NEWS / Missing Death Certificates Delay Release of Vital U.S. Mortality Data, Raising Concerns for Public Health Researchers

A bureaucratic snafu in North Carolina has thrown a wrench into the gears of the nation's mortality data, leaving public health researchers and policymakers in the dark about how Americans are dying. The missing pieces? Incomplete death certificates.

Typically released every December, the National Center for Health Statistics' (NCHS) final data on U.S. mortality paints a detailed picture of how Americans die, informing research on everything from life expectancy to the opioid epidemic. But this year, the report remains unreleased, its publication postponed in late 2023 after the North Carolina vital records office discovered its data for 2022 was riddled with missing information.

"The North Carolina Office of Vital Records notified NCHS on November 30, 2023, that they had identified death records that had not been submitted to NCHS," CDC spokesperson Christy Hagen acknowledged in an email to The News & Observer. This, she explained, led to the decision to delay the release of the final 2022 data until the missing pieces were found and analyzed.

While provisional data remains available, offering a preliminary glimpse into mortality trends, federal officials have no clear deadline for releasing the finalized report. Meanwhile, efforts in North Carolina to track down the missing information are expected to last through February 2024.

The delay has sent ripples of concern through the public health community, particularly amid anxieties about a potential reversal of the long-standing downward trend in U.S. life expectancy.

"These data are important to know if we're still continuing in that downward longevity curve," emphasized Dr. Victor Weedn, a forensic pathology expert and former chief medical examiner for Maryland. "To me, right now, when we're really paying attention to mortality, having a glitch like this is very concerning."

The timing couldn't be worse, experts say. With variants of COVID-19 still circulating, understanding trends exacerbated by the pandemic's aftershocks – rising maternal mortality and opioid-related deaths – is crucial.

"Are they still on the rise? Have they stabilized? Have they gone down? Those will be the big questions," observed Marie Thoma, a maternal health researcher at the University of Maryland. "Everyone's just sort of anxiously awaiting this data from a policy perspective."

The missing information, though less than 1% of the state's annual death toll, casts a shadow over the entire dataset. The transition to a new electronic death reporting system in North Carolina is suspected to be a culprit, potentially contributing to inconsistencies and incomplete submissions.

While state officials remain tight-lipped about the specifics of the missing information, they insist that none of the incomplete death certificates were sent to the CDC. Tonizzo, a spokesperson for the N.C. Department of Health and Human Services, assures that these deaths will be reported once the necessary details are obtained.

Not every expert, however, views the delay with alarm. Scott Lynch, director of the Center for Population Health and Aging at Duke University, points out that revisions due to errors and omissions are common even with on-time data releases.

"I don't think it will have a major impact on scholarship," he conceded in an email. However, the delay breaks with the CDC's recent practice of consistent annual releases, with the latest typically occurring in late January. For researchers like Nathan Dollar of Carolina Demography at UNC-Chapel Hill, this disrupts the vital flow of information needed for timely analysis, impacting not just understanding how people die, but also evaluating the potential effectiveness of government interventions.

For policymakers grappling with critical funding decisions, the lack of data can have tangible consequences, Weedn cautioned. "That data is either available for 2022 or it's not," he said. "It will have a real-world impact in the states where they are making decisions based on that data and have to make those decisions before the data catches up."

Dollar admits the delay is "unfortunate," but underscores the importance of accuracy over immediacy. "We don't want to rush it," he emphasizes. "We want to make sure North Carolina and federal agencies do their due diligence to make sure it's clean and accurate. These things take time."

The missing death certificates, while seemingly small, serve as a stark reminder of the complex systems underpinning our understanding of the nation's health. As these systems stumble, it's the crucial information about how and why we die that gets thrown into the shadows, leaving critical questions unanswered and potentially impacting the very lives we strive to save.