Typically released every December, the National Center for Health Statistics’ finalized data on mortality in the United States is built from millions of death certificates filed in every state and territory. Public health and population researchers use the data to study everything from life expectancy to the impacts of the opioid epidemic.
But the Centers for Disease Control and Prevention late last year quietly postponed the latest publication of data — detailing deaths in 2022 — after North Carolina’s vital records office alerted the federal agency that its data was incomplete.
“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 said in an email to The News & Observer. “As a result, NCHS decided to delay release of the final 2022 until we had received and analyzed these data... NCHS is working with the North Carolina Office of Vital Records to ensure we receive complete data for 2022.”
Although more recent provisional data remains publicly available, federal officials say they have no projected timetable for release of the country’s latest final mortality statistics. A spokesperson from the N.C. Department of Health and Human Services, meanwhile, said efforts to track down what’s missing in the state’s data “will continue through February 2024.”
The delay means it may take months before researchers can access a detailed measure of how people in America die. Public health experts say that information is especially important amid evidence that the country’s downward trend in life expectancy may be slowly reversing.
“These data are important to know if we’re still continuing in that downward longevity curve,” said Dr. Victor Weedn, an expert in forensic pathology and the former chief medical examiner for the state of Maryland. “To me, right now, when we’re really paying attention to mortality, having a glitch like this is very concerning.”
In the wake of a COVID-19 crisis that claimed more than 1 million lives across the country, researchers say the timing of the delay is particularly bad.
Although variants of the virus continue to spread years after the onset of the pandemic, declining death rates in 2022 make it an important time to examine trends exacerbated by the effects of COVID-19 — for example, rising rates of maternal mortality and opioid-related deaths.
“Are they still on the rise? Have they stabilized? Have they gone down? Those will be the big questions,” Marie Thoma, a maternal health researcher at the University of Maryland, said. “Everyone’s just sort of anxiously awaiting this data from a policy perspective.”
‘Under 800’ records missing data
Exactly what’s missing from North Carolina’s death data isn’t clear.
State health officials have identified “under 800” incomplete records in the 2022 death data, N.C. Department of Health and Human Services spokesperson Summer Tonizzo told The N&O in an email. That’s less than 1% of the 100,000 or so deaths logged every year in the state on average.
Death certificate data is supposed to flow to the state’s vital records office from funeral directors and medical providers, who since September 2022 have been required by law to use a new electronic system that began rolling out county by county in late 2020.
Prior to the change to all-digital entry, Tonizzo said, deaths could be reported to DHHS electronically, on paper or both.
“The variation in death reporting methods in 2022 may have contributed to inconsistent or incomplete submissions,” Tonizzo said. “With the full implementation of electronic death reporting, NCDHHS can now better detect and address partial reporting of vital events.”
Because partially recorded data can’t be submitted to the CDC, she said none of the deaths with missing information were reported to the federal agency.
“Partial death reports for calendar year 2022 were entered into the North Carolina Electronic Death Registration System by stakeholders responsible for reporting death,” Tonizzo said. “When the death reports are completed by these stakeholders, they will be reported to CDC.”
Issues with missing data have not affected reports from past years, Tonizzo said
Nor are they related to an ongoing backlog of autopsy reports, often necessary for the completion of death certificates, she said. A joint N&O and Charlotte Observer investigation last year found that since 2020, nearly 1,400 autopsy cases took more than a year to complete, slowing some prosecutions and leaving grieving families in financial limbo.
Asked what details were missing from the hundreds of incomplete death reports, Tonizzo said state officials “have not performed this level of analysis.”
“Each record requires manual inspection during follow back activities with stakeholders responsible for death reporting,” Tonizzo said.
Experts: Getting data right worth the wait
Not every public health expert is concerned about the delayed release of the mortality data. Scott Lynch, director of the Center for Population Health and Aging at Duke University, said even on-time releases have been subject to revisions as health experts discover errors and omissions.
“I don’t think it will have a major impact on scholarship,” Lynch said in an email.
But at least in recent years, a CDC spokesperson said, the agency has not delayed a report once it has announced when the report would be published. Mortality data is generally released within a year, according to the CDC.
In the last decade, the latest it’s been published was late January.
Nathan Dollar, director of Carolina Demography at UNC-Chapel Hill, said any delay in the release of the annual mortality file affects the ability of population researchers like him to conduct timely analysis not just of causes of death, but the potential impacts of government intervention.
“The longer it’s delayed, the worse its effect is,” Dollar said.
And that can matter for policymakers trying to decide what programs to fund or cut, said Weedn, the forensic pathologist.
“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.”
But Dollar notes that although a delay in the mortality data is “unfortunate,” the information is not much good to researchers if it’s incomplete.
“We don’t want to rush it,” Dollar said. “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.”
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