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
