all areas
                              except  Puerto Rico.          

                              1       ...  Mexican
                              2       ...  Puerto Rican
                              3       ...  Cuban     
                              4       ...  Central or South American
                              5       ...  Other and unknown Hispanic
                              6       ...  Non-Hispanic White
                              7       ...  Non-Hispanic Black
                              8       ...  Non-Hispanic other or unknown
                                           race
                              9       ...  Origin unknown or not stated


65-66          2              FRACE
                              Race of Father

                              Beginning with 1992 data, some areas started
                              reporting additional Asian or
                              Pacific Islander codes for race.  See
                              reporting flags.  Codes 18 -68 replace old code
                              08 for these areas.  Code 78 replaces old code 08 for
                              all other areas.  
                              Code 09 (all other races) has been changed to
                              99.

                              United States Occurrence    
                              01      ...  White
                              02      ...  Black
                              03      ...  American Indian (includes
                                           Aleuts and Eskimos)
                              04      ...  Chinese
                              05      ...  Japanese
                              06      ...  Hawaiian (includes
                                           part-Hawaiian)
                              07      ...  Filipino
                              18      ...  Asian Indian
                              28      ...  Korean
                              38      ...  Samoan
                              48      ...  Vietnamese
                              58      ...  Guamanian
                              68      ...  Other Asian or Pacific
                                           Islander in areas reporting codes 18-58
                              78      ...  Combined other Asian or
                                           Pacific Islander, includes
                                           codes 18-68 for areas that do
                                           not report them separately
                              99      ...  Unknown or not stated
                
                              Puerto Rico Occurrence
                              00      ...  Other races
                              01      ...  White
                              02      ...  Black
                              99      ...  Unknown or not stated
                
                              Virgin Islands Occurrence
                              01      ...  White
                              02      ...  Black
                              03      ...  American Indian (includes
                                           Aleuts and Eskimos)
                              04      ...  Chinese
                              05      ...  Japanese
                              06      ...  Hawaiian (includes part-
                                           Hawaiian)
                              07      ...  Filipino
                              08      ...  Other Asian or Pacific
                                           Islander
                              99      ...  Unknown or not stated
                

65-66          2              FRACE
                              Race of Father  (Cont'd)

                              Guam Occurrence
                              01      ...  White
                              02      ...  Black
                              03      ...  American Indian (includes
                                           Aleuts and Eskimos)
                              04      ...  Chinese
                              05      ...  Japanese
                              06      ...  Hawaiian (includes part-
                                           Hawaiian)
                              07      ...  Filipino
                              08      ...  Other Asian or Pacific
                                           Islander
                              58      ...  Guamanian
                              99      ...  Unknown or not stated

67             1              PLDEL
                              Place or Facility of Delivery 

                              1       ...  Hospital 
                              2       ...  Freestanding Birthing Center
                              3       ...  Clinic or Doctor's Office
                              4       ...  A Residence
                              5       ...  Other
                              9       ...  Unknown or not stated

68             1              BIRATTND
                              Attendant at Delivery

                              1       ...  Doctor of Medicine (M.D.)
                              2       ...  Doctor of Osteopathy (D.O.)
                              3       ...  Certified Nurse Midwife(C.N.M.)
                              4       ...  Other Midwife
                              5       ...  Other
                              9       ...  Unknown or not stated

69             1              R2
                              Reserved position

70             1              GESTESTM
                              Clinical Estimate of Gestation Used Flag
                              This position is flagged whenever the clinical
                              estimate of gestation is used.  It is used when
                              gestation could not be computed or when the computed                  
                              gestation is outside the 17-47 code range.

                              Blank   ...  Clinical Estimate is not used
                              1       ...  Clinical Estimate is used


71-72          2              CLINGEST
                              Clinical Estimate of Gestation

                              Clinical estimate is not reported by all
                              areas. 
                              See reporting flags.

                              17-47   ...  Estimated gestation in
                                           weeks
                              99      ...  Unknown or not stated

73             1              GESTIMP
                              Gestation Imputation Flag

                              Blank   ...  Gestation is not imputed
                              1       ...  Gestation is imputed

74-75          2              GESTAT
                              Gestation - Detail in Weeks

                              This item is: a) computed using dates of birth
                              of child and last normal menses; b)
                              imputed from LMP date; c) the clinical estimate;
                              or d) unknown when there is insufficient data
                              to impute or no valid clinical estimate.
                              This is the gestation item used in NCHS
                              publications.

                              17-47   ...  17th through 47th week
                                           of gestation
                              99      ...  Unknown

76-77          2              GESTAT 10
                              GESTATION RECODE 10

                              01      ...  Under 20 weeks
                              02      ...  20 - 27 weeks
                              03      ...  28 - 31 weeks
                              04      ...  32 - 35 weeks
                              05      ...  36 weeks
                              06      ...  37 - 39 weeks
                              07      ...  40 weeks
                              08      ...  41 weeks
                              09      ...  42 weeks and over
                              10      ...  Not stated

78             1              CSEXIMP
                              Sex Imputation Flag

                              Blank   ...  Sex is not imputed
                              1       ...  Sex is imputed

79             1              CSEX
                              Sex

                              1       ...  Male
                              2       ...  Female



80-87          8              BIRTHWEIGHT

                              Beginning in 1995, an imputation for not-
                              stated birthweight was added to
                              reduce potential bias in the data (see section
                              on changes beginning with the
                              1995 data year in the introductory text to
                              this documentation). The following
                              imputation flag can be used to delete imputed
                              values for those researchers
                              wishing to use only reported birthweight data.

80             1              BWIF
                              Birthweight Imputation Flag 
               
                              Blank   ...  Birthweight is not
imputed
                              1       ...  Birthweight is imputed

81-84          4              DBIRWT
                              Birthweight Detail in Grams (Imputed)

                              0227-8165...  Number of grams
                              9999    ...  Not stated birth weight 

85-86          2              BIRWT12
                              Birthweight Recode 12 (Imputed)
                           
                              01      ...  499 grams or less
                              02      ...  500-999 grams
                              03      ...  1000-1499 grams
                              04      ...  1500-1999 grams
                              05      ...  2000-2499 grams
                              06      ...  2500-2999 grams
                              07      ...  3000-3499 grams
                              08      ...  3500-3999 grams
                              09      ...  4000-4499 grams
                              10      ...  4500-4999 grams
                              11      ...  5000-8165 grams
                              12      ...  Unknown or not stated

87             1              BIRWT4
                              Birthweight Recode 4 (Imputed)

                              1       ...  1499 grams or less
                              2       ...  1500-2499 grams
                              3       ...  2500 grams or more
                              4       ...  Unknown or not stated

88             1              PLURIMP
                              Plurality Imputation Flag

                              Blank        ...  Plurality is not imputed
                              1       ...  Plurality is imputed



89             1              DPLURAL
                              Plurality

                              1       ...  Single
                              2       ...  Twin
                              3       ...  Triplet
                              4       ...  Quadruplet
                              5       ...  Quintuplet or higher

90-91          2              FMAPS
                              Five-Minute Apgar Score

                              Apgar score is not reported by all areas.  See
                              reporting flags.

                              00-10   ...  A score of 0-10
                              99      ...  Unknown or not stated

92-186         95             MEDINFO
                              Medical and Health Data

                              Some States do not report an entire item while
                              other States do not report all of the
                              categories within an item.  If an item is not
                              reported, it is indicated by
                              code zero in the appropriate reporting flag. 
                              If a category within an item is not reported it
                              is indicated by code 8 in the position for
                              that category.

92-99          8              DELMETH
                              Method of Delivery

                              Each method is assigned a separate position,
                              and the code structure for each 
                              method (position) is:

                              1       ...  The method was used
                              2       ...  The method was not used
                              8       ...  Method not on certificate
                              9       ...  Method unknown or not stated

92             1              VAGINAL
                              Vaginal

93             1              VBAC
                              Vaginal Birth After Previous C-Section

94             1              PRIMAC
                              Primary C-Section

95             1              REPEAC
                              Repeat C-Section

96             1              FORCEP
                              Forceps


97             1              VACUUM
                              Vacuum

98             1              R3
                              Reserved Position

99             1              DELMETH5
                              Method of Delivery Recode

                              1       ...  Vaginal (excludes Vaginal
                                           after previous C-section)
                              2       ...  Vaginal birth after previous C-
                                           section
                              3       ...  Primary C-section
                              4       ...  Repeat C-Section
                              5       ...  Not stated

100-117        18             MEDRISK
                              Medical Risk Factors

                              Each risk factor is assigned a separate
                              position, and the code structure for
                              each risk factor (position) is:

                              1       ...  Factor reported
                              2       ...  Factor not reported
                              8       ...  Factor not on certificate
                              9       ...  Factor not classifiable

100            1              MRFLAG
                              No Medical Risk Factors Reported Flag

                              Blank   ...  One or more medical risk
                                           factors coded, one, eight, or nine
                              2       ...  No medical risk factors
                                           reported.  Each factor is coded a two.

101            1              ANEMIA
                              Anemia (Hct.<30/Hgb.<10)

102            1              CARDIAC
                              Cardiac disease

103            1              LUNG
                              Acute or chronic lung disease

104            1              DIABETES
                              Diabetes

105            1              HERPES
                              Genital herpes

106            1              HYDRA
                              Hydramnios/Oligohydramnios

107            1              HEMO
                              Hemoglobinopathy

108            1              CHYPER
                              Hypertension, chronic

109            1              PHYPER
                              Hypertension, pregnancy-associated


110            1              ECLAMP
                              Eclampsia

111            1              INCERVIX
                              Incompetent cervix

112            1              PRE4000
                              Previous infant 4000+ grams

113            1              PRETERM
                              Previous preterm or small-for-gestational-age
infant

114            1              RENAL
                              Renal disease

115            1              RH
                              Rh sensitization

116            1              UTERINE
                              Uterine bleeding

117            1              OTHERMR
                              Other Medical Risk Factors 

118-128        11             OTHERRSK
                              Other Risk Factors for this Pregnancy

118-121        4              TOBACRSK
                              Tobacco Risks

118            1              TOBACCO
                              Tobacco Use During Pregnancy

                              1       ...  Yes
                              2       ...  No
                              9       ...  Unknown or not stated

119-120        2              CIGAR
                              Average Number of Cigarettes Per Day

                              00-97   ...  As stated
                              98      ...  98 or more cigarettes per day
                              99      ...  Unknown or not stated

121            1              CIGAR6
                              Average Number of Cigarettes Per Day Recode

                              0       ...  Nonsmoker
                              1       ...  1-5 cigarettes per day
                              2       ...  6-10 cigarettes per day
                              3       ...  11-20 cigarettes per day
                              4       ...  21-40 cigarettes per day
                              5       ...  41 or more cigarettes per day
                              6       ...  Unknown or not stated

122-125        4              ALCOHRSK
                              Alcohol

122            1              ALCOHOL
                              Alcohol Use During Pregnancy

                              1       ...  Yes
                              2       ...  No
                              9       ...  Unknown or not stated

123-124        2              DRINK
                              Average Number of Drinks Per Week

                              00-97   ...  As stated
                              98      ...  98 or more drinks per week
                              99      ...  Unknown or not stated

125            1              DRINK5
                              Average Number of Drinks Per Week Recode

                              0       ...  Non drinker
                              1       ...  1 drink per week
                              2       ...  2 drinks per week
                              3       ...  3-4 drinks per week
                              4       ...  5 or more drinks per week
                              5       ...  Unknown or not stated

126-128        3              WTGANRSK
                              Weight Gain During Pregnancy

126-127        2              WTGAIN
                              Weight Gain

                              00-97   ...  Stated number of pounds
                              98      ...  98 pounds or more
                              99      ...  Unknown or not stated


128            1              WTGAIN9
                              Weight Gain Recode

                              1       ...  Less than 16 pounds
                              2       ...  16-20 pounds
                              3       ...  21-25 pounds
                              4       ...  26-30 pounds
                              5       ...  31-35 pounds
                              6       ...  36-40 pounds
                              7       ...  41-45 pounds
                              8       ...  46 or more pounds
                              9       ...  Unknown or not stated

129-136        8              OBSTETRC
                              Obstetric Procedures

                              Each procedure is assigned a separate
                              position, and the code structure for each
                              procedure (position) is:

                              1       ...  Procedure reported
                              2       ...  Procedure not reported
                              8       ...  Procedure not on certificate
                              9       ...  Procedure not classifiable

129            1              OBFLAG
                              Obstetric Flag

                              Blank   ...  One or more obstetric
                                           procedures coded, one, eight,
                                           or nine
                              2       ...  No obstetric procedures
                                           reported.  Each factor is 
                                           coded a two.

130            1              AMNIO
                              Amniocentesis

131            1              MONITOR
                              Electronic fetal monitoring

132            1              INDUCT
                              Induction of labor

133            1              STIMULA
                              Stimulation of labor

134            1              TOCOL
                              Tocolysis

135            1              ULTRAS
                              Ultrasound

136            1              OTHEROB
                              Other Obstetric Procedures

137-153        17             LABOR
                              Complications of Labor and/or Delivery

                              Each complication is assigned a separate
                              position, and the code structure for
                              each complication (position) is:

                              1       ...  Complication reported
                              2       ...  Complication not reported
                              8       ...  Complication not on
                                           certificate
                              9       ...  Complication not classifiable

137            1              FBFLAG
                              Labor Flag

                              Blank   ...  One or more labor and/or
                                           delivery complications
                                           coded, one, eight, or nine
                              2       ...  No labor and/or delivery
                                           complication reported.
                                           Each factor is coded a two.

138            1              FEBRILE
                              Febrile (>100 degrees F. or 38 degrees C.) 

139            1              MECONIUM
                              Meconium, moderate/heavy

140            1              RUPTURE
                              Premature rupture of membrane (>12 hours) 

141            1              ABRUPTIO
                              Abruptio placenta

142            1              PREPLACE
                              Placenta previa

143            1              EXCEBLD
                              Other excessive bleeding

144            1              SEIZURE
                              Seizures during labor

145            1              PRECIP
                              Precipitous labor (<3 hours) 

146            1              PROLONG
                              Prolonged labor (>20 hours)

147            1              DYSFUNC
                              Dysfunctional labor

148            1              BREECH
                              Breech/Malpresentation

149            1              CEPHALO
                              Cephalopelvic disproportion

150            1              CORD
                              Cord prolapse

151            1              ANESTHE
                              Anesthetic complications

152            1              DISTRESS
                              Fetal distress
                                
153            1              OTHERLB
                              Other Complications of Labor and/or Delivery


154-163        10             NEWBORN
                              Abnormal conditions of the Newborn

                              Each condition is assigned a separate
                              position, and the code structure for each
                              condition (position)is:

                              1       ...  Condition reported
                              2       ...  Condition not reported
                              8       ...  Condition not on certificate
                              9       ...  Condition not classifiable

154            1              NBFLAG
                              Newborn Flag

                              Blank   ...  One or more abnormal
                                           conditions of the newborn
                                           coded, one, eight, or nine
                              2       ...  No abnormal condition of the
                                           newborn reported.
                                           Each factor is coded a two.
     

155            1              NANEMIA
                              Anemia Hct.>39/Hgb.<13)

156            1              INJURY
                              Birth injury

157            1              ALCOSYN
                              Fetal alcohol syndrome

158            1              HYALINE
                              Hyaline membrane disease

159            1              MECONSYN
                              Meconium aspiration syndrome

160            1              VENL30
                              Assisted ventilation, less than 30 minutes

161            1              VEN30M
                              Assisted ventilation, 30 minutes or more

162            1              NSEIZ
                              Seizures

163            1              OTHERAB
                              Other Abnormal Conditions of the Newborn

164-186        23             CONGENIT
                              Congenital Anomalies

                              Each anomaly is assigned a separate position,
                              and the code structure for
                              each anomaly (position) is:

                              1       ...  Anomaly reported
                              2       ...  Anomaly not reported
                              8       ...  Anomaly not on certificate
                              9       ...  Anomaly not classifiable

164            1              CGFLAG
                              Congenital Flag

                              Blank   ...  One or more congenital
                              anomalies coded, one,eight, or
                              nine
                              2       ...  No congenital anomaly is
                                           reported.  Each factor is
                                           coded a two.

165            1              ANEN
                              Anencephalus

166            1              SPINA
                              Spina bifida/Meningocele

167            1              HYDRO
                              Hydrocephalus

168            1              MICROCE
                              Microcephalus

169            1              NERVOUS
                              Other central nervous system anomalies

170            1              HEART
                              Heart malformations

171            1              CIRCUL
                              Other circulatory/respiratory anomalies

172            1              RECTAL
                              Rectal atresia/stenosis

173            1              TRACHEO
                              Tracheo-esophageal fistula/Esophageal atresia

174            1              OMPHALO
                              Omphalocele/Gastroschisis

175            1              GASTRO
                              Other gastrointestinal anomalies

176            1              GENITAL
                              Malformed genitalia

177            1              RENALAGE
                              Renal agenesis

178            1              UROGEN
                              Other urogenital anomalies

179            1              CLEFTLP
                              Cleft lip/palate

180            1              ADACTYLY
                              Polydactyly/Syndactyly/Adactyly

181            1              CLUBFOOT
                              Club foot

182            1              HERNIA
                              Diaphragmatic hernia

183            1              MUSCULO
                              Other musculoskeletal/integumental anomalies

184            1              DOWNS
                              Down's syndrome

185            1              CHROMO
                              Other chromosomal anomalies

186            1              OTHERCON
                              Other congenital anomalies

187-203        17             FLRES
                              Reporting Flags for Place of Residence

                              These positions contain flags to indicate
                              whether or not the specified item is
                              included on the birth certificate of the State
                              of residence or of the SMSA of
                              residence.   The code structure of each flag
                              (position) is:

                              0       ...  The item is not reported
                              1       ...  The item is reported or
                                           partially reported.

187            1              ORIGM
                              Origin of mother

188            1              ORIGF
                              Origin of father

189            1              EDUCM
                              Education of mother

190            1              R4
                              Reserved Position

191            1              GESTE
                              Clinical estimate of gestation

192            1              R5
                              Reserved position
                              
193            1              FMAPSRF
                              5-minute Apgar score

194            1              DELMETRF
                              Method of delivery

195            1              MEDRSK
                              Medical risk factors

196            1              TOBUSE
                              Tobacco use

197            1              ALCUSE
                              Alcohol use

198            1              WTGN
                              Weight gain

199            1              OBSTRC
                              Obstetric procedures

200            1              CLABOR
                              Complications of labor and/or delivery

201            1              ABNML
                              Abnormal conditions of newborn

202            1              CONGAN
                              Congenital anomalies
 
203            1              API flag
                              Race codes 18-68 reported (beginning with 1992
data)

204            1              CDOBMIMP
                              Month of Birth of Child Imputation Flag

                              Blank   ...  Month is not imputed
                              1       ...  Month is imputed

205-206        2              BIRMON
                              Month of Birth

                              01      ...  January
                              02      ...  February
                              03      ...  March
                              04      ...  April
                              05      ...  May
                              06      ...  June
                              07      ...  July
                              08      ...  August
                              09      ...  September
                              10      ...  October
                              11      ...  November
                              12      ...  December            
          
207-208        2              R6
                              Reserved Position
          
209            1              WEEKDAYB
                              Day of Week Child Born

                              1       ...  Sunday
                              2       ...  Monday
                              3       ...  Tuesday
                              4       ...  Wednesday
                              5       ...  Thursday
                              6       ...  Friday
                              7       ...  Saturday

210            1              FLGND
                              Flag Indicating Records Included in Both
                              Numerator and Denominator Files

                              This variable is included in the denominator
                              file only, and identifies a record which is also
                              included in the numerator file.  Please note that
                              not all infant deaths in the numerator file are
                              represented in the denominator file, because
                              some of the infants who died in 1999 were born
                              in 1998. 
                         
                              1       ...  Record also included in
                                           numerator file
                              Blank   ...  Record not included in
                                           numerator file


Here ends the Denominator file.  Documentation for the Mortality Section of
the Numerator (Linked) file follows.



Locations 211-535 contain data from the Death Certificate. Residence items
in the Denominator Record and in the natality section of the Numerator (Linked)
Record refer to the usual place of residence of the Mother; whereas in the
mortality section of the Numerator (Linked)Record, these items refer to the
place of residence of the Decedent.


Item           Item           Variable Name,
Location       Length         Item and Code Outline



211-213        3              AGED
                              Age at Death in Days

                              The generated age at death in days is
                              calculated from the date of death on the
                              death certificate minus the date of birth on
                              the birth certificate unless the
                              reported age of death is less than 2 days,
                              then the reported age is used.  If the
                              exact date of birth and/or death is unknown,
                              the age is imputed.

                              000-364 ...  Number of days

214            1              AGER5
                              Infant Age Recode 5

                              1       ...  Under 1 hour
                              2       ...  1-23  hours
                              3       ...  1-6   days                   
                              4       ...  7-27 days (late neonatal)
                              5       ...  28 days and over
                                           (postneonatal)


215            1              ACCIDPL
                              Place of  Injury for Causes W00-Y34, except
                              Y06.- and Y07.-

                              0       ...  Home
                              1       ...  Residential institution
                              2       ...  School, other institution and
                                           public administrative area
                              3       ...  Sports and athletics area
                              4       ...  Street and highway
                              5       ...  Trade and service area
                              6       ...  Industrial and construction
                                           area
                              7       ...  Farm
                              8       ...  Other Specified Places
                              9       ...  Unspecified place
                              Blank   ...  Causes other than W00-Y34,
                                           except Y06.- and Y07.-   
                          

216-219        4              UCOD
                              ICD Code (10th Revision)

                              See the International Classification of
                              Diseases, 1992 Revision, Volume 1. 

220-222        3              UCODR130
                              130 Infant Cause Recode

                              A recode of the ICD cause code into 130 groups
                              for NCHS publications. Further back in this
                              document is a complete list of recodes and the causes            
                              included.

                              001-158 ...  Code range (not inclusive)


223-230        8              RECWT
                              Record weight

                              Beginning in 1995, a record weight was added
                              to the  linked file to adjust for the
                              approximately 2-3% of  records each year which
                              cannot be linked to their corresponding birth
                              certificates (see introduction to this tape
                              documentation for further details).  These
                              weights are used to produce all NCHS linked file 
                              tables, including Documentation tables 1-5
                              included in this tape documentation. The
                              general format for this record weight is the
                              number one followed by a decimal point and six
                              decimal places as follows:

                              1.XXXXXX

261-504        244            MULTCOND
                              Multiple Conditions

                              See the "International Classification of
                              Diseases", 1992 Revision, Volume 1. 
                              Both the entity-axis and record-axis
                              conditions are coded according to this
                              revision (10th).

261-262        2              EANUM
                              Number of Entity-Axis Conditions

                              00-20   ...  Code range

263-402        140            ENTITY
                              ENTITY - AXIS CONDITIONS

                              Space has been provided for a maximum of 20
                              conditions.  Each condition              
                              takes 7 positions in the record.  The 7th
                              position will be blank.  Records that do not
                              have 20 conditions are blank in the unused area. 
                         

                              Position 1:  Part/line number on
                              certificate

                              1       ...  Part I,  line 1 (a)
                              2       ...  Part I,  line 2 (b)
                              3       ...  Part I,  line 3 (c)
                              4       ...  Part I,  line 4 (d)
                              5       ...  Part I,  line 5 (e)
                              6       ...  Part II,  

                              Position 2:  Sequence of condition within
                              part/line

                              1-7     ...  Code range

                              Positions 3 - 6:  Condition code (ICD 10th
                              Revision)

                          
263-269        7              1st Condition

270-276        7              2nd Condition

277-283        7              3rd Condition

284-290        7              4th Condition

291-297        7              5th Condition

298-304        7              6th Condition

305-311        7              7th Condition

312-318        7              8th Condition 

319-325        7              9th Condition

326-332        7              10th Condition

333-339        7              11th Condition

340-346        7              12th Condition

347-353        7              13th Condition

354-360        7              14th Condition

361-367        7              15th Condition

368-374        7              16th Condition

375-381        7              17th Condition

382-388        7              18th Condition

389-395        7              19th Condition

396-402        7              20th Condition

                              RANUM
403-404        2              Number of Record-Axis Conditions

                              00-20   ...  Code range

405-504        100            RECORD
                              RECORD - AXIS CONDITIONS

                              Space has been provided for a maximum of 20
                              conditions.  Each condition    takes 5 positions
                              in the record.  The 5th position will be blank. 
                              Records that do not have 20 conditions are blank
                              in the unused area.

                              Positions 1-4:    Condition code (ICD10th
                              Revision)

405-409        5              1st Condition

410-414        5              2nd Condition

415-419        5              3rd Condition

420-424        5              4th Condition

425-429        5              5th Condition

430-434        5              6th Condition

435-439        5              7th Condition

440-444        5              8th Condition

445-449        5              9th Condition

450-454        5              10th Condition

455-459        5              11th Condition

460-464        5              12th Condition

465-469        5              13th Condition

470-474        5              14th Condition

475-479        5              15th Condition

480-484        5              16th Condition

485-489        5              17th Condition

490-494        5              18th Condition

495-499        5              19th Condition

500-504        5              20th Condition

                                   
505            1              RESSTATD
                              Resident Status - Death
                              United States Occurrence 
                              1  ...  RESIDENTS:  State and county of
                                      occurrence and residence  are the
                                      same.
                              2  ...  INTRASTATE NONRESIDENTS:  State of
                                      occurrence and residence are the
                                      same, but county is different.
                              3  ...  INTERSTATE NONRESIDENTS:  State of
                                      occurrence and residence are
                                      different, but both are in the 50
                                      States and D.C.
                              4  ...  FOREIGN RESIDENTS:  State of
                                      occurrence is one of the 50 States
                                      or the District of Columbia, but
                                      place of residence is outside of the
                                      50 States and D.C.

505            1                      RESSTATD
                                      Resident Status - Death (Cont'd)

                                      Puerto Rico Occurrence
                              1  ...  RESIDENTS: State and county of
                                      occurrence and residence are the
                                      same.
                              2  ...  INTRASTATE NONRESIDENTS:  State of
                                      occurrence and residence are the
                                      same, but county is different.
                              4  ...  FOREIGN RESIDENTS: Occurred in
                                      Puerto Rico to a resident of any
                                      other place.
      

                              Virgin Islands Occurrence
                              1  ...  RESIDENTS: State and county of
                                      occurrence and residence are
                                      the same.
                              2  ...  INTRASTATE NONRESIDENTS: 
                                      State of occurrence and
                                      residence are the same, but
                                      county is different.
                              4  ...  FOREIGN RESIDENTS:  Occurred
                                      in the Virgin Islands to a
                                      resident of any other place.

                              Guam Occurrence
                              1  ...  RESIDENTS: Occurred in Guam to
                                      a resident of Guam or to a
                                      resident of the U.S.
                              4  ...  FOREIGN RESIDENTS:  Occurred
                                      in Guam to a resident of any
                                      place other than Guam or  the
                                      U.S. 
 
506-507        2              DRSTATE
                              Expanded State of Residence - NCHS Codes -
                              Deaths
                              This item is designed to separately identify
                              New York City records from other New York State
                              records.

                              United States Occurrence
                              01      ...  Alabama
                              02      ...  Alaska
                              03      ...  Arizona
                              04      ...  Arkansas
                              05      ...  California
                              06      ...  Colorado
                              07      ...  Connecticut
                              08      ...  Delaware
                              09      ...  District of Columbia
                              10      ...  Florida
                              11      ...  Georgia
                              12      ...  Hawaii
                              13      ...  Idaho
                              14      ...  Illinois
                              15      ...  Indiana
                              16      ...  Iowa
                              17      ...  Kansas
                              18      ...  Kentucky
                              19      ...  Louisiana
                              20      ...  Maine

506-507        2              DRSTATE
                              Expanded State of Residence - NCHS Codes -
                              Deaths (Cont'd)  
                         
                              United States Occurrence
                              21      ...  Maryland
                              22      ...  Massachusetts
                              23      ...  Michigan
                              24      ...  Minnesota
                              25      ...  Mississippi
                              26      ...  Missouri
                              27      ...  Montana
                              28      ...  Nebraska
                              29      ...  Nevada
                              30      ...  New Hampshire
                              31      ...  New Jersey
                              32      ...  New Mexico
                              33      ...  New York
                              34      ...  New York City
                              35      ...  North Carolina
                              36      ...  North Dakota
                              37      ...  Ohio
                              38      ...  Oklahoma
                              39      ...  Oregon
                              40      ...  Pennsylvania
                              41      ...  Rhode Island
                              42      ...  South Carolina
                              43      ...  South Dakota
                              44      ...  Tennessee
                              45      ...  Texas
                              46      ..   Utah
                              47      ...  Vermont
                              48      ...  Virginia
                              49      ...  Washington
                              50      ...  West Virginia
                              51      ...  Wisconsin
                              52      ...  Wyoming
                              53-58,
                              60      ...  Foreign Residents
                              53      ...  Puerto Rico
                              54      ...  Virgin Islands
                              55      ...  Guam
                              56      ...  Canada
                              57      ...  Cuba
                              58      ...  Mexico
                              60      ...  Remainder of the World

                              Puerto Rico Occurrence
                              53      ...  Puerto Rico
                              01-52,
                              54-58,60...  Foreign Residents: 
                                           Refer to U.S. for specific code 
                                           structure.     

506-507        2              DRSTATE
                              Expanded State of Residence - NCHS Codes -
                              Deaths (Cont'd)  

                              Virgin Islands Occurrence
                              54      ...  Virgin Islands
                              01-53,55-58,
                              60      ...  Foreign Residents: 
                                           Refer to U.S. for specific code
                                           structure.     
                              Guam Occurrence
                              55      ...  Guam
                              01-52   ...  U.S. resident is also
                                           considered a resident of
                                           Guam.
                              53,54,58,
                              60      ...  Foreign Residents: 
                                           Refer  to U.S. for specific code
                                           structure.

508-512        5              FIPSOCCD
                              Federal Information Processing Standards 
                              (FIPS) Geographic Codes (Occurrence) - Death

                              Refer to the Geographic Code Outline further
                              back in this document for a 
                              detailed list of areas and codes.  For an
                              explanation of FIPS codes, reference
                              should be made to various National Institute
                              of Standards and Technology
                              (NIST) publications.

508-509        2              STOCCFIPD
                              State of Occurrence (FIPS) - Death 

                              United States
                              01      ...  Alabama
                              02      ...  Alaska
                              04      ...  Arizona
                              05      ...  Arkansas
                              06      ...  California
                              08      ...  Colorado
                              09      ...  Connecticut
                              10      ...  Delaware
                              11      ...  District of Columbia
                              12      ...  Florida
                              13      ...  Georgia
                              15      ...  Hawaii
                              16      ...  Idaho
                              17      ...  Illinois
                              18      ...  Indiana
                              19      ...  Iowa
                              20      ...  Kansas
                              21      ...  Kentucky
                              22      ...  Louisiana
                              23      ...  Maine
                              24      ...  Maryland
                              25      ...  Massachusetts
                              26      ...  Michigan
                              27      ...  Minnesota
                              28      ...  Mississippi
                              29      ...  Missouri
                              30      ...  Montana

508-509        2              STOCCFIPD
                              State of Occurrence (FIPS) - Death (Cont'd) 

                              United States
                              31      ...  Nebraska
                              32      ...  Nevada
                              33      ...  New Hampshire
                              34      ...  New Jersey
                              35      ...  New Mexico
                              36      ...  New York
                              37      ...  North Carolina
                              38      ...  North Dakota
                              39      ...  Ohio
                              40      ...  Oklahoma
                              41      ...  Oregon
                              42      ...  Pennsylvania   
                              44      ...  Rhode Island
                              45      ...  South Carolina
                              46      ...  South Dakota
                              47      ...  Tennessee
                              48      ...  Texas
                              49      ...  Utah
                              50      ...  Vermont
                              51      ...  Virginia  
                              53      ...  Washington
                              54      ...  West Virginia
                              55      ...  Wisconsin
                              56      ...  Wyoming

                              Puerto Rico                      
       
                              72      ...  Puerto Rico

                              Virgin Islands                        
     
                              78      ...  Virgin Islands 

                              Guam
                              66      ...  Guam                     

510-512        3              CNTOCFIPD
                              County of Occurrence (FIPS) - Death

                              001-nnn ...  Counties and county
                                           equivalents (independent and
                                           coextensive cities) are
                                           numbered alphabetically within
                                           each State. (Note:  To
                                           uniquely identify a county,
                                           both the State and county
                                           codes must be used.)
                              999     ...  County with less than 250,000
                                           population

513-517        5              FIPSRESD
                              Federal Information Processing Standards (FIPS)
                              Geographic Codes (Residence) - Death

                              Refer to the Geographic Code Outline further
                              back in this document for a
                              detailed list of areas and codes.  For an
                              explanation of FIPS codes, reference
                              should be made to various National Institute
                              of Standards and Technology
                              (NIST) publications.

513-514        2              STRESFIPD
                              State of Residence (FIPS) - Death

                              United States Occurrence
                              00      ...  Foreign residents
                              01      ...  Alabama
                              02      ...  Alaska
                              04      ...  Arizona
                              05      ...  Arkansas
                              06      ...  California
                              08      ...  Colorado
                              09      ...  Connecticut
                              10      ...  Delaware
                              11      ...  District of Columbia
                              12      ...  Florida
                              13      ...  Georgia
                              15      ...  Hawaii
                              16      ...  Idaho
                              17      ...  Illinois
                              18      ...  Indiana
                              19      ...  Iowa
                              20      ...  Kansas
                              21      ...  Kentucky
                              22      ...  Louisiana
                              23      ...  Maine
                              24      ...  Maryland
                              25      ...  Massachusetts
                              26      ...  Michigan
                              27      ...  Minnesota
                              28      ...  Mississippi
                              29      ...  Missouri
                              30      ...  Montana
                              31      ...  Nebraska
                              32      ...  Nevada
                              33      ...  New Hampshire
                              34      ...  New Jersey
                              35      ...  New Mexico
                              36      ...  New York
                              37      ...  North Carolina
                              38      ...  North Dakota
                              39      ...  Ohio
                              40      ...  Oklahoma

513-514        2              STRESFIPD
                              State of Residence (FIPS) - Death (Cont'd)

                              United States Occurrence
                              41      ...  Oregon
                              42      ...  Pennsylvania
                              44      ...  Rhode Island
                              45      ...  South Carolina
                              46      ...  South Dakota
                              47      ...  Tennessee
                              48      ...  Texas
                              49      ...  Utah
                              50      ...  Vermont
                              51      ...  Virginia
                              53      ...  Washington
                              54      ...  West Virginia
                              55      ...  Wisconsin
                              56      ...  Wyoming

                              Puerto Rico Occurrence

                              72      ...  Puerto Rico
                              00-56,
                              66,78   ...  Foreign resident: Refer
                                           to U.S. for specific code
                                           structure.
     
                              Virgin Islands Occurrence
       
                              78      ...  Virgin Islands
                              00-56,
                              66,72   ...  Foreign resident: Refer
                                           to U.S. for specific code
                                           structure. 

                              Guam Occurrence                       
       
                              66      ...  Guam
                              01-56,
                              00,72,78...  Foreign resident: Refer to
                                           U.S.  for specific code
                                           structure.     

515-517        3              CNTYRFPD
                              County of Residence (FIPS) - Death

                              000     ...  Foreign residents
                              001-nnn ...  Counties and county
                                           equivalents (independent and
                                           coextensive cities) are
                                           numbered alphabetically within
                                           each State (Note:  To uniquely
                                           identify a county, both the
                                           State and county codes must be
                                           used.)  A complete list of
                                           counties is shown in the
                                           Geographic Code Outline
                                           further back in this document.
                              999     ...  County with less than 250,000
                                           population

518-522        5              PLRES
                              Place (City) of Residence (FIPS)

                              A complete list of cities is shown in the
                              Geographic code outline further back in this
                              document.

                              00000   ...  Foreign residents
                              00001-nnnnn..Code range               
                                               
                              99999   ...  Balance of county; or
                                           city less than 250,000
                                           population

523            1              HOSPD
                              Hospital and Patient Status

                              1       ...  Hospital, Clinic or Medical
                                           Center - Inpatient
                              2       ...  Hospital, Clinic or Medical
                                           Center - Outpatient or 
                                           admitted to Emergency Room
                              3       ...  Hospital, Clinic or Medical
                                           Center - Dead on arrival
                              4       ...  Hospital, Clinic or Medical
                                           Center - Patient status
                                           unknown
                              5       ...  Nursing home
                              6       ...  Residence
                              7       ...  Other
                              9       ...  Place of death unknown

524-527        4              DTHYR
                              Year of Death

                              1999    ...  Death occurred in 1999

528-529        2              DTHMON
                              Month of Death

                              01      ...  January
                              02      ...  February
                              03      ...  March
                              04      ...  April
                              05      ...  May
                              06      ...  June
                              07      ...  July
                              08      ...  August
                              09      ...  September
                              10      ...  October
                              11      ...  November
                              12      ...  December

530-531        2              R9
                              Reserved Position

532            1              WEEKDAYD
                              Day of Week of Death

                              1       ...  Sunday
                              2       ...  Monday
                              3       ...  Tuesday
                              5       ...  Thursday
                              6       ...  Friday
                              7       ...  Saturday
                              9       ...  Unknown

533-535        3              R10
                              Reserved positions




This page last reviewed: Thursday, January 28, 2016
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.
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