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Scientific Data Documentation
Epidemiologic Followup Study, 1992 Mortality
ACKNOWLEDGMENTS
Overall responsibility for the data processing and the compilation and
documentation for the NHANES I Epidemiologic Followup Study (NHEFS), 1992
Mortality Data Public Use data tape rested with Christine S. Cox.  Assistance
was provided by other members of the NHEFS data management team: Sandra T.
Rothwell, Michael Mussolino, Jennifer H. Madans, Dawn M. Scott, Madelyn A.
Lane, Keith Zevallos, Cordell Golden, Cynthia Reuben, Joel C. Kleinman, and
Jacob J. Feldman.  Special thanks are extended to Joan Cornoni-Huntley of the
National Institute on Aging (NIA) who played an important role in the
development and continuation of the NHEFS.  The contribution of the
contractor, Westat Inc., of Rockville, Maryland, who conducted the field work
is also gratefully acknowledged.
The NHEFS originated as a joint project between the National Center for Health
Statistics (NCHS) and NIA.  It has been funded primarily by NIA, with
additional financial support from the following components of the National
Institutes of Health and other Public Health Service agencies: the National
Center for Chronic Disease Prevention and Health Promotion; the National
Cancer Institute; the National Heart, Lung, and Blood Institute; the National
Institute on Alcohol Abuse and Alcoholism; the National Institute of Mental
Health; the National Institute of Diabetes and Digestive and Kidney Diseases;
the National Institute of Arthritis and Musculoskeletal and Skin Diseases; the
National Institute of Allergy and Infectious Diseases; and, the National
Institute of Neurological and Communicative Disorders and Stroke.
                             Contents
                                                                     Page
Use of NHEFS Data....................................................   1
Errors in the Data Tapes and Survey Differences......................   2
Introduction to the 1992 NHEFS Mortality Data Tape Documentation.....   3
NCHS Procedures Used to Code Multiple Cause Data.....................   9
1992 NHEFS Mortality Data Tape Characteristics.......................  16
1992 NHEFS Mortality Data Tape Record Layout.........................  17
1992 NHEFS Mortality Data Public Use Tape Documentation..............  18
Appendix 1 NCHS ICD-9th Revision 282 Cause of Death Recodes..........  37
Appendix 2 NCHS ICD-9th Revision 72 Cause of Death Recodes...........  45
Appendix 3 NCHS ICD-9th Revision 34 Cause of Death Recodes...........  47
Use of NHEFS Data
With the goal of mutual benefit, NCHS requests the cooperation of recipients
of data tapes in certain actions related to their use:
A.   Any published material derived from the data should acknowledge the
     National Center for Health Statistics (NCHS) as the original source.  
     It should also include a disclaimer which credits any analyses,
     interpretations, or conclusions reached to the author (recipient of the
     tape) and not to NCHS, which is responsible only for the initial data.
B.   Consumers who wish to publish a technical description of the data will
     make a reasonable effort to insure that the description is not
     inconsistent with that published by NCHS.  This does not mean, however,
     that NCHS will review such descriptions.
C.   Authors should provide NCHS with a reprint of published articles which
     utilize the 1992 NHEFS data.  Please send reprints to:
          NHEFS Data Management Staff
          Division of Epidemiology
          National Center for Health Statistics
          Presidential Building, Room 730
          6525 Belcrest Road
          Hyattsville, Maryland 20782
ERRORS IN THE NHEFS DATA TAPES AND SURVEY DIFFERENCES
The NHEFS Public Use data tapes have been subjected to a great deal of careful
editing.  However, due to the large volume of data in the series, it is likely
that a small number of errors or discrepancies remain undetected.
In general, the NHEFS data management team has not attempted to resolve
substantive data discrepancies that may exist 1) within the 1992 NHEFS data
tapes, or 2) between the 1992 NHEFS data tapes and the data tapes of the
original National Health and Nutrition Examination Survey (NHANES I) and/or
other NHEFS followup waves.                                 
 INTRODUCTION TO THE 1992 NHEFS MORTALITY DATA TAPE DOCUMENTATION
The NHANES I Epidemiologic Followup Study (NHEFS) is a longitudinal study
which uses as its baseline those adult persons ages 25 to 74 years who were
examined in the first National Health and Nutrition Examination Survey
(NHANES I).  The NHEFS is comprised of a series of four followup surveys.  The
first wave of data collection, the 1982-84 NHEFS, was conducted from 1982 to
1984 and included all persons who were between 25 and 74 years at their NHANES
I examination (n=14,407).  The second wave of data collection, the 1986 NHEFS,
was conducted for members of the NHEFS cohort who were 55-74 years at their
baseline examination and not known to be deceased at the 1982-84 NHEFS
(n=3,980).  The third wave, the 1987 NHEFS, was conducted for the entire non-
deceased NHEFS cohort (n=11,750).  The fourth wave of data collection, the
1992 NHEFS, includes the entire non-deceased NHEFS cohort (n=11,195).   
NHANES I collected data from a national probability sample of the United
States civilian noninstitutionalized population between the ages of 1 and 74
years.  The survey, which included a standardized medical examination and
questionnaires that covered various health-related topics, took place from
1971 through 1974 and was augmented by an additional national sample in
1974-75.  The NHANES I sample included 20,729 persons 25 to 74 years of age,
of whom 14,407 (70 percent) completed a medical examination. The design,
content and operation of NHANES I has been described elsewhere (Vital and
Health Statistics, Series 1, Nos. 10a, 10b, and 14).
Although NHANES I provided a wealth of information on the prevalence of health
conditions and risk factors, the cross-sectional nature of the original survey
limits its usefulness for studying the effects of clinical, environmental, and
behavioral factors and in tracing the natural history of disease.  Therefore,
the NHEFS was designed to investigate the association between factors measured
at the baseline and the development of specific health conditions.  It
originated as a joint project between the National Center for Health
Statistics (NCHS) and the National Institute on Aging with collaboration from
components of the National Institutes of Health and other Public Health
Service agencies.  The 14,407 participants who were 25 to 74 years of age when
they were examined in NHANES I (1971-75) were included in the followup study
population.
In the first wave, the 1982-84 NHEFS, data were collected on all 14,407
subjects (i.e., individuals examined at NHANES I) in the cohort.  Tracing of
subjects began in 1981 and data collection was conducted from 1982 to 1984. 
Approximately 93 percent (n=13,383) of the cohort was successfully traced by
the end of the survey period.  Detailed information on the design, content,
and operation of the 1982-84 NHEFS may be found in the Plan and Operation of
the NHANES I Epidemiologic Followup Study 1982-84, Vital and Health
Statistics, Series 1, No. 22.  The basic design of the 1982-84 NHEFS consisted
of the following components:
     --   tracing subjects or their proxies to a current address;
     --   acquiring death certificates for deceased subjects;
     --   performing in-depth interviews with the subjects or with their
          proxies including, for surviving subjects, taking pulse, blood
          pressure, and weight measurements of subjects; and,
     --   obtaining hospital and nursing home records, including pathology
          reports and electrocardiograms.
The second wave of NHEFS, the 1986 NHEFS, was conducted to assess changes in
the health and functional status of the oldest members of the NHEFS cohort
since the last contact period.  It included 5,677 subjects who were 55 years
or older at their NHANES I examination (almost 40 percent of the entire NHEFS
cohort).  Data collection was restricted to 3,980 subjects aged 55 years or
older at NHANES I who were not known to be deceased at the time of the 1982-84
NHEFS, regardless of their tracing or interview status in 1982-84.  The
remaining 1,697 subjects who were deceased at the time of the 1982-84 NHEFS
were excluded from additional data collection in the 1986 NHEFS.  Detailed
information on the design, content, and operation of the 1986 NHEFS may be
found in the Plan and Operation of the NHANES I Epidemiologic Followup Study,
1986, Vital and Health Statistics, Series 1, No. 25.
The 1987 NHEFS, the third wave of data collection, was conducted to continue
to collect information on changes in the health and functional status of the
NHEFS cohort since the last contact period.  Tracing and data collection were
conducted during this followup survey only for the members of the NHEFS cohort
who had not been identified as deceased in 1982-84 or 1986 (n=11,750)
regardless of their previous tracing or interview status.  The 2,657
previously deceased subjects were excluded from further data collection in the
1987 NHEFS.  Detailed information on the design, content, and operation of the
1987 NHEFS may be found in the Plan and Operation of the NHANES I
Epidemiologic Followup Study, 1987, Vital and Health Statistics, Series 1, No.
27.
The fourth wave of the NHEFS, the 1992 NHEFS, collected information on changes
in the health and functional status of the NHEFS cohort since the last
contact.  The 1992 NHEFS cohort includes 3,212 subjects who were deceased at
the time of the 1982-84, 1986 and 1987 NHEFS and 11,195 subjects who were not
known to be deceased prior to the 1992 NHEFS data collection period.  Tracing
and data collection in the 1992 NHEFS was undertaken only for the non-deceased
subjects, regardless of their tracing or interview status in previous surveys. 
The 3,212 previously deceased subjects were excluded from additional data
collection in the 1992 NHEFS.  Detailed information on the design, content,
and operation of the 1992 NHEFS may be found in the Plan and Operation of the
NHANES I Epidemiologic Followup Study, 1992, Vital and Health Statistics,
Series 1, No. 35. 
The design and data collection procedures adopted in the 1992 NHEFS were very
similar to the ones developed in the previous surveys: subjects were traced;
subject and proxy interviews were conducted; and, health care facility
abstracts and death certificates were collected.  All subjects whose vital
status was not obtained through tracing procedures were considered lost-to-
followup in the 1992 NHEFS.  In some cases, information about the death of a
subject was obtained from a former neighbor, a relative or another tracing
source.  Although this information was noted in the subject's tracing record,
he or she was considered lost-to-followup unless the information was verified
by means of a death certificate or proxy interview.  A subject's death had to
be confirmed by either a death certificate or proxy interview.  
In addition to verifying the subject's vital status, the tracing process also
was used to obtain the current address of surviving subjects as well as to
identify a knowledgeable proxy respondent for deceased subjects.  Respondents
who were identified and located through the tracing procedures were asked to
participate in a telephone interview.  In a few cases, subjects who had been
traced successfully could not be relocated for the interview.  Only their
vital status and the date when they were last traced in the 1992 survey are
available.
A major difference between the NHEFS waves was the manner in which the
interviews were conducted.  In the 1982-84 NHEFS, the two-hour subject
interview was usually conducted in-person while, in subsequent followups, the
interview was shortened to approximately 30 minutes in length and was
conducted primarily by telephone.  In addition, since the questionnaire was
not administered in-person, no physical measurements were made in the later
followups.
The 1992 NHEFS interviews were conducted over the telephone using a Computer
Assisted Telephone Interviewing (CATI) system.  CATI is a telephone
interviewing technique that allows the interviewer to enter the answers
supplied by the respondent directly into the computer.  Thus, editing and
coding time is reduced and keypunching from a hard copy questionnaire is
eliminated.  A computer program drives the questionnaire so that the correct
skip patterns are followed and the appropriate questions are displayed on the
computer monitor.  The skip patterns are based on information gathered from
previous data collection waves or on responses provided during the 1992
interview.  For example, certain questions on pregnancy and menstrual history
in the 1992 interview were programmed to be skipped automatically if the
subject was male or if the female subject was interviewed previously and was
45 years of age or older at the time of that interview.  Edit and logic checks
are incorporated into the data collection system itself, thus improving the
quality of the data.
As of July 19, 1993, the end of the 1992 NHEFS data collection period, 10,079
(90.0 percent) of the 11,195 members of the 1992 NHEFS cohort had been
successfully traced.  Interviews were conducted for 9,281 subjects (92.1
percent of those successfully traced).  In addition, 10,535 facility stay
records were collected for 4,162 subjects using information obtained from the
interview, death certificate, or some other source.  Death certificates were
obtained for 1,374 (98.7 percent) of the 1,392 subjects who were known to have
died since last contact.  Detailed information on the design, content, and
operation of the 1992 NHEFS may be found in the Plan and Operation of the
NHANES I Epidemiologic Followup Study 1992, Vital and Health Statistics,
Series 1, No. 35.
The data collected from the 1992 NHEFS are stored on four separate tapes:
     1)   Vital and Tracing Status tape -- contains summary information
          about the status of the entire NHEFS cohort, 
     2)   Interview tape -- contains the data collected from the subject and
          proxy interviews,
     3)   Health Care Facility Stay tape -- contains information on reports
          of stays in hospitals and nursing homes as well as information
          abstracted from facility medical records, 
     4)   Mortality Data tape  -- contains data abstracted from the death
          certificates from all three NHEFS surveys.  This tape is discussed
          below in more detail.
There are 4,497 records on the 1992 NHEFS Mortality Data Public Use tape.  
It contains the death certificate information for all subjects who were
identified as deceased in either the 1982-84, 1986, 1987, or 1992 NHEFS and
for whom a death certificate was obtained.  Positions 3-7 contain the Sample
Sequence Number, which is the subject identification number.  This number is
unique for each subject and is used when linking files.  By using the Sample
Sequence Number, the NHEFS 1992 Followup Mortality Data tape can be linked to
all other NHEFS and NHANES I data tapes.
The layout of this tape is identical to the layout used for the previous NHEFS
Mortality Data Public Use tapes. The source flag variable located in position
18 indicates the survey in which the subject was identified as deceased and
when his or her death certificate was received. Records with a source code of
1 identify 1982-84 Followup decedents whose death certificates were received
during the 1982-84 NHEFS data collection period.  (Several data items on one
of the records from the 1982-84 tape have been updated on this file based on
data collected since the release of the 1982-84 NHEFS Mortality Public Use
tape.)  A source code of 2 identifies 1982-84 Followup decedents whose death
certificates were received after the end of the 1982-84 survey period. 
Records with a source code of 3 identify 1986 Followup decedents whose death
certificates were received during the 1986 NHEFS data collection period.  A
source code of 4 is assigned to subjects who were first identified as deceased
in the 1987 NHEFS and whose death certificates were obtained during that
Survey.  Records with a source code of 5 identify 1992 Followup decedents
whose death certificates were received during the 1992 NHEFS data collection
period.  Lastly, a source code of 6 identifies 1987 Followup decedents whose
death certificates were received after the end of the 1987 survey period.
The 1992 NHEFS Mortality Data Public Use tape follows the coding
specifications used for the NCHS Multiple Cause-of-Death Public Use Data
tapes.  No attempts have been made to resolve any discrepancies that may exist
between the demographic information coded on this data tape and the
information from other NHEFS or NHANES I data tapes.
An asterisk next to variables listed in the record layout documentation
indicates that the variable was computer-generated.  All other variables
(excluding Sample Sequence Number) are extracted directly from the subject's
death certificate.
A change occurred in the geographic coding from the death certificate after
the close of the 1982-84 NHEFS survey period.  If the Death Certificate Source
Flag in position 18 is coded 1, the Population Size of City of Residence and
Metropolitan-Nonmetropolitan County of Residence variables coded in positions
39 and 40, respectively, are based on data from the 1970 Census.  If the Death
Certificate Source Flag is coded 2 through 5, then these two place of
residence variables are based on data from the 1980 Census.  If the Death
Certificate Source Flag is coded 6 then these variables are based on data from
the 1990 Census.
         NCHS Procedures Used to Code Multiple Cause Data
The original scheme for coding conditions listed on the death certificate was
designed with two objectives in mind.  First, to facilitate etiological
studies of the relationships among conditions, it was necessary to reflect
accurately, in coded form, each condition and its location on the
certification in the exact manner given by the certifier.  Secondly, the
codification needed to be carried out in a manner by which the underlying
cause-of-death could be assigned through computer applications.  The approach
was to suspend the linkage provisions of the ICD for the purpose of condition
coding and code each entity with minimum regard to other conditions present on
the certification.  This general approach is hereafter called entity coding.
Unfortunately, the set of multiple cause codes produced by entity coding is
not conducive to a third objective--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 certificate and
modified or linked to such conditions as provided by ICD-9.  By definition,
the entity data cannot meet this requirement since the linkage provisions
distort the character and placement of the information originally recorded by
the certifying physician.
Since the two objectives are incompatible, the Division of Vital Statistics
(DVS) at the National Center for Health Statistics chose to create from the
original set of entity codes a new code set called record axis multiple cause
data.  Essentially, the axis of classification has been converted from an
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.  The translation is
accomplished by a computer system called TRANSAX (TRANSLATION OF AXIS) through
selective use of 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 which are free of contradictions and are the most precise within the
constraints of ICD-9 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-9
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 5715
               (cirrhosis of liver without mention of alcohol) and 303
               (alcohol dependence syndrome).  Tabulation of records with
               5715 would on the surface falsely imply that such records
               had no mention of alcohol.  A preferable codification would
               be 5712 (alcoholic cirrhosis of liver) in lieu of both 5715
               and 303.
     Case 2:   If "gastric ulcer" and "bleeding gastric ulcer" are reported
               on a record they are coded to 5319 (gastric ulcer,
               unspecified as acute or chronic, without mention of
               hemorrhage or perforation) and 5314 (gastric ulcer, chronic
               or unspecified, with hemorrhage).  A more concise
               codification would be to code 5314 only since the 5314 shows
               both the gastric ulcer and the bleeding.
     A.   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 tape.  The following paragraphs describe the format and application
     of entity axis data.
          
     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
                                      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 certificate.
                   2. position indicator: The next byte indicates the position
                                          of the codes on the line, i.e., it
                                          is the first (1), second (2),
                                          ---eighth (8) code on the line.
                   3. cause category:  The next four bytes represent the ICD-9
                                       cause code.
                   4. nature of injury flag: ICD-9 uses the same series of numbers
                                             (800-999) to indicate nature of injury (N
                                             codes) and external cause codes (E codes). 
                                             This flag distinguishes between the two
                                             with a one (1) representing nature of
                                             injury codes and a zero (0) representing
                                             all other cause codes.
          
     A maximum of 20 of these seven byte codes is 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.  
     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 Part
     11 of the NCHS Vital Statistics Instructions Manual Series.  
     ENTITY AXIS APPLICATIONS:  The entity axis multiple cause data set is
     appropriate to analyses which 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 certificate. 
     Within this framework, the entity data are appropriate to the
     examination of etiological relationships among conditions, accuracy of
     certification reporting, and the validity of traditional assumptions in
     underlying cause selection.  Additionally, the entity data provide in
     certain categories a more detailed code assignment which is linked out
     in the creation of record axis data.  Where such detail is needed for a
     study, the user should selectively employ entity data.  Finally, the
     researcher may not wish to be bound by the assumptions used in the axis
     translation process preferring rather to investigate hypotheses of his
     own predilection.
By definition, the main limitation of entity axis data is that an entity code
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 5750 is titled "Acute cholecystitis without
mention of calculus."  Within the framework of entity codes this is
interpreted to mean that the codable entity itself contained no mention of
calculus rather than that calculus was not mentioned anywhere on the record. 
Tabulation of records with a "5750" as a count of persons having acute
cholecystitis without mention of calculus would therefore be erroneous.  This
illustrates the fact that under entity coding the ICD-9 titles cannot be taken
literally.  The user must study the rules for entity coding as they relate to
his/her research prior to utilization of entity data.  The user is further
cautioned that the inclusion notes in ICD-9 which relate to modifying and
combining categories are seldom applicable to entity coding (except where
provided in Part 2b of the Vital Statistics Instruction Manual Series).
In tabulating the entity axis data, one may count codes with the resultant
tabulation of an individual code representing the number of times the
disease(s) represented by the code appears in the file.  In this kind of
tabulation of morbid condition prevalence, 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.
     B.   Record Axis Codes
     The following paragraphs describe the format and application of
     record-axis data.  Part 2f of the Vital Statistics Instruction Manual
     Series describes the TRANSAX process for creating record axis data from
     entity axis data.
     FORMAT:  Each record (or person) axis code is displayed in five bytes.
              Locational information is not relevant.  The code consists of 
              the following components:
              1. cause category: The first four bytes represent the ICD-9
                                   cause code.
              2. nature of injury flag: The last byte contains a 0 or 1 with the 1
                                        indicating that the cause is a nature of
                                        injury category.
     Again, a maximum of 20 codes are captured on a record for multiple cause
     purposes.  
     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.
     RECORD AXIS APPLICATIONS:  The record axis multiple cause data set is
     the basis for NCHS core multiple cause tabulations.  Location of codes
     is not relevant to this data set and conditions have been linked into
     the most meaningful categories for the certification.  The most
     immediate consequences for the user is that the codes on the record
     already represent mention of a disease assignable to that particular
     ICD-9 category.  This is in contrast to the entity code which is
     assigned each time such a disease is reported on two different lines of
     the certification.  Secondly, the linkage implies that within the
     constraints of ICD-9 the most meaningful code has been assigned.  The
     translation process creates for the user a data set which 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.  Likewise, they are comparable to general
     morbidity coding where the linkage provisions of ICD-9 are usually
     utilized.  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 code as literally representing the
information conveyed in ICD-9 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-9 are utilized.  (See Part 2f of the Vital Statistics
Instruction Manual Series.)
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 which combine individual cause categories must take
into account the possible interaction of up to 20 codes on a single
certificate.
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 Part 2f of
the Vital Statistics Instruction Manual Series 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 assumptions of axis translation.  In
certain situations, a combination of entity and record axis data may be the
more appropriate alternative.
Additional Reference Documents
The following documents provide detailed information on the rules employed for
coding multiple cause of death information from death certificate records:
1.       Manual of the International Statistical Classification of
         Diseases, Injuries, and Causes of Death: Based on the
         Recommendations of the Ninth Revision Conference, 1975, and
         Adopted by the Twenty-ninth World Health Assembly, Volumes 1 and
         2, 1977 (World Health Organization).
2.       NCHS Instruction Manual Data Preparation Part 2a, Vital Statistics
         Instructions for Classifying the Underlying Cause of Death, 1979.
3.       NCHS Instruction Manual Data Preparation, Part 2b, Vital
         Statistics Instructions for Classifying Multiple Causes of Death,
         1979.
4.       NCHS Instruction Manual Data Preparation, Part 2c, Vital
         Statistics ICD-9 ACME Decision Tables for Classifying Underlying
         Causes of Death, 1979.
5.       NCHS Instruction Manual Data Preparation, Part 2f, Vital
         Statistics ICD-9 TRANSAX Disease Reference Tables for Classifying
         Multiple Causes of Death, 1981.



Data Tape Characteristics


Data Set Name:          NHEFS3.MORT87PB
Record Length:          440
Blocksize:              32560
Number of Records: 4,497
Number of Reels:        1
Recording Mode:    FIXED BLOCK, EBCDIC
Density:           6250 bpi
Channel:           9 TRACK
Created by:        Office of Analysis and Epidemiology
                   Division of Epidemiology
                   National Center for Health Statistics
                   Presidential Building, Room 730
                   6525 Belcrest Road
                   Hyattsville, Maryland  20782           


RECORD LAYOUT
                               Tape
   Data Items                                        
   Positions
1. Sample Sequence Number                            3-7
2. General
   a.  Year of death                                 1-2
   b.  Death certificate source flag                 
   18
   c.  Record type                                   19
   d.  Resident status                               20
   e.  Month of death                                55-56
   f.  Day of death                                  57-58
3. Occurrence
   a.  Region                                        26
   b.  Division                                           27
   c.  Place of death--hospital and status           75
4. Residence
   a.  Population size of city of residence          39
   b.  Metropolitan/nonmetropolitan county                40
   c.  Region                                        41
   d.  Division                                           42
5. The Decedent
   a.  Sex                                           59
   b.  Race                                          60-63
   c.  Age                                           64-72
   d.  Marital status                                77
6. Underlying Cause
   a.  ICD-9 code                                    142-145
   b.  282 cause recode                              146-150
   c.  72 cause recode                               151-153
   d.  34 cause recode                               157-159
   e.  Autopsy performed                                  84
   f.  Place of accident for causes E850-E929        141
7. Multiple Conditions
a. Entity-Axis conditions
   1.  Number of                                     160-161
   2.  The conditions                                162-301
b. Record-Axis conditions
   1.  Number of                                     338-339
   2.  The conditions                                341-440
            
    1-2     2    Year of Death
                              
                   71-93     ... Year of death (1971-1993)
                                 
                 (Note: Month and Day of Death are stored in tape locations 55-56
                  and 57-58, respectively.)
    3-7     5    Sample Sequence Number  
                
 
   8-17     2    Blank
     18     1    Death Certificate Source Flag (*)
                 1         ... Death certificate received for 1982-84                   
                               NHEFS decedent in the 1982-84 NHEFS period
                 2         ... Death certificate received for 1982-84                                      NHEFS decedent
                               after the 1982-84 NHEFS period 
                 3         ... Death certificate received for 1986 NHEFS                
                               decedent in the 1986 NHEFS period                             
                 4         ... Death certificate received for 1987 NHEFS                                   decedent
                               in the 1987 NHEFS period
                 5         ... Death certificate received for 1992 NHEFS                
                               decedent in the 1992 NHEFS period
                 6         ... Death certificate received for 1987 NHEFS                
                               decendent after the 1987 NHEFS period                                   
     19     1    Record Type (*)
                   1         ... RESIDENT 
                                 State and County of Occurrence and
                                 Residence are the same.
                   2         ... NONRESIDENT
                                 State and/or County of Occurrence and
                                 Residence are different.
                                                                            
_____________________
*) indicates that the variable was computer-generated. All other variables
(excluding Sample Sequence Number) are extracted directly from the subject's
death certificate.                                        

     20     1    Resident Status (*)
                   1         ... RESIDENT
                                 State and County of Occurrence and
                                 Residence are the same.
                   2         ... INTRASTATE NONRESIDENT
                                 State of Occurrence and Residence are the                
                                 same, but County is different.
                   3         ... INTERSTATE NONRESIDENT
                                 State of Occurrence and Residence are                    
                                 different, but both are in the U.S.
                   4         ... FOREIGN RESIDENT (OCCURRENCE IS IN THE                   
                                 U.S.)
                                 State of Occurrence is one of the 50                     
                                 States or the District of Columbia, but                                 
                                 Place of Residence is outside of the U.S.
                   Blank     ... PLACE OF OCCURRENCE IS OUTSIDE THE U.S.
  21-25     5    Blank
                                                                              26-27     2 
                   Region (*) and Division (*) of Occurrence of Death                 
                   Position 26 is Region.  Position 27 is Division. Divisions are
                   coded within Region and States are coded within Division.  The
                   code structure is designed to sequence the states as they appear
                   in NCHS publications.                         
 
                   Loc. Loc. 
                   26   27    
                   0    0          ... OCCURRENCE IS OUTSIDE THE U.S.
                   1               ... NORTHEAST
                        1          ...    New England
                                   ...       Maine
                                   ...       New Hampshire
                                   ...       Vermont
                                   ...       Massachusetts
                                   ...       Rhode Island
                                   ...       Connecticut                                  
         2          ...    Middle Atlantic
                                   ...       New York
                                   ...       New Jersey
                                   ...       Pennsylvania
    27     2    Region (*) and Division (*) of Occurrence of Death --
                Continued
                   Loc. Loc.                                                              
    26   27   
                                                                                          
    2               ... MIDWEST
                        3          ...    East North Central                              
                    ...       Ohio
                                   ...       Indiana
                                   ...       Illinois
                                   ...       Michigan
                                   ...       Wisconsin
                        4          ...    West North Central
                                   ...       Minnesota
                                   ...       Iowa
                                   ...       Missouri
                                   ...       North Dakota
                                   ...       South Dakota
                                   ...       Nebraska
                                   ...       Kansas
                   3               ... SOUTH
                        5          ...    South Atlantic
                                   ...       Delaware
                                   ...       Maryland
                                   ...       District of Columbia
                                   ...       Virginia
                                   ...       West Virginia
                                   ...       North Carolina
                                   ...       South Carolina
                                   ...       Georgia
                                   ...       Florida
                        6          ...    East South Central
                                   ...       Kentucky
                                   ...       Tennessee
                                   ...       Alabama
                                   ...       Mississippi
                        7          ...    West South Central
                                   ...       Arkansas
                                   ...       Louisiana
                                   ...       Oklahoma
                                   ...       Texas                                        
                            

  26-27     2    Region (*) and Division (*) of Occurrence of Death-- 
                 Continued
                 
                   Loc. Loc.
                   26   27 
                   4               ... WEST
                        8          ...    Mountain
                                   ...       Montana 
                                   ...       Idaho
                                   ...       Wyoming
                                   ...       Colorado
                                   ...       New Mexico
                                   ...       Arizona
                                   ...       Utah
                                   ...       Nevada
                        9          ...    Pacific
                                   ...       Washington
                                   ...       Oregon
                                   ...       California
                                   ...       Alaska
                                   ...       Hawaii
  28-38    11    Blank
     39     1    Population Size of City of Residence (*)
                     0         ... Place of 1,000,000 or more persons
                     1         ... Place of   500,000 to 1,000,000 persons
                     2         ... Place of   250,000 to   500,000 persons
                     3         ... Place of   100,000 to   250,000 persons
                     4         ... Place of    50,000 to   100,000 persons
                     5         ... Place of    25,000 to    50,000 persons
                     6         ... Place of    10,000 to    25,000 persons
                     9         ... All other areas in the U.S.
                     Z         ... Foreign resident
                                                                            
                  (Note: If position 18 is coded 1, this variable is based on data
                  from the 1970 Census.  If position 18 is coded 2 through 5 then
                  this variable is based on data from the 1980 Census.  If position
                  18 is coded 6 then this variable is based on data from the 1990
                  Census.)
     40     1    Metropolitan - Nonmetropolitan County of Residence (*)
                   1         ... Metropolitan county
                   2         ... Nonmetropolitan county
                   Z         ... Foreign resident
                   9         ... Unknown
                  (Note: If position 18 is coded 1, this variable is based on data
                  from the 1970 Census.  If position 18 is coded 2 through 5 then
                  this variable is based on data from the 1980 Census.  If position
                  18 is coded 6 then this variable is based on data from the 1990
                  Census.)                   
  41-42     2    Region (*) and Division (*) of Residence                                 
                  Position 41 is Region.  Position 42 is Division.  Divisions are
                  coded within Region and States are coded within Division. 
                  The code structure is designed to sequence the States as they
                  appear in NCHS publications.  
                   
                   Loc. Loc. 
                   41   42   
                   0    0          ... FOREIGN RESIDENT
                   1               ... NORTHEAST
                        1          ...    New England
                                   ...       Maine
                                   ...       New Hampshire
                                   ...       Vermont
                                   ...       Massachusetts
                                   ...       Rhode Island
                                   ...       Connecticut
                        2          ...    Middle Atlantic
                                   ...       New York
                                   ...       New Jersey
                                   ...       Pennsylvania
                   2               ... MIDWEST
                        3          ...    East North Central
                                   ...       Ohio
                                   ...       Indiana
                                   ...       Illinois
                                   ...       Michigan
                                   ...       Wisconsin
                   41-42     2    Region (*) and Division (*) of Residence -- Continued
                   Loc. Loc.
                   41   42 
                        4          ...    West North Central
                                   ...       Minnesota
                                   ...       Iowa
                                   ...       Missouri
                                   ...       North Dakota
                                   ...       South Dakota
                                   ...       Nebraska
                                   ...       Kansas
                   3               ... SOUTH
                        5          ...    South Atlantic
                                   ...       Delaware
                                   ...       Maryland
                                   ...       District of Columbia
                                   ...       Virgin
                                   ...       West Virginia
                                   ...       North Carolina
                                   ...       South Carolina
                                   ...       Georgia
                                   ...       Florida
                        6          ...    East South Central
                                   ...       Kentucky
                                   ...       Tennessee
                                   ...       Alabama
                                   ...       Mississippi
                        7          ...    West South Central
                                   ...       Arkansas
                                   ...       Louisiana
                                   ...       Oklahoma
                                   ...       Texas
                   4               ... WEST
                        8          ...    Mountain
                                   ...       Montana
                                   ...       Idaho
                                   ...       Wyoming
                                   ...       Colorado
                                   ...       New Mexico
                                   ...       Arizona
                                   ...       Utah
                                   ...       Nevada
                       
  41-42     2    Region (*) and Division (*) of Residence -- Continued
                   Loc. Loc.
                   41   42 
                        9          ...    Pacific
                                   ...       Washington
                                   ...       Oregon
                                   ...       California
                                   ...       Alaska
                                   ...       Hawaii
  43-51     9    Blank
  52-53     2    Education
                   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
                  (Note:  This information is only available for deaths occurring in
                  1989 and later.  For earlier years, this field will be blank.)
  54        1    Education Recode
                   1         ... 0 - 8 years
                   2         ... 9 - 11 years
                   3         ... 12 years
                   4         ... 13 - 15 years
                   5         ... 16 years or more
                   6         ... Not stated
                  (Note:  This information is only available for deaths occurring in
                  1989 and later.  For earlier years, the field will be blank.)
 (55-58)    4    DATE OF DEATH
                   (Note:  Year of Death is given in tape locations 1-2)
  55-56     2    Month
                   01        ... January
                   02        ... February
                   03        ... March
                   04        ... April 
                   05        ... May
                   06        ... June
                   07        ... July
                   08        ... August
                   09        ... September
                   10        ... October
                   11        ... November
                   12        ... December
  57-58     2    Day
                   01-31     ... As applicable to Month of Death
                   99        ... Not stated
     59     1    Sex
                   1         ... Male
                   2         ... Female
 (60-63)    4    RACE
                 SPECIAL INSTRUCTION: For deaths occurring in 1988 and
                 earlier, use definition (a). For deaths occurring in 1989
                 and later, use definition (b). The two definitions are a 
                 result of a change in coding rules.
  60-61     2    Detail Race (a)
                   00        ... Other Asian or Pacific Islander
                   01        ... White
                   02        ... Black
                   03        ... American Indian (includes Aleuts and                     
                  Eskimos)
                   04        ... Chinese
                   05        ... Japanese
                   06        ... Hawaiian (includes Part-Hawaiian)
                   07        ... All other races
                   08        ... Filipino       
  60-61     1    Detail Race (b)
                   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
                   09        ... All other races
     62     1    Race Recode #1 (*)
                   1         ... White 
                   2         ... Races other than white or black
                   3         ... Black
     63     1    Race Recode #2 (*)
                   1         ... White
                   2         ... All other races
 (64-72)    9    AGE OF DEATH                                                             
                     
                   (Note: The age at death listed on the death certificate                
                   is often incorrect due to erroneous information provided 
                   by the informant.  The NHEFS team suggests that the analyst 
                   use the computer-generated Age at Death variable in positions 
                   67-68 on the 1992 NHEFS Vital and Tracing Status Public Use 
                   data tape, which is  based on the Date of Death and the NHEFS 
                   Date of Birth.)                                                        
                                 
 64-66     3     Detail Age at Death 
                   029-097   ... Age in years (not inclusive)
                   999       ... Age not stated
                   (Note: A leading zero in position 64 indicates that the                
                   subject was less than 100 years old at Date of Death.)
    
  67-68     2    Age of Death Recode #1 (*)
                             
                   31        ... 25 - 29 years
                   32        ... 30 - 34 years
                   33        ... 35 - 39 years
                   34        ... 40 - 44 years
                   35        ... 45 - 49 years
                   36        ... 50 - 54 years
                   37        ... 55 - 59 years
                   38        ... 60 - 64 years
                   39        ... 65 - 69 years
                   40        ... 70 - 74 years
                   41        ... 75 - 79 years
                   42        ... 80 - 84 years
                   43        ... 85 - 89 years
                   44        ... 90 - 94 years
                   45        ... 95 - 99 years
                   46        ... 100 - 104 years
                   47        ... 105 - 109 years
                   48        ... 110 - 114 years
                   49        ... 115 - 119 years
                   50        ... 120 - 124 years
                   51        ... 125 years and over
                   52        ... Age not stated
  69-70     2    Age of Death Recode #2 (*)
                 
                   11        ... 25 - 29 years                                            
                   12        ... 30 - 34 years    
                   13        ... 35 - 39 years 
                   14        ... 40 - 44 years          
                   15        ... 45 - 49 years         
                   16        ... 50 - 54 years                        
                   17        ... 55 - 59 years                                       
                   18        ... 60 - 64 years
                   19        ... 65 - 69 years
                   20        ... 70 - 74 years                                                 
                   21        ... 75 - 79 years      
                   22        ... 80 - 84 years                     
                   23        ... 85 - 89 years                                    
                   24        ... 90 - 94 years                                                
                   25        ... 95 - 99 years
                   26        ... 100 years and over                                            
                   27        ... Age not stated
                                                                              
  71-72     2 

  Age of Death Recode #3 (*)
                   05        ... 25 - 34 years
                   06        ... 35 - 44 years
                   07        ... 45 - 54 years
                   08        ... 55 - 64 years
                   09        ... 65 - 74 years
                   10        ... 75 - 84 years
                   11        ... 85 years and over
                   12        ... Age not stated 
    73-74     2    Blank
    (75)         SPECIAL INSTRUCTION:  for deaths occurring in 1988 and 
                 earlier, use definition (a).  For deaths occurring in                    
                 1989 and later, use definition (b).  The two definitions
                 are a result of a change in coding rules.
     75     1    (a) Place of Death -- Hospital and 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         ... Hospital, clinic or medical center                                          
                                 - Patient status not on certificate                           
                   6         ... Other institutions providing patient 
                                 care               
                   7         ... All other reported entries                         
                   8         ... Dead on arrival                                                   
                                 - Hospital, clinic or medical center name                                    
                                   not given                                                   
                   9         ... Hospital and patient status not stated     
                                                        
                 (b) Place of Death -- Decedent's 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
     76     1    Blank
     77     1    Marital Status
                   1         ... Never married, single
                   2         ... Married
                   3         ... Widowed
                   4         ... Divorced
                   8         ... Marital status not on certificate
                   9         ... Marital status not stated
  78-83     6    Blank
     84     1    Autopsy Performed
                   1         ... Yes                                                      
                   2         ... No                                                            
                   8         ... Autopsy performed not on certificate   
                   9         ... Autopsy performed not stated       
 
                                                                              85-140   56 
  Blank
     141    1    Place of Accident for Causes E850-E929
                   0         ... Home
                   1         ... Farm
                   2         ... Mine and quarry
                   3         ... Industrial place and premises
                   4         ... Place for recreation and sports
                   5         ... Street and highway
                   6         ... Public building
                   7         ... Resident institution
                   8         ... Other specified place
                   9         ... Place of accident not specified
                   Blank     ... Causes other than E850-E929
(142-159)  18    UNDERLYING CAUSE OF DEATH
 142-145    4    ICD Code (9th Revision)
                   See the Manual of the International Statistical
                   Classification of Diseases, Injuries, and Causes of
                   Death:  Based on the Recommendations of the Ninth
                   Revision Conference, 1975, and Adopted by the Twenty-
                   ninth World Health Assembly, Volume 1, 1977 (World
                   Health Organization).  For injuries and poisonings, the
                   external cause is coded (E800-E999) rather than the
                   Nature of Injury (800-999).  These positions do not
                   include the letter E for the external cause of injury.
                   For those causes that do not have a 4th digit,
                   position 145 is blank.
 146-150    5    Cause-of-Death Recode -- 282 Groups
                                                      
                   A recode of the ICD-9 cause-of-death code into 282
                   groups for NCHS publications.  See Appendix 1 for a                    
                   complete list of recodes and the causes included.
                   00100-35800 ... Code range (not inclusive)
 
 151-153    3    Cause-of-Death Recode -- 72 Groups
                                                      
                   A recode of the ICD-9 cause-of-death code into 72
                   groups for NCHS publications.  See Appendix 2 for a
                   complete list of recodes and the causes included.
                   010-840   ... Code range (not inclusive)
 154-156    3    Blank
 157-159    3    Cause-of-Death Recode -- 34 Groups (*) 
                                                       
                   A recode of the ICD-9 cause code into 34 groups for
                   NCHS publications.  See Appendix 3 for a complete list
                   of recodes and the causes included.
                   010-370   ... Code range (not inclusive)
(160-440)  281   MULTIPLE CONDITIONS
 160-161    2    Number of Entity-Axis Conditions                                         
                            
                   01-20     ... Code range (not inclusive)                 
 162-301   140   ENTITY - AXIS CONDITIONS
                   Space has been provided for maximum of 20 conditions.  
                   Each condition takes 7 positions in the record.
                   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
                                    1-8     ... Code range
                  Positions 3 - 6: ICD-9 condition code
                                   See the Manual of the International
                                   Statistical Classification of Diseases,
                                   Injuries, and Causes of Death: Based on the
                                   Recommendations of the Ninth Revision
                                   Conference, 1975, and Adopted by the Twenty-
                                   ninth World Health Assembly, Volume 1, 1977
                                   (World Health Organization) for a complete
                                   list of codes.
                   Position 7:     Nature of Injury Flag
                                   1       ... Indicates that the code in         
                                               positions 3-6 is a Nature               of
                                               Injury code
                                   0       ... All other codes
 162-168    7     1st Condition
 169-175    7     2nd Condition
 176-182    7     3rd Condition
 183-189    7     4th Condition
 190-196    7     5th Condition
 197-203    7     6th Condition
 204-210    7     7th Condition
 211-217    7     8th Condition
 218-224    7     9th Condition
 225-231    7     10th Condition
 232-238    7     11th Condition
 239-245    7     12th Condition
 246-252    7     13th Condition
 253-259    7     14th Condition
 260-266    7     15th Condition
 267-273    7     16th Condition
 274-280    7     17th Condition
 281-287    7     18th Condition
 288-294    7     19th Condition
 295-301    7     20th Condition
 302-337   36    Blank
 338-339    2    Number of Record-Axis Conditions
                  01-20     ... Code range (not inclusive)
     340    1    Blank

(341-440) 100    RECORD - AXIS CONDITIONS
                  Space has been provided for a maximum of 20 conditions.  Each
                  condition takes 5 positions in the record.  Records that do not
                  have 20 conditions are blank in the unused area.
                               
                  Positions 1 - 4: ICD-9 condition code
                                   See the Manual of the International
                                   Statistical Classification of Diseases,
                                   Injuries, and Causes of Death: Based on the
                                   Recommendations of the Ninth Revision
                                   Conference, 1975, and Adopted by the Twenty-
                                   ninth World Health Assembly, Volume 1, 1977
                                   (World Health Organization) for a complete
                                   list of codes.
                  Position 5:      Nature of Injury Flag
                                   1       ... Indicates that the code in
                                               positions 1-4 is a Nature 
                                               of Injury code
                                   
                                   0       ... All other codes
 341-345    5     1st Condition
 346-350    5     2nd Condition
 351-355    5     3rd Condition
 356-360    5     4th Condition
 361-365    5     5th Condition
 366-370    5     6th Condition
 371-375    5     7th Condition
 376-380    5     8th Condition
 381-385    5     9th Condition
 386-390    5     10th Condition
 391-395    5     11th Condition
 396-400    5     12th Condition
 401-405    5     13th Condition
 406-410    5     14th Condition
 411-415    5     15th Condition
 416-420    5     16th Condition
 421-425    5     17th Condition
 426-430    5     18th Condition
 431-435    5     19th Condition
 436-440    5     20th Condition




This page last reviewed: Thursday, January 28, 2016
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