Vital Statistics Health Article

VITAL STATISTICS

Vital statistics are perhaps the most widely used national, state, and local data for identifying and addressing major public health issues. In the United States, legal authority for the registration of vital events (births, deaths, marriages, divorces, fetal deaths, and induced terminations of pregnancy [abortions]) resides with the states, and individually with New York City, the District of Columbia, and the U.S. territories. The states are the legal proprietors of these data and are responsible for maintaining registries and issuing copies of the records.

The existence of a national data system of registration-based vital statistics depends on a cooperative relationship between the states and the federal government. This relationship has evolved over many decades, with its initial beginnings in the early development of the public health movement and the creation of the American federal vital statistics system.

THE HISTORY OF VITAL STATISTICS

The registration of births, marriages, and deaths has a long history in the United States, beginning with registration laws enacted by the Grand Assembly of Virginia in 1632 and the General Court of the Massachusetts Bay Colony in 1639. In enacting this legislation, the early settlers, who were predominantly English, were following English customs. Thus, Virginia law required the clergy to keep a record of all christenings, marriages, and burials in their parishes. The Massachusetts law differed from Virginia's in two important respects: it called for the recording of vital events (births, deaths, and marriages) rather than church-related ceremonies; and it placed responsibility for registration of vital events on government officials rather than the clergy. Little or no statistical use was made of such records, however—along with wills and property inventories, they were regarded primarily as statements of fact essential to the protection of individual rights, especially those relating to the ownership and distribution of property.

The impetus for the use of vital records as the basis of a public health data system came from the realization that records of births and deaths, particularly records of deaths by cause of death, could provide information needed for the control of epidemics and the conservation of human life through sanitary reform. The origin of vital statistics in the modern sense can be traced to an analysis of the English bills of mortality published by John Graunt in 1662. Similarly, the clergyman Cotton Mather noted, in 1721, during a severe smallpox epidemic in Boston, that more than one in six of the natural cases died, but only one in sixty of the inoculated cases died.

In the nineteenth century, the industrial revolution resulted in rapid urbanization, overcrowding of cities, and a deterioration of social and living conditions for large sectors of the population. Public health reformers became acutely conscious of the need for general sanitary reform as a means of controlling epidemics of disease, particularly cholera. These early sanitarians used the crude death statistics of the time to arouse public awareness of the need for improved sanitation, and in the process they pressed for more precise statistics through effective registration practices and laws. The work of Edwin Chadwick (1800–1890) and Dr. William Farr (1807–1883) in England and of Lemuel Shattuck (1793–1859) in Massachusetts was instrumental in the development of public health organization and practice, including the recording of vital statistics. Thus, the history of public health is largely the history of vital registration and statistics.

The United States Constitution provided for a decennial census but not a national vital registration system. To obtain national data on births, marriages, and deaths, the decennial censuses in the latter half of the nineteenth century included questions about vital events, such as: "Born within the year," "Married within the year," and "Disease, if died within the year." These census items were soon recognized as inefficient and the results as deficient. Therefore, when the Bureau of the Census was made a permanent agency of the federal government in 1902, the enabling legislation authorized the bureau to obtain annually copies of records filed in the vital statistics offices of those states and cities having adequate death registration systems and to publish data from these records. This marked the birth of the National Vital Statistics System. Ten states and cities provided death records to the Census Bureau in 1902. In 1915, birth registration was added to the system, and by 1933 all states were registering live births and deaths and providing the required data.

In 1946 responsibility for collecting and publishing national vital statistics was transferred from the Census Bureau to the U.S. Public Health Service, first in the National Office of Vital Statistics and later (1960) in the National Center for Health Statistics (NCHS). In 1987 NCHS became part of the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.

In the early part of the twentieth century, the Bureau of the Census received unit record data from the states in hard copy or microfilm. States were reimbursed for copying efforts at four cents per record. Data were transcribed (later key entered) at both the national and state levels, as both states and federal government produced statistics. In 1971 NCHS began an experiment with the state of Florida to receive data on computer tape. This effort expanded and evolved over time, and by 2000, electronic processing and transmission was the norm. NCHS provides partial funding support for state vital statistics efforts and also works with states to implement standards for data elements, editing and coding specifications, quality control procedures, and data transmission schedules.