Scientific Data DocumentationNational Nursing Home Survey Followup: Mortality Data, 1990DSN: CC37.NNHS90F.MORT ABSTRACT DATA USE RESTRICTIONS Read Carefully Before Using The Public Health Service Act (Section 308 (d)) provides that the data collected by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), may be used only for the purpose of health statistical reporting and analysis. Any effort to determine the identity of any reported case is prohibited by this law. NCHS does all it can to assure that the identity of data subjects cannot be disclosed. All direct identifiers, as well any characteristics that might lead to identification, are omitted from the dataset. Any intentional identification or disclosure of a person or establishment violates the assurances of confidentiality given to the providers of the information. Therefore, users will: 1. Use the data in this dataset for statistical reporting and analysis only. 2. Make no use of the identity of any person or establishment discovered inadvertently and advise the Director, NCHS, of any such discovery. 3. Not link this dataset with other individually identifiable data from NCHS or other sources with the exception of the National Nursing Home Survey Followup tapes described in this document. By using these data you signify your agreement to comply with the above-stated Statutorily-based requirements.BACKGROUND Introduction to the NNHSF Mortality Data Tape Documentation The National Nursing Home Survey Followup (NNHSF) is a longitudinal study which follows the cohort of current residents and discharged residents sampled in the l985 National Nursing Home Survey (NNHS). The NNHSF builds on the data collected in 1985 NNHS by extending the period of observation by approximately 5 years and providing longitudinal information on nursing home and hospital utilization. The followup consists of three waves of data collection. Wave I was conducted from August through December 1987. Wave II began in July 1988 and ended in November of that same year. Wave III interviewing began in January 1990 and was completed in April 1990. The study was a collaborative project between the National Center for Health Statistics (NCHS), Centers for Disease Control (CDC) and the National Institute on Aging (NIA). The 1985 NNHS collected a variety of information about long-term care facilities and their residents. Data were collected on a sample of patients who were current residents at the time of contact with the facility as well as a sample of discharges that occurred within the 12 months prior to the facility contact. There were 5,243 current residents and 6,023 discharges. For the current residents, detailed information was collected regarding dependence in activities of daily living, functional impairments, diagnoses, the receipt of services, cognitive and emotional status, charges, source of payments, and a number of other topics of considerable prognostic significance. For the discharged residents, detailed information was obtained regarding diagnoses and services, nursing home and hospital use prior to the sampled nursing home stay, hospitalizations during the sample stay, and nursing home readmissions subsequent to the sample stay. To supplement the current and discharged resident components, the l985 NNHS included a Next-of-Kin (NOK) component. The NOK interview, using a Computer Assisted Telephone Interviewing (CATI) system, was designed to collect information about current and former nursing home residents that is not generally available from patient records or other sources in the nursing home. Information on the resident's characteristics prior to admission and history of prior nursing home utilization was collected. The Next-of-Kin questionnaire was administered to a family member, the former resident, an institutional representative, or another knowledgeable person who could answer questions about the resident. All residents for whom a Current Resident Questionnaire (CRQ) or a Discharged Resident Questionnaire (DRQ) had been completed during the field data collection portion of the NNHS were eligible for the NOK component. As stated earlier, the current resident file contained 5,243 cases and the discharge resident file contained 6,023 sample discharge cases. Since the DRQ sample is an event sample, an individual resident could have more than one stay in the discharged resident sample and/or could have stays in both the current resident and discharged resident samples. The NOK, however, was designed to follow residents and not events. Thus, only the first stay for any resident was eligible for the NOK. Eleven thousand one hundred and eighty one (11,181) individuals, - 5,200 CRQ's and 5,981 DRQ's, were identified on the resident CRQ/DRQ tapes after accounting for those residents who had more than one sampled stay. Of those eligible, 9,077 respondents were interviewed. Thirty three percent (n=3,023) of the sample were found to be deceased at the NOK. The Next-of-Kin interview was conducted about three months after the facility contact, beginning in October, l985. The National Nursing Home Survey Followup obtained additional information on a portion of the residents for whom a CRQ or a DRQ was completed. Of the 6,607 subjects who were identified for inclusion in Wave I, interviews were completed for 6,001 subjects. At the time of Wave II, 4,040 subjects were eligible for interviewing. Some information was collected on 3,868 subjects. Three thousand one hundred and twenty one (3,121) subjects were identified as potentially eligible for Wave III. Some information was obtained at Wave III on 3,041 subjects. In all waves of the followup, the preferred respondent was someone who knew about the subject's experiences since the last contact. Facility respondents were used if the subject was a nursing home resident at the last contact and community based respondents were used if the subject had been discharged into the community. The survey was designed to allow more than one respondent to be used, if necessary, in order to maximize the amount of information collected. For example, if a community respondent was contacted and in the course of the interview it was learned that the subject had been readmitted to a facility, that facility was then contacted, if necessary, to obtain information on utilization since that admission as well as information on current status. Conversely, if a facility was contacted initially and in the course of the interview it was learned that the subject had been discharged, a new respondent was contacted (either a relative, or the subject depending on the type of discharge) if necessary, to provide information on the subject's current status. Usually, the respondent who provided the information at the previous wave was the first respondent contacted at the next wave. Although more than one respondent could be contacted for data collection purposes, information was merged from all respondents concerning a subject to provide one complete, consecutive record of nursing home and hospital stays. The NNHSF interviews were conducted using a CATI system. With CATI, data collection and data entry are concurrent and computer- controlled. The CATI questionnaire used for the NNHSF was a modified version of the questionnaire developed for the Next-of- Kin Component of the 1985 NNHS. At each wave, questions concerning vital status, nursing home and hospital utilization since the last contact, current living arrangements, Medicare number and source of payment were asked. Programming was slightly modified at Wave II and again at Wave III. Unless otherwise specified on the questionnaire, the same set of questions was asked irrespective of whether the respondent was a subject, next-of-kin, or a facility official. Approximately 1-2 weeks before the start of the data collection period, advance letters were mailed to respondents. A letter was mailed to each primary respondent for whom an address was available. A special introductory paragraph which included the contents of the letter was added to the questionnaire for respondents for whom no address was available. Upon contacting the appropriate respondent, the interviewer proceeded with the interview, if possible, or scheduled a time to call back. A minimum of five attempts were made to contact each potential respondent for whom there appeared to be a workable telephone number. Many of the respondents were the facilities in which the residents were living at the time of the field interview. To reduce the number of contacts with these facilities, the letter listed all the subjects about whom the facility would be asked. This eliminated the need for multiple letters to the same nursing home. The CATI questionnaire was programmed to allow the interviewer to complete all cases within a sample nursing home on one call without having to reread the introduction. If a sample nursing home refused to participate or could not be contacted, all cases that should have been completed by the facility were changed to "proxy" interviews. In some cases the names of the proxies to be contacted were given by the facility; in most cases, however, interviewers had to use the names listed in the CATI respondent roster for the NOK questionnaire. If the designated respondent could not or would not participate, the interviewer attempted to obtain the name and telephone number of another potential respondent. If the designated respondent could not be located, other contact names that were in the NOK CATI file were examined and attempts were made to locate and interview another individual. Detailed information on the design, content, and operation of the NNHSF may be found in the Plan and Operation of the National Nursing Home Survey Followup, 1987, 1988, 1990, Vital and Health Statistics, Series 1, No. 30. The data collected from the NNHSF are stored on four separate tapes: 1) National Nursing Home Survey Followup: Wave I, 1987, 2) National Nursing Home Survey Followup: Wave II, 1988, 3) National Nursing Home Survey Followup: Wave III, 1990, and 4) National Nursing Home Survey Followup Mortality Data Tape, 1984-1990. This tape is discussed below.DESCRIPTION OF THE NNHSF MORTALITY TAPE To create the Mortality data tape, record linking and matching of files had to be performed. The NNHSF matched survey records with two record bases: The National Death Index (NDI), the computerized records of deaths in the United States maintained by NCHS, and the Multiple Cause-of-Death file maintained by NCHS. The NDI is a computerized file of death record information compiled from magnetic tapes submitted under contractual arrangements to NCHS by the State vital statistics offices. The NDI can be used only for statistical purposes in medical and health research. An application to obtain information from the NDI was submitted to the Division of Vital Statistics (DVS) within NCHS. The application was reviewed and approved by the Director of NCHS and by an advisory panel composed of persons not employed by NCHS. The application included a statement of the purpose and objectives of the match, the number of records to be matched, how the NDI data would be used, and how and to whom the results would be released. Matching to the NDI determined if persons in the NNHSF who were alive at the last contact had died or if a date of death obtained during one of the followup waves was accurate. A file containing 12,348 NNHSF records was sent to DVS requesting information for the years 1984 through 1990. Information submitted for use in the NDI match included: first, middle and last name; social security number; month, day and year of birth; sex, race, marital status and state of residence. For each decedent, the NDI provided the name of the State where the death occurred, the corresponding death certificate number, and the date of death. The matching criteria in the NDI retrieval program were designed such that the number of potential matches identified would be maximized. Because of this design feature, the retrieval program generated a significant number of false matches. All NDI matches were examined and false ones were identified.NDI MATCHING CRITERIA A scoring algorithm was developed to determine the quality of the NDI match. The following methodology was used to assess the probability of obtaining a true match: 1. Each potential match was assigned an initial score of 0. Points were added to the score for each of the following field level matching situations between the user submitted field value and the value in the NDI record: 10 points if last names match exactly 2 points if middle initials match or user provided no middle initial 5 points if first names match exactly 3 points if user last name sounds like the NDI last name 1 point if first initial of user first name field matches 3 points if first initial of first name matches and user first name sounds like NDI first name 5 points for each digit of the social security numbers that matches 4 points if days of birth match 4 points if months of birth match 8 points if years of birth match 4 extra points if 2 of 3 birth date fields match or 9 extra points if all three birth date fields match 1 point if user birth year is within two years (plus or minus) of the NDI birth year or 3 points if user birth year is within one year (plus or minus) of the NDI birth year 10 points if sex fields match 1 point if race fields match 1 point if marital status fields match 1 point if state of residence fields match 2. Records where all user provided data match NDI data were initially considered true matches. 3. Records with scores above 85 were also initially considered true matches as long as there was only one such possible match for a given person. Where more than one exact match and/or match with a score of 85 or more occurred for a given person, the matches were adjudicated by hand. Records with scores between 50 and 85 were also adjudicated by hand. 4. The Social Security Number accounted for 45 points in the total score of 100. Records with scores less than 50 were considered and adjudicated using the remaining available data if either the NNHSF or NDI data was missing the Social Security Number. Primary consideration was given to name and birth date. Regardless of score, the death date on all selected matches was compared with dates of death collected during the field and followup surveys. Before being finalized as a true match, the NDI death date was evaluated with respect to the date that the subject was reported to have died or was last thought to be alive as well as the relationship to the subject of the source of this vital status information. In a few situations the date of death obtained from the probable NDI match was inconsistent with the date the subject had been reported deceased or last known alive, but there was also reason to believe the respondent would not have known the exact date of death. For these cases, the probable match has been included with the file. Such matches have been coded and the user may include them in analysis at his or her discretion. Of the 12,348 records originally sent to NDI for matching, 6,507 of those matches were found to be true or highly probable matches. These were then matched to the NCHS multiple cause-of-death file.MULTIPLE CAUSE-OF-DEATH FILE Multiple cause-of-death data have been obtained for the NNHSF sample persons who were identified as deceased in the NDI match. To obtain information from the multiple cause-of-death file, a memorandum requesting permission for the linkage was submitted to the Director of Vital Statistics (DVS), National Center for Health Statistics. This memorandum described the objectives of the survey, the confidentiality provisions taken by the study staff, and the plans for the release of the data. The data can be used only for the purposes described in the NDI application. Permission was granted to match the NNHSF decedents identified in the NDI match with the multiple cause-of-death file maintained by NCHS. Based on the contracts with the States, such permission may be granted only under NCHS' own legislative authority. Only matches identified by the NDI match as "true" and "probable" were sent for matching to the multiple cause-of-death file. The file sent for matching the multiple cause-of-death file had to conform to the format specified in the National Death Index User's Manual (9). The linkage itself was performed by the DVS Systems and Programming Branch, which is responsible for linking the decedent cases identified by the NDI match with the multiple cause-of-death file.MORTALITY DATA TAPE The NNHSF Mortality Public Use tape contains the multiple cause- of-death information for all 6,507 subjects for whom a match was selected from the NDI. Data for these subjects was obtained from their last and/or final interview. There were 633 (9.7%) subjects who had only the 1985 baseline interview from which to provide information. Data was last obtained at the NOK for 2,575 (39.6%) subjects who were not in any of the later followup waves. Wave I had 1,685 (25.9%) completed interviews with no additional waves; Wave II had 616 (9.5%) completed interviews with no Wave III followup; and Wave III interviews were completed for 998 (15.3%) of the total subjects. Positions 10-16 in the data tape contain the Identification Number. This number is unique for each subject and is used when linking files. By using the ID Number, the NNHSF Mortality Data tape can be linked to all the 1985 NNHS data tapes and to each wave of the three NNHSF data tapes. The NNHSF Mortality Public Use Data tape follows the coding specifications used for the NCHS Multiple Cause-of-Death Public Use Data tapes. An asterisk next to variables listed in the record layout documentation indicates that the variable was generated from NNHSF data. All other variables are extracted directly from the NCHS multiple cause-of-death file. Questions Questions concerning data on this tape should be directed to the Division of Epidemiology, National Center for Health Statistics, 6525 Belcrest Road, Hyattsville, Maryland 20782.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 for Coding Procedures 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.NNHSF MORTALITY DATA TAPE CHARACTERISTICS Title: NNHSF Mortality Data Tape Data Set Name: NNHSF.MORTTAPE.PUB90 Record Length: 440 Blocksize: 23,320 Number of Records: 6,507 Recording Mode: FIXED BLOCK, EBCDIC Density: IBM 3480 cartridge tape Created by: Office of Analysis, Epidemiology and Health Promotion Division of Epidemiology National Center for Health Statistics Presidential Building, Room 750 6525 Belcrest Road Hyattsville, Maryland 20782RECORD LAYOUT Tape Locations 1-40 Tape Field Variable Description and Codes Pos. Size 1-2 2 Year of Death 84-90 ... Year of death (1984-1990) (Note: Month and Day of Death are stored in tape locations 55-56 and 57-58, respectively.) 3-9 7 Blank 10-16 7 NNHSF ID * 17 1 Quality of Match * (Note: Records where all NNHSF data match NDI data were considered exact matches. Records were also accepted as matches if they met the criteria of the NNHSF scoring algorithm. However, in some cases the multiple cause dates of death conflicted with information received in the NNHSF interviews but met the scoring algorithm. We therefore included them in the file. These cases can be identified by the user.) 1 ... Exact NDI match 2 ... Not an exact NDI match but selected 3 ... Meets the criteria of the NNHSF scoring algorithm but contains conflicting dates 18 1 Blank __________________ * indicates that the variable was generated from NNHSF data. All other variables are extracted directly from the NCHS multiple cause-of-death file. 19 1 Record Type 1 ... RESIDENT (where subject lived) State and County of Occurrence and Residence are the same. 2 ... NONRESIDENT (place of death) State and/or County of Occurrence and Residence are different. 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 Divisions are coded within Regions and States are coded within Divisions. Location 26 is Region. Location 27 is Division. 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 2 ... MIDWEST 3 ... East North Central ... Ohio ... Indiana ... Illinois ... Michigan ... Wisconsin 4 ... West North Central ... Minnesota ... Iowa ... Missouri ... North Dakota ... South Dakota ... Nebraska ... Kansas 26-27 2 Region and Division of Occurrence of Death -- Continued Loc. Loc. 26 27 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 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. or unknown Z ... Foreign resident 40 1 Metropolitan - Nonmetropolitan County of Residence 1 ... Metropolitan county 2 ... Nonmetropolitan county Z ... Foreign resident 9 ... Unknown Tape Locations 41-54 41-42 2 Region and Division of Residence Divisions are coded within Regions and States are codeded within Divisions. Location 41 is Region. Location 42 is Division. 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 4 ... West North Central ... Minnesota ... Iowa ... Missouri ... North Dakota ... South Dakota ... Nebraska ... Kansas 41-42 2 Region and Division of Residence -- Continued Loc. Loc. 41 42 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 4 ... WEST 8 ... Mountain ... Montana ... Idaho ... Wyoming ... Colorado ... New Mexico ... Arizona ... Utah ... Nevada 9 ... Pacific ... Washington ... Oregon ... California ... Alaska ... Hawaii 43-48 6 Blank 49 1 Population Size of County of Occurrence Based on the results of the 1980 Census 0 ... County of 1,000,000 or more 1 ... County of 500,000 to 1,000,000 2 ... County of 250,000 to 500,000 3 ... County of 100,000 to 250,000 9 ... County of less than 100,000 (Note: This information is available only for 1989 and later. For earlier years, the field will be blank.) 50 1 Population Size of County of Residence Based on the results of the 1980 Census 0 ... County of 1,000,000 or more 1 ... County of 500,000 to 1,000,000 2 ... County of 250,000 to 500,000 3 ... County of 100,000 to 250,000 9 ... County of less than 100,000 Z ... Foreign resident (Note: This information is only available for 1989 and later. For earlier years, the field will be blank.) (51) 1 SPECIAL INSTRUCTION: For deaths occurring in 1989 use definition (a). For deaths occurring in 1990 or later, use definition (b). For deaths occurring in 1988 and earlier, the field will be left blank. The two definitions are a result of a change in coding rules. 51 1 (a) Population Size of SMSA Based on the results of the 1980 Census 1 ... SMSA of 250,000 or more 2 ... SMSA of 100,000 to 250,000 3 ... SMSA of less than 100,000 9 ... Nonmetropolitan area Z ... Foreign resident (b) Population Size of PMSA/MSA Based on 1990 Census county population counts 1 ... Area of 250,000 or more 2 ... Area of 100,000 to 250,000 3 ... Area of less than 100,000 9 ... Nonmetropolitan area Z ... Foreign resident 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 1989 and later. For earlier years, the 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 1989 and later. For earlier years, the field will be blank.) Tape Locations 55-74 (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 (Note: Sex is taken from the 1985 NNHS baseline data.) (60-63) 4 RACE 60-61 2 Detail Race 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 (Note: Detail Race is coded according to the 1989 Detail Race coding structure.) 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 AT DEATH * (Note: For subjects where an acceptable birthdate was collected at the NNHS baseline, the age at death is calculated using the baseline data. For subjects where no acceptable birthdate is available, age at death is taken from the Multiple Cause Record. Position 114 indicates the source of this age.) 64-66 3 Detail Age at Death * 022-109 ... Age in years (not inclusive) 67-68 2 Age of Death Recode #1 * 30 ... 20 - 24 years 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 69-70 2 Age of Death Recode #2 * 10 ... 20 - 24 years 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 71-72 2 Age of Death Recode #3 * 04 ... 15 - 24 years 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 73-74 2 Blank Tape Locations 75-141 (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 78-79 2 Blank (80-81) 2 SPECIAL INSTRUCTION: For deaths occurring in 1989 or earlier, use definition (a). For deaths occurring in 1990 or later, use definition (b). The two definitions are a result of a change in coding rules. 80-81 2 (a) Origin or Descent 00 ... Non-Spanish 01 ... Mexican 02 ... Puerto Rican 03 ... Cuban 04 ... Central or South American 05 ... Other or Unknown Spanish 06 ... American 07 ... American Indian 08 ... British, Scottish, Welsh, Scotch-Irish 09 ... Irish 10 ... German 11 ... French 12 ... Norwegian, Swedish, Danish 13 ... Polish 14 ... Italian 15 ... Other North, Central, and South American 16 ... Other Western European 17 ... Other Northern European 18 ... Other Eastern European 19 ... Other Southern European (excluding Spain) 20 ... Southeast Asian and Pacific Islander 21 ... South Central Asian 22 ... Other Asian 23 ... North African 24 ... Other African 88 ... Not reported 99 ... Not classifiable 80-81 (b) Origin or Descent 00 ... Non-Hispanic 01 ... Mexican 02 ... Puerto Rican 03 ... Cuban 04 ... Central or South American 05 ... Other or Unknown Hispanic 99 ... Unknown 82-83 2 Blank 84 1 Autopsy Performed 1 ... Yes 2 ... No 8 ... Item "Autopsy performed" not on certificate 9 ... Item "Autopsy performed" left blank 85-90 6 Blank 91-93 3 52 Cause Recode A recode of the cause code into 52 groups designed for use in producing tabulations. Appendix 1 contains a complete list of recodes and categories. 010-560 ... Code range (not inclusive) 94-113 20 Blank 114 1 Source for Age at Death * 1 ... Age is calculated from the baseline data. 2 ... Age is taken from the Multiple Cause Record. 115-140 26 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 Tape Locations 142-340 (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, location 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 2 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 3 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 4 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 00-20 ... 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 1-9 ... 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 00-20 ... Code range (not inclusive) 340 1 Blank Tape Locations 341-440 (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
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