1 naphsis – 75 years highlights from the history of vital statistics reporting

1

NAPHSIS – 75 YearsHighlights from the History of Vital

Statistics Reporting

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1721 First smallpox inoculation

1842 First registration law (births, deaths, and marriages) was enacted

1869 Law enacted creating State Board of Health

1873 First venereal disease clinic in the nation started in Boston

1891 Food and Drug Laboratory established- first of its kind

1927 First state-supported cancer clinics opened

1962 Mandatory PKU (phenylketonuria) screening required in newborns

1971 First to require childhood lead poisoning prevention

1985 First health hazard warnings on smokeless tobacco products

1992 First mandatory reporting & surveillance of work-related injuries and occupational illness of persons under age 18

2000 Children’s and Families’ Protection Act

Massachusetts Public Health Milestones

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MA Infant Mortality Rate 1842 to 2006

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

184218461850185418581862186618701874187818821886189018941898190219061910191419181922192619301934193819421946195019541958196219661970197419781982198619901994199820022006

IMRTrend (Joinpoint)

1902

1953

1964

APC 1 = 0.48* APC 3 =

0.86

APC 2 = -3.85*

APC 4 = -3.91*

4

1858150 Years Ago

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1858 - History• Edwin T. Holmes installs 1st electric burglar alarm (Boston,

Massachusetts) • Pencil with attached eraser patented by Hyman L. Lipman• Abraham Lincoln says "A house divided against itself cannot stand" • Fee 1st charged to see a baseball game (50 cents ) (New York beats

Brooklyn 22-18)

6

1858Queen Victoria and President Buchanan exchange

messages over the first transatlantic cable

7

1858 • Guillaume-Benjamin-Amand Duchenne

documented the case of a 9-year-old boy who was losing the ability to walk due to a muscle-wasting disease.

• Demonstration of the contagious nature of puerperal fever (childbed fever) (Ignaz Semmelweis)

8

1858Charles Darwin publishes the Origin of the Species

by Means of Natural Selection in 1859

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Highlights From the 17th Annual MA vital statistics report - 1858

• There were 84 pages of text, followed by 11 tables for 1858 and

9 tables for 1852 to 1858• The birth tables included “Plurality Births” (684, 2%; 339 sets of twins;

2 sets of triplets) and “Illegitimate Births” (293, 75 or 26% at the state almshouses);

• “Persons Married by “Conjugal Conditions”, i.e., “Bachelors to Maids (8,108)”, “Bachelors to Widows (451)”, “Widowers to Maids(1,207)”, “Widowers to Widows (613)“; seasons: “the largest number of marriages are associated with the festivities of our annual Thanksgiving holidays, which occur in the month of November”

• “The year 1858 was one of comparative immunity from excessive death”

• Statistics were compared with those of England, e.g., mean duration of life for Massachusetts = 40 years, for England in 1841, 41 years.

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MA Vital Statistics - 1858

34,491

10,527

20,776

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

1858

Bir t hs

Deat hs

Mar r iage

Population 1,191,568

11

1908(100 Years Ago)

12

1908• Henry Ford mass produces the Model

T.• British suffragettes begin a campaign

for female suffrage.• Bureau of Investigation, forerunner of

the FBI, is founded. • Grand Canyon National Monument is

designated (becomes a National Park in February 1919).

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VITAL STATISTICS IN SOME MUNICIPAL REPORTS*. CRESSY L. WILBUR, M. D.

Chief Statistician, Bureau of the Census, Washington, D. C.

* Read before the Joint Session of the Sections of Municipal Health Officers and Vital Statistics, American Public Health Association, Colorado Springs, September, 1913. Am J Public Health, 1914 Feb 01, 120-574

…There were 109 cities of this size (50,000), out of which number the annual reports of eighty-six were available for either 1910, 1911, or 1912. In these eighty-six reports there were about 6,395 pages devoted to matters of public health, of which 1,782 pages, or 27 per cent, consisted of tables or discussions of vital statistics. The fact that over one fourth of the permanent printed records of the activity of the municipal health departments of the country consists of vital statistics would seem to indicate that great care should be taken to make such records accurate, precise, and thoroughly comparable with those of other cities, of the states, and of the nation. Yet it is extremely difficult, in a very large proportion of cases, to obtain exact information in regard to some of the most elementary facts, such, for example, as the total number of births (living births, exclusive of stillbirths), the total number of deaths (again exclusive of stillbirths but inclusive of all other deaths of children born alive that occurred in the area under consideration), or the causes of death (properly compiled in accordance with the International List, and hence comparable with the statistics of other offices).

… great care should be taken to make such records accurate, precise, and thoroughly comparable with those of other cities, of the states, and of the nation.Yet it is extremely difficult… [to] obtain exact information in regard … the total number of births (living births, exclusive of stillbirths), the total number of deaths (again exclusive of stillbirths but inclusive of all other deaths of children born alive that occurred in the area under consideration), or the causes of death (properly compiled in accordance with the International List, and hence comparable with the statistics of other offices)

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At the outset one is met by the difficulty that a considerable proportion(nearly one fifth) of the eighty-six reports examined are for years other than the calendar year. This makes the compilations practically worthless for many purposes of comparison.

The total number of deaths for the same group of sixty-seven cities(326,884) also slightly exceeded the number compiled by the census forthe same cities and years (326,505). The difference, only 379 deaths, maynot fully represent deaths not returned because the figures for certain city reports include stillbirths.

Some of the offices attempting to make use of the International List [of Causes of Death] , either in its original or revised editions, have seen fit to modify it, sometimes even adding new divisions or groups, so that the purpose of uniformity and comparability is entirely or largely defeated..

VITAL STATISTICS IN SOME MUNICIPAL REPORTS. Cressy, 1914, Continued

[reports are for] other than the calendar year.. This makes the compilations practically worthless for many purposes of comparison.

[The number of deaths]…May not fully represent deaths … because the figures for certain city reports include stillbirths.

Some of the offices …have seen fit to modify[the International List of Deaths], sometimes even adding new divisions or groups, so that the purpose of uniformity and comparability is entirely or largely defeated…

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POPULARIZING VITAL STATISTICSC. ST. CLAIR DRAKE, M. D.,

Director, Illinois State Department of Public Health, Springfield, Illinois.

* Read before Section on Vital Statistics, American Public Health Association, at New Orleans, La.,October 29, 1919. 1920 Feb 01, Am J Public Health, 112-574.

Fitting dry-as-dust vital statistics to the psychology of the people is one of the most important problems in modem popular health education. For the benefit of brother health officers Dr. Drake gives a few leaves out of his own experience in impressing fundamental statistical truths on a public that demands interesting presentation together with pictures and variety and novelty.

…It has long been recognized that the average citizen, rich or poor, can appreciate the value of dollars and cents more clearly than that of human life or human efficiency and, on this account, a common method of popularization of vital statistics has come to be the expression of human wastage in terms of money.

…It has long been recognized that the average citizen, rich or poor, can appreciate the value of dollars and centsmore clearly than that of human life

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Some years ago, when it seemed particularly desirable to impress upon the people of Chicago the unnecessary wastage due to communicable diseases and when mere words, however expressive, seemed to arouse little attention, we employed the plan of measuring the cost of these diseases to the several city wards in silver dollars and illustrated the cost by pictures showing these piles of dollars as compared in height with the Masonic Temple, then the highest and best known building in the city. When it was shown that diphtheria, scarlet fever and measles, for a period of six months, had cost one city ward a stack of silver dollars over nine times as high as the twenty-story Masonic Temple, there was general surprise and very extensive discussion, … the important thing was that a much larger percentage of the Chicago population was thinking of the value of health more definitelythan it had been formerly.

POPULARIZING VITAL STATISTICS, DRAKE, Continued

When it was shown that diphtheria, scarlet fever and measles, for a period of six months, had cost one city ward a stack of silver dollars over nine times as high as the twenty-story Masonic Temple, there was general surprise and very extensive discussion, the important thing was that a much larger percentage of the Chicago population was thinking of the value of health more definitelythan it had been formerly.

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Highlights from the 67th Annual MA Vital Statistics Report - 1908

• Used the 1st (1900) Revision of the International Classification of Causes of Death

• Number of tables was reduced from the 90s and tables with no “practical utility” were eliminated

• Omitted tables that depended on the decennial census

• Statistics on “illegitimate births” were omitted because they would be “practically a violation of the law”

• “The statistics of the births is less accurate than [those of marriage and births]”

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51,788

27,071

1,766

86,911

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

1908

Births

Deaths

Marriage

Divorces


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1908 – Nativity of Mothers1

1Public Document 1, 1908, Secretary of Commonwealth of Massachusetts, accessed from http://www.books.google.com.

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% Non-U.S. Born Mothers Massachusetts: 1990-2006

27.0%

15.0%

0%

10%

20%

30%

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Pe

rce

nt

of

bir

ths

1995 +1.4% APC

+5.2%* APC

* Statistically Significant (p ≤.05) APC = Annual Percentage Change

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1933(75 Years Ago)

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1933• The Lone Ranger debuts on radio. • American President Herbert Hoover is

succeeded by Franklin D. Roosevelt • Great Depression: The U.S. Congress

begins its first 100 days of enacting New Deal legislation.

• The first Major League Baseball All-Star Game is played at Comiskey Park in Chicago.

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IT is not my purpose to review the rise and progress of preventive medicine. It is enough to say that with the concentration of population in the new industrial cities there came the beginning of sanitation. Then in the last half of the 19th century came the brilliant discoveries of Pasteur, Koch, and a host of other scientists, which now form the basis of the efficient work of the modern health officer. The record of these triumphs of sanitation and preventive medicine is the subject matter of vital statistics. Vital statistics are inseparable from preventive medicine just as accounting is inseparable from modern business. Without vital statistics the health officer, the modern public health administrator, would be working in the dark. He would have no means of measuring the degree of his success or failure…

The health officer does not need to be a vital statistician, any more than a business man needs to be an accountant, but he should be able to understand vital statistics and to use them effectively in his daily work. He should know the uses and the limitations of every device used in vital statistics, although he may depend upon his statistician to compute even the crude death rate and the infant mortality rate.

Statistics and the Health Officer*GEORGE B. L. ARNER, PH.D.,U. S. Bureau of the Census,

Washington, D. C.

* Read before Health Officers Section, American Public Health Association at Sixty-first Annual Meeting in Washington, D.C., October 24, 1932. Am J Public Health, 23, 28-34.

Vital statistics are inseparable from preventive medicine just a accounting is inseparable from modern business.

The health officer does not need to be a vital statistician, any more than a business man needs to be an accountant, but he should be able to understand vital statistics and to use them effectively in his daily work.

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Statistics, like the Holy Scriptures, are usually accepted on faith, and they lend themselves readily to the spreading of false doctrine. The devil can quote Scripture, and the booster, the propagandist, the high pressure salesman, and the unscrupulous advertiser can prove anything by statistics…

Vital statistics, as well as economic statistics, lend themselves readily to the use of the professional booster and to the health officer whose chief interest is his own self-glorification …

The health officer should understand and correctly interpret the findings of the statistician. For example, the crude death rate is frequently misused by those who do not understand its shortcomings. The crude death rate is easy to compute and readily understood, and is very useful within proper limits, but beyond those limits it may be grossly misleading. For comparisons between cities or between any two areas of different social composition, it is often improperly used. …

In order to make an honest comparison of death rates between one community and another, the death rate must be adjusted for residence and corrected for age. The adjustment of death rates for residence, as well as the adjustment of birth rates by residence of the mother, can only be made if the information as to residence is accurately stated on the death and birth certificates.

Statistics and the Health Officer, ARNER, Continued

The crude death rate is easy to compute and readily understood, and is very useful within proper limits, but beyond those limits it may be grossly misleading.

In order to make an honest comparison of death rates between one community and another, the death rate must be adjusted for residence and corrected for age

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1933In 1932, the Public Health Service, working with the Tuskegee Institute, began a study to record the natural history of syphilis in hopes of justifying treatment programs for blacks. It was called the "Tuskegee Study of Untreated Syphilis in the Negro Male."

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Names of NAPHSIS• 1933 American Association of State Registration Executives• 1938 American Association of State and Provincial

Registration Executives• 1939 American Association of Registration Executives

(AARE)• 1958 American Association for Vital Records and Public

Health Statistics (AAVRPHS)• 1980 Association for Vital Records and Health Statistics

(AVRHS)• 1995 Association for Public Health Statistics and

Information Systems (APHSIS)• 1996 National Association for Public Health Statistics and

Information Systems (NAPHSIS)

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Highlights from the From 92nd Annual MA Vital Statistics Report-1933

• “Death registration often gives the first intimation of pestilential disease, permitting health officers to attack epidemics in their incipiency.”

• Used 4th (1929) Revision of the International List of Causes of Disease

• “Heart Disease was the leading cause of death in 1933.”• “No accurate data are available [for death rate per number

of automobiles]…as the Department of Public Works show the number of machines registered, and thus contain duplications, since one machine may be registered more than once in a calendar year.”

• The birth rate (14.7 live births per 1,000 population) was the lowest ever recorded in MA, and the IMR was the lowest on record

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Highlights from the From 92nd Annual MA Vital Statistics Report-1933 (con’t.)

• “Marriages may be performed by … a minister of the gospel…a rabbi of the Israelitish faith…by a justice of the peace…among Friends or Quakers…no person shall solemnize a marriage…unless he can read and write in the English language”

• “The practical purposes of marriage records are: As evidence to establish dower and curtesy rights of husband and wife….for pension purposes… and to prove legitimacy of children”

• “The average number of years libellants were married at the time of application of divorce…was 10.4 years in 1933 …”

• Divorce table statistics were by cause of divorce: Desertion, Cruel and abusive treatment, Adultery, Intoxication, Non-support, Impotency, and Imprisonment. Cruel and abusive treatment was the leading cause.

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50,832

25,949

3,210

63,457

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

1933

Births

Deaths

Marriage

Divorces


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195850 Years Ago

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1958• The Soviet Union launches Sputnik 3. • Ted Williams oldest player in history to win

batting crown (.328) at age 40.• American League wins All-Star Game 4-3 in

Baltimore (on my birthday) • President Dwight D. Eisenhower signs the Alaska

Statehood Act into United States law. • Instant noodles go on sale for the first time. • A CDC team traveled overseas, for the first time,

to Southeast Asia to respond to an epidemic of cholera and smallpox

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VITAL STATISTICS -THEIR PAST AND FUTURECarl L. Erhardt, M.P.A., M.S. (Hyg.), F.A.P.H.A.

.

* This paper was presented before a Joint Session of the Association for VitalRecords and Public Health Statistics and the Statistics Section of the AmericanPublic Health Association at the Eighty-Sixth Annual Meeting in St. Louis, Mo.,October 27, 1958. Am J Public Health, 49: 192-196.

New ways of tabulating vital statistics are constantly adding to their usefulness. More detailed data are made available for small areas and the term "small areas" includes, in addition to census tracts or other traditional segments of a city, hospital service areas and individual hospitals. Greater emphasis is being placed on birth statistics; with reduction of infant mortality to a resistant plateau we have recognized that more information is needed about the course of the pregnancy and delivery. As a result, such facts as period of gestation, weight at birth, complications of pregnancy, and operative interventions are ascertained on the birth certificate for each delivery in most states and in some areas even more factors are investigated.

New ways of tabulating vital statistics are constantly adding to their usefulness. More detailed data are made available for small areas and the term "small areas" includes, in addition to census tracts or other traditional segments of a city, hospital service areas and individual hospitals.

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VITAL STATISTICS -THEIR PAST AND FUTURECarl L. Erhardt, M.P.A., M.S. (Hyg.), F.A.P.H.A.

.The relative stabilization of infant mortality has also stimulated more intensive investigation of prenatal mortality; a number of states now require reporting of all terminated pregnancies, regardless of period of gestation, in efforts to get better indications of the full extent of pregnancy wastage and to encourage further exploration of its causes…Administrative control of programs is demanding more extensive use of statistics. But here the statistician must urge extreme caution on the administrator lest the tail wag the dog. Collection of data for administrative purposes can become so detailed that the expense of its collection is unwarranted. Gaines phrased the idea succinctly when he said, "Be sure the juice is worth the squeeze." An even greater danger, however, is that the detail becomes so marked that no one any longer bothers to look at the material. The effort then becomes a complete waste, for we not alone squeeze more juice than is needed, but do not even drink any of it. .

…the statistician must urge extreme caution on the administrator lest the tail wag the dog. Collection of data for administrative purposes can become so detailed that the expense of its collection is unwarranted. Gaines phrased the idea succinctly when he said, "Be sure the juice is worth the squeeze." An even greater danger, however, is that the detail becomes so marked that no one any longer bothers to look at the material. The effort then becomes a complete waste, for we not alone squeeze more juice than is needed, but do not even drink any of it.

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Highlights from the 117th MA Vital Statistics - 1958

• “…the steadily declining rate [in infant mortality]…is largely due to constantly improving methods of infant feeding and the continued developments in community and home sanitation...”

• Causes of death were from the International Classification of Diseases, 7th Revision, 1955.

• Tx of Infant’s Eyes after birth: “Chapter 46, Acts of 1943 requires attending physician to record…the use of a prophylactic remedy with which he has treated the eyes of a child…”

• Married persons are now referred to as “Brides” and “Grooms”

• “Divorces on the grounds of desertion have decreased 28.5 per cent in the [last] twenty-five year[s]

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54,792

33,449

5,458

114,563

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

1958

Births

Deaths

Marriage

Divorces


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1983(25 Years Ago)

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1983• 1983: First gene is mapped • CDC established a Violence

Epidemiology Branch to apply public health prevention strategies to child abuse, homicide, and suicide.

• McDonald's introduces the McNugget

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Highlights from the 142nd

MA Vital Statistics - 1983• Uses ICD-9 International classification of

Diseases (WHO)• “≈ 2,000 copies of the report are distributed to

federal, state, and local agencies…” • “Although there appears to be a growing interest

in home births, such births accounted for only 439 births registered in 1983.”

• “The rank order of the ten leading causes of deaths changed slightly in 1983 with pneumonia and influenza in 4th place and accidents in 5th.

• “Heart disease (39.1%) and cancer (23.8%) are slightly higher that the U.S. percentages.”

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54,15048,789

18,477

76,031

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

1983

Births

Deaths

Marriage

Divorces


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2008The 75th Anniversary

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Highlights from MA Birth and Death Statistics - 2006

• “While the number of white non-Hispanic births remained stable, there were significant increases in the numbers of Hispanic (6.3%). Black Non-Hispanic (6.1%), and Asian (4.1%) births”

• “Gestational diabetes mellitus (GDM) is an emerging issue associated with an increased risk of developing overt diabetes…”

• “In 2006, the Cesarean section delivery rate rose …to an all time high of 33.4% of all deliveries.”

• “The age-adjusted death rate…fell to a record low of 717.6 deaths” per 100,000 population.”

• The International Classifications of Disease, Revision 10 (ICD-10) is used in the Deaths Report.

• “In 2006, cancer was the leading cause of death in Massachusetts, surpassing heart disease for the first time…”

• “There was a 23% increase in the number of poisoning deaths among Massachusetts residents.”

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53,293

37,993

14,621

77,670

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

2006

Births

Deaths

Marriage

Divorces


43

MA Vital Statistics in 25 Year Intervals from 1858

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

1858 1908 1933 1958 1983 2006

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000Births

Deaths

Marriage

Divorces

Population

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MA Cause of Death Rates in 25 Year Intervals from 1858

0

100

200

300

400

500

600

700

1858 1908 1933 1958 1983 2006

Heart DiseaseCancerTuberculosis

Maternal Mort. (per 100,000 live births)Injury

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Summary

• Ascertainment• Interpretation• Presentation• Influence by programs on data collection• Framing vital stats – human & economic terms• Some basic demographics in MA haven’t

changed in 100 years

Jean-Baptiste Alphonse Karr (1808 – 1890)

46

Inf . Disease

Cancer

Heart Disease

Injuries

0%

10%

20%

30%

40%

50%

60%1

84

2

18

48

18

54

18

60

18

66

18

72

18

78

18

84

18

90

18

96

19

02

19

08

19

14

19

20

19

26

19

32

19

38

19

44

19

50

19

56

19

62

19

68

19

74

19

80

19

86

19

92

19

98

20

06

Year

Pe

rce

nt

of

To

tal D

ea

ths

Causes of Death Massachusetts: 1842-2006

1 naphsis – 75 years highlights from the history of vital statistics reporting

Documents