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									NAPHSIS – 75 Years
 Highlights from the History of Vital
        Statistics Reporting




                                        1
       Massachusetts Public Health Milestones
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
                                                                         2
        MA Infant Mortality Rate 1842 to 2006

                                                       IMR
200.0
                                                       Trend (Joinpoint)
180.0

160.0

140.0

120.0                   1902   APC 2 = -3.85*
100.0

 80.0   APC 1 = 0.48*
 60.0
                                                APC 3 = 0.86

 40.0
                                           1953      1964
 20.0                                                       APC 4 = -3.91*
  0.0
        1842
        1846
        1850
        1854
        1858
        1862
        1866
        1870
        1874
        1878
        1882
        1886
        1890
        1894
        1898
        1902
        1906
        1910
        1914
        1918
        1922
        1926
        1930
        1934
        1938
        1942
        1946
        1950
        1954
        1958
        1962
        1966
        1970
        1974
        1978
        1982
        1986
        1990
        1994
        1998
        2002
        2006
                                                                        3
 1858
150 Years Ago



                4
       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)




                                                  5
                 1858
Queen Victoria and President Buchanan exchange
  messages over the first transatlantic cable




                                             6
               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)



                                        7
                  1858
Charles Darwin publishes the Origin of the
  Species by Means of Natural Selection in 1859




                                                  8
    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.    9
         MA Vital Statistics - 1858
40,000
              34,491
35,000                         Population
                                1,191,568
30,000

25,000                                        Births
                       20,776
20,000                                        Deaths

                                              Marriage
15,000
                                     10,527
10,000

 5,000

    0
                        1858


                                                       10
  1908
(100 Years Ago)



                  11
                     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).

                                                 12
                   VITAL STATISTICS IN SOME MUNICIPAL REPORTS*.
                                    CRESSY L. WILBUR, M. D.
                   Chief Statistician, Bureau of the Census, Washington, D. C.


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

    * 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
                                                                                                                  13
 VITAL STATISTICS IN SOME MUNICIPAL REPORTS. Cressy, 1914,
                        Continued

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

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

 Some of the offices …have seen fit to modify
Some of the offices attempting to make use of the International List [of
 Causes of Death] , either of Deaths],
[the International Listin its original or revised editions, have seen fit to
 modify it, sometimes even new divisions or groups,
sometimes even adding adding new divisions or groups, so that the
 purpose of purpose of comparability is entirely or largely
so that theuniformity anduniformity and comparability defeated..
is entirely or largely defeated…
                                                                               14
                     POPULARIZING VITAL STATISTICS
                           C. ST. CLAIR DRAKE, M. D.,
    Director, Illinois State Department of Public Health, Springfield, Illinois.


  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
…It has long been recognized that the average citizen, that
  experience in impressing fundamental statistical truths on a public
  demands interesting presentation together with pictures and cents
rich or poor, can appreciate the value of dollars and variety and
  novelty.
more clearly than that of human life
  …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.

  * 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.
                                                                                                        15
      POPULARIZING VITAL STATISTICS, DRAKE, Continued
   When it was shown that diphtheria, scarlet fever and measles,
   for a period of it seemed particularly desirable to impress
Some years ago, when six months, had cost one city ward upon the
   a stack of silver unnecessary wastage times as high
people of Chicago the dollars over nine due to communicable diseases
and when mere words, however expressive, seemed to arouse little
   as the twenty-story Masonic Temple, there was general surprise
attention, we employed the plan of measuring the cost of these diseases to
theand very extensive discussion, the important thing was that a
    several city wards in silver dollars and illustrated the cost by pictures
    much larger of dollars as of the Chicago population was
showing these pilespercentage compared in height with the Masonic
    thinking of highest and best known building in the city.
Temple, then the the value of health more definitely When it was
shown that diphtheria, scarlet fever and measles, for a period of six months, had
    than it had been formerly.
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 definitely
than it had been formerly.
                                                                                           16
         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]”

                                                          17
          MA Vital Statistics - 1908
100,000

 90,000
          86,911

 80,000
                             Population
 70,000
                               3,129,128
 60,000
                   51,788
 50,000                                       Births
                                              Deaths
 40,000
                                   27,071
                                              Marriage
 30,000
                                              Divorces
 20,000

 10,000
                                            1,766
     0

                            1908
                                                         18
          1908 – Nativity of Mothers1




1PublicDocument 1, 1908, Secretary of Commonwealth of Massachusetts, accessed from   19
http://www.books.google.com.
                                    % Non-U.S. Born Mothers
                                    Massachusetts: 1990-2006
                    30%                                                                                 27.0%


                                                                        +5.2%* APC


                    20%
Percent of births




                                  +1.4% APC
                                                   1995
                          15.0%




                    10%




                    0%
                          1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

* Statistically Significant            (p ≤.05) APC = Annual Percentage Change                             20
 1933
(75 Years Ago)




                 21
                   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.




                                                 22
                Statistics and the Health Officer*
 GEORGE B. L. ARNER, PH.D.,U. S. Bureau of the Census, Washington, D. C.

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 inseparable from preventive medicine just a
Vital statistics are the modern health officer. The record of these triumphs of sanitation
 accounting is inseparable subject matter of vital statistics. Vital statistics are
and preventive medicine is thefrom modern business.
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
 The health officer does not need he may depend upon his
device used in vital statistics, althoughto be a vital statistician,statistician to compute
 any more than a business the infant mortality an accountant, but he
even the crude death rate and man needs to be rate.
should be able to understand vital statistics
and to use them effectively in his daily work.

  * 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.                     23
       Statistics and the Health Officer, ARNER,
                       Continued
   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 rate is easy to compute and readily understood,
The crude death well as economic statistics, lend themselves readily to the use of the professional
   booster and to the within proper limits, but beyond those limits
and is very usefulhealth officer whose chief interest is his own self-glorification …
it may be grossly misleading.
   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 of age. The adjustment of death
  In order to make an honest comparison for death rates between rates for residence,
   as well as the adjustment of birth rates by residence of the mother, can only be made if the information
  one community and another,on the death and birth certificates.
   as to residence is accurately stated
  the death rate must be adjusted for residence and corrected for age




                                                                                                        24
               1933
In 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."


                                        25
               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)




                                                                     26
       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



                                                                          27
    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.



                                                                   28
         MA Vital Statistics - 1933
70,000   63,457              Population
60,000                            4,318,137
                  50,832
50,000

40,000                                         Births
                                               Deaths
30,000                            25,949
                                               Marriage

20,000                                         Divorces


10,000                                        3,210
    0

                           1933

                                                          29
 1958
50 Years Ago


               30
                    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
                                                       31
       VITAL STATISTICS -THEIR PAST AND FUTURE
        Carl L. Erhardt, M.P.A., M.S. (Hyg.), F.A.P.H.A.
                                                  .


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




* This paper was presented before a Joint Session of the Association for Vital
Records and Public Health Statistics and the Statistics Section of the American
Public Health Association at the Eighty-Sixth Annual Meeting in St. Louis, Mo.,
                                                                                  32
October 27, 1958. Am J Public Health, 49: 192-196.
    VITAL STATISTICS -THEIR PAST AND FUTURE
     Carl 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
…the statistician must urge extreme caution on the administrator lest the tail
 encourage further exploration of its causes…
wag the dog. Collection of data for administrative purposes can become so
 Administrative control of programs is demanding more extensive use of
detailed that the expense of its collection is unwarranted. Gaines phrased the
 statistics. But here the statistician must urge extreme caution on the
idea succinctly when he said, "Be sure the juice is worth the squeeze." An even
 administrator lest the tail wag the dog. Collection of data for administrative
greater danger, however, is that the detail becomes so marked that no one any
 purposes can become so detailed that the expense of its collection is
longer bothers to look at the material. The effort then becomes a complete
 unwarranted. Gaines phrased the idea succinctly when he said, "Be sure the
waste, for we not alone squeeze more juice than is needed, but do not even
 juice is worth the squeeze." An even greater danger, however, is that the
drink any of it.
 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.
  .



                                                                             33
     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]




                                                                     34
            MA Vital Statistics - 1958

140,000                             Population
          114,563                    4,946,055
120,000


100,000

                                                  Births
 80,000
                                                  Deaths
 60,000             54,792                        Marriage
                                                  Divorces
 40,000                             33,449

 20,000
                                                 5,458
     0

                             1958
                                                             35
 1983
(25 Years Ago)




                 36
                 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



                                             37
     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.”
                                                             38
           MA Vital Statistics - 1983

80,000   76,031                   Population
70,000                             5,750,015
60,000            54,150
                                               Births
                                  48,789
50,000
                                               Deaths

40,000                                         Marriage
                                               Divorces
30,000

                                           18,477
20,000

10,000

    0
                           1983
                                                          39
   2008
The 75th Anniversary



                       40
      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.”
                                                                          41
         MA Vital Statistics - 2006


90,000                     Population
         77,670
80,000                      6,437,193
70,000
                                      Births
60,000            53,293
                                      Deaths
50,000
                                      Marriage
                            37,993
40,000
                                      Divorces
30,000

20,000                               14,621
10,000

    0
                       2006
                                                 42
      MA Vital Statistics in 25 Year Intervals
                    from 1858
140,000          Births                                      7,000,000
                 Deaths

120,000          Marriage                                    6,000,000
                 Divorces

100,000          Population                                  5,000,000


 80,000                                                      4,000,000


 60,000                                                      3,000,000


 40,000                                                      2,000,000


 20,000                                                      1,000,000


     0                                                       0
          1858            1908   1933   1958   1983   2006
                                                                  43
               MA Cause of Death Rates
             in 25 Year Intervals from 1858
                               Heart Disease
700
                               Cancer
                               Tuberculosis
600                            Maternal Mort. (per 100,000 live births)
                               Injury
500


400


300


200


100


  0
      1858      1908    1933     1958           1983           2006 44
                    Summary
        Jean-Baptiste Alphonse Karr (1808 – 1890)

•   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

                                                    45
                              Percent of Total Deaths




                    10%
                                20%
                                         30%
                                                40%
                                                                        50%
                                                                                          60%




              0%
       1842
       1848
       1854
       1860
       1866
       1872
       1878
       1884
       1890
       1896
       1902
       1908
                                                                          Inf . Disease




       1914
       1920
       1926




Year
       1932
       1938
       1944
       1950
       1956
       1962
                                                                                                    Causes of Death




                                Cancer




       1968
                                                        Heart Disease




       1974
                   Injuries




       1980
       1986
       1992
       1998
                                                                                                Massachusetts: 1842-2006




  46




       2006

								
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