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Scientific Data Documentation
National Nursing Home Survey Followup: Mortality Data, 1990
DSN: 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  20782
RECORD 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




This page last reviewed: Thursday, January 28, 2016
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