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The Four Hands Of Death Sub Download


  • The mortality data are based on information from all death certificates filed in the fifty states and the District of Columbia. Deaths of nonresidents (e.g. nonresident aliens, nationals living abroad, residents of Puerto Rico, Guam, the Virgin Islands, and other territories of the U.S.) and fetal deaths are excluded.Mortality data from the death certificates are coded by the states and provided to NCHS through the Vital Statistics Cooperative Program or coded by NCHS from copies of the original death certificates provided to NCHS by the State registration offices. For more information, see Technical Appendix from Vital Statistics of United States: 1999 Mortality. About suppressed data and unreliable rates:Statistics representing fewer than ten persons (0-9) are suppressed.See Assurance of Confidentiality for more information.

  • Rates are marked as "unreliable" when the death count is less than 20.

  • About cause of death classification: The underlying cause-of-death is defined by the World Health Organization (WHO) as "the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury." Underlying cause-of-death is selected from the conditions entered by the physician on the cause of death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the ICD, and associated selection rules and modifications.

  • Causes of death are classified in accordance with the International Classification of Disease. Deaths for 1979-98 are classified using the Ninth Revision (ICD-9). Deaths for 1999 and beyond are classified using the Tenth Revision (ICD-10).

  • Beginning with data for 2006, the valid ICD-10 codes used to classify causes of death changed. Effective with the 2006 data year, 18 codes were introduced as valid causes of death, and 4 codes were discontinued. Effective with the 2007 data year, 4 codes were introduced as valid causes of death, and 2 codes were discontinued. See ICD-10 Changes for more information.

  • Beginning with data for 2001, NCHS introduced categories *U01-*U03 for classifying and coding deaths due to acts of terrorism. The asterisks before the category codes indicate that they are not part of the International Classification of Diseases, Tenth Revision (ICD-10). Description of the specific 4-digit codes can be found at NCHS Classifications of Diseases, and Functioning & Disability: Appendix I. Deaths classified to the terrorism categories are included in the categories for Assault (homicide) and Intentional self-harm (suicide) in the 113 cause-of-death list. Additional information on these new categories can be found at NCHS Classifications of Diseases, and Functioning & Disability: Classification of Death and Injury Resulting from Terrorism.

  • About race and ethnicity reporting: Race and Hispanic origin are reported separately on the death certificate in accordance with standards set forth by the Office of Management and Budget. The American Indian or Alaska Native race category includes: North, Central, and South American Indians, Eskimos, and Aleuts. The Asian or Pacific Islander race category includes Chinese, Filipino, Hawaiian, Japanese, and Other Asian or Pacific Islanders.

  • Hispanic origin was not reported on the death certificate for some deaths. On the mortality file, missing Hispanic origin information is coded as "not stated". There is no corresponding population figure for this group. Therefore, deaths with Hispanic origin not stated are excluded when death rates are calculated by Hispanic origin.

  • Information included on the death certificate about the race and Hispanic ethnicity of the decedent is reported by the funeral director as provided by an informant, often the surviving next of kin, or, in the absence of an informant, on the basis of observation. Race and ethnicity information from the census is by self-report. To the extent that race and Hispanic origin are inconsistent between these two data sources, death rates will be biased. Studies have shown that persons self-reported as American Indian, Asian, or Hispanic on census and survey records may sometimes be reported as white or non-Hispanic on the death certificate, resulting in an underestimation of deaths and death rates for the American Indian, Asian, and Hispanic groups. Bias also results from undercounts of some population groups in the census, particularly young black males, young white males, and elderly persons, resulting in an overestimation of death rates.In "Quality of death rates by race and Hispanic origin: A summary of current research, 1999," the authors estimate that the misclassification and under-coverage result in overstated death rates for the white and black populations (1% and 5%, respectively) and understated death rates for other population groups (American Indians, 21%; Asian or Pacific Islanders, 11%; and Hispanics, 2%). See also The validity of race and Hispanic Origin reporting on death certificates in the United States.

  • For 1979-2002, all 50 States and the District of Columbia collected race data on the death certificates using four single-race categories (American Indian or Alaska Native, Asian or Pacific Islander, Black, and White) in accordance with the 1977 OMB standards, allowing only a single race to be reported. Beginning with the 2003 data year, some States began collecting race data in accordance with the 1997 OMB standards, allowing one or more of five race categories to be reported. In order to provide uniformity and comparability of mortality data during the transition from the single-race format to the multiple-race format, NCHS is "bridging" the race responses of those for whom more than one race is reported (multiple race) to one of the single-race categories. The bridging procedure is similar to the procedure used to bridge multiple-race population estimates. Multiple-race decedents are imputed to a single race (White, Black, American Indian or Alaska Native, or Asian or Pacific Islander) according to their combination of races, Hispanic origin, sex, and age indicated on the death certificate. The imputation procedure is described in detail atNCHS Procedures for Multiple-Race and Hispanic Origin Data.

  • For more discussion of race and ethnicity data, see Race and Ethnicity Questions.

  • About "Not Stated" age or ethnicity: Deaths of persons with Age "Not Stated" are included in "All" counts and rates, but are not distributed among age groups, so are not included in age-specific counts, age-specific rates or in any age-adjusted rates.

  • Data for the "Not Stated" age category or the "Not Stated" Hispanic Origin category cannot be combined with any other specified age group or Hispanic Origin categories.

  • Death rates are not calculated specifically for the "Not Stated" groups because there are no corresponding population denominator data for these groups.





The Four Hands of Death sub download


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  • Notes: Population denominator data are not available for the "Not stated" category, thus rates are flagged as "not applicable."

  • Deaths of persons with unknown or "Not Stated" Hispanic origin are included in "All" counts and rates, but are not distributed among Hispanic Origin groups, so are not included in the Hispanic Origin specific counts and rates .See About "Not Stated" age or ethnicity for more information.

  • See Race and Ethnicity Questionsfor more information about the issues of race categories and ethnicity in the data.

  • The Hispanic Origin categories are identified by two columns, labels and codes, in data extracts.

  • Step 4. Select year and month:Select any specific years or year/month dates to limit your data to the specified time of occurrence of death.The default value is the full range of years and months in the data collection.How?The first level shows the years. Select one or more years, and then click the Open button below the list to see the months in each year.

  • See "How do I use a Finder?" for help.

  • If you prefer, You can also enter date values by hand: Click the link for Advanced mode. (Advanced mode is only available when JavaScript is enabled.)

  • Use yyyy (1994) for years, yyyy/mm (1992/01) for months. Enter one date per line.

  • See Finder Tool help for more hints.

  • Notes: Each month is considered a unique combination of year and month, such as July, 2011.

  • Rates and populations are shown as "Not Applicable" for months.

  • When the data are exported, separate columns show both the label and the code for each value.

  • Step 5. Select weekday, autopsy and place of death:Limit your data for any of the following data elements: Weekday of death: - Sunday through Saturday, Unknown

  • Autopsy performed: - No, Yes, Unknown

  • Place of Death: - Medical Facility - Inpatient, Medical Facility - Outpatient or ER, Medical Facility - Dead on Arrival,Medical Facility - Status unknown (years 1999-2002 only)Decedent's home, Hospice Facility (years 2003 and later only), Nursing home/long term care,Other, Place of death unknown

  • Note that rates and populations are shown as "Not Applicable" for Weekday, Autopsy and Place of Death.Weekday of DeathSelect All any combination of other values for the weekday of occurrence of death: Sunday through Saturday, Unknown. How? See "How do I select items from the list box?"Notes: Note that rates and populations are shown as "Not Applicable" for weekday of death.

  • Erratum: Between December 15, 2011 and March 13, 2012, the number of deaths by Weekday of Death reported in CDC WONDER for the year 2003 were inaccurate for the following states:California, Idaho, Montana and New York.We regret this error and apologize for any inconvenience.

  • Data are identified by two columns, labels and codes, in data extracts.

  • Autopsy PerformedSelect All any combination of other values for the whether an autopsy was performed: No, Yes, Unknown. How? See "How do I select items from the list box?"Notes: Note that rates and populations are shown as "Not Applicable" for whether an autopsy was performed.

  • Data are identified by two columns, labels and codes, in data extracts.

  • Place of DeathSelect All any combination of other values for the place of death: Medical Facility - Inpatient, Medical Facility - Outpatient or ER, Medical Facility - Dead on Arrival,Medical Facility - Status unknown (years 1999-2002 only),Decedent's home, Hospice Facility (years 2003 and later only), Nursing home/long term care,Other, Place of death unknown. How? See "How do I select items from the list box?"Notes: Note that rates and populations are shown as "Not Applicable" for place of death.

  • The Place of Death categories changed in 2003.The "Medical Facility - Status unknown" category is only available in years 1999-2002.The "Hospice Facility" category is only available in years 2003 and later.Death counts for these categories are shown as "Missing" for those years when the data are unavailable.

  • Erratum: Between December 15, 2011 and February 22, 2012, the number of deaths by "Place of Death" reported in CDC WONDER for the years 1999-2002 were inaccurate for the following categories:Decedent's home, Hospice Facility, and Nursing home/long term care.We regret this error and apologize for any inconvenience.

  • Data are identified by two columns, labels and codes, in data extracts.

  • Step 6. Select underlying cause of death:Select categories that represent the underlying cause of death from the death certificate.Only one underlying cause of death is indicated for each death.Deaths are coded to the International Classification of Disease Tenth Revision (ICD-10) codes.The ICD system is organized by chapters, sub-chapters and codes.Selected causes are also grouped into categories for mortality analysis.Any number of causes can be specified here. However, you can only limit data to one of the lists for any single query.Be sure the Radio Button is set to your choice. Pick between: ICD-10 Codes listed as chapters, sub-chapters and individual codes

  • ICD-10 113 Groups for selected causes of death

  • ICD-10 130 Groups for selected causes of infant mortality

  • Drug/Alcohol Induced Causes

  • Injury Intent and Mechanism

  • Hints: Only those ICD codes and causes that are used to classify underlying causes of death in the mortality dataare available in the Finder for this section. Symptoms are not classified as underlying causes of death.

  • Deaths in the years 1999 and later are coded to the tenth revision of the International Classification of Diseases (ICD-10).There are 113 selected causes of death groups for the ICD-10 codes.

  • When you select a code, remember that some deaths are coded to the 3 length code, and not the more detailed designation.Thus some deaths may be excluded from your data selection if your criteria are limited to only 4 length codes.For example, the ICD-10 code A09 is the correct specification; A09.0 will not pick up deaths coded A09.

  • The causes of death are identified by two columns, labels and codes, in data extracts.

  • Notes: About the International Classification of Diseases:The mortality data are compiled in accordance with the World Health Organization (WHO) regulations, which specify that member nations classify and code causes of death in accordance with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). The International Classification of Diseases is developed collaboratively between the World Health Organization (WHO) and 10 international centers, for purposes of ensuring that medical terms reported on death certificates are internationally comparable and lend themselves to statistical analysis. The ICD has been revised approximately every 10 years since 1900 in order to reflect changes in understanding of disease mechanisms and in disease terminology.

  • See also ICD 10th revision notes.

  • ICD-10 CodesLimit the data to any number of causes of death, for selected chapters, sub-chapters or codes.The default selection is "all causes" of death.How? Click the Radio Button to the left of the box, to pick your preferred list.

  • Select one or more items from the list to limit your data. The default value for any list is all causes of death.Hints: See How do use a Finder? to learn more about search options, expanding or collapsing selected items,and displaying details for selected items in the Finder.

  • The "plus" symbol, "+" indicates that you can open the item, to see more items below it.

  • The results to a search are shown in blue, and indicated by ">".

  • The Advanced mode let you easily pick several items from different parts of the list.Items are not selected until you click the "Move" button in Advanced mode.

  • You may also enter values by hand, one code per line, in the Advanced mode.Use the Finder to see the correct code format. For example, "I20-I25" is the ICD-10 code for ischemic heart diseases.

  • See Finder Tool help for more hints.

  • Notes: The International Classification of Disease (ICD) 10th revisionis used to represent the causes of death for the years 1999 and later.The ICD system is organized by chapters, sub-chapters and codes.

  • ICD-10 uses a 4-length alphanumeric coding scheme. Each of the 21 chapters in ICD-10 is classified to a letter or letters of the alphabet. Infectious disease codes in Chapter 1, for example, begin with an "A" or "B". Thus, Acute poliomyelitis is associated with the codes A80.0-A80.9 and Viral hepatitis is classified as B15.0-B19.9. The ICD 10 system begins codes with a letter from the alphabet, followed by two numerals,then a decimal point to indicate subordinate position, and then more numerals.Some causes of death are represented by 3 length codes, although most causes of death are represented by 4 length codes (format A12.3).Greater detail than 4 length codes are not included in the data.

  • About Underlying Cause of Death:The underlying cause-of-death is defined by the World Health Organization (WHO) as "the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury." Underlying cause-of-death is selected from the conditions entered by the physician on the cause of death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the ICD, and associated selection rules and modifications.

  • Each death certificate contains a single underlying cause of death.

  • Only those ICD codes that are used to classify underlying causes of death in the mortality dataare available in the Finder for selecting underlying causes of death. Symptoms are not classified as underlying causes of death.

About changes in ICD-10 codes: The valid ICD-10 codes used to classify cause of death change over time, refer to table below for details.Effective with the 2020 data year, 1 code was introduced as a valid cause of death. Effective with the 2019 data year, 1 code was introduced as a valid cause of death. Effective with the 2011 data year, 33 codes were introduced as valid causes of death. Effective with the 2009 data year, 5 codes were introduced as valid causes of death, and 11 codes were discontinued. Effective with the 2007 data year, 4 codes were introduced as valid causes of death, and 2 codes were discontinued. Effective with the 2006 data year, 18 codes were introduced as valid causes of death, and 4 codes were discontinued. The World Health Organization (WHO) added code I27.2 in 2003. Prior to 2003, if the certifier listed "secondary pulmonary hypertension" the condition would be coded I27.0 because there was no code for secondary pulmonary hypertension. After code I27.2 was added in 2003, the number of deaths coded to I27.0 dropped significantly.New causes of death in 2020ICD-10 CodeTitleU07.1 COVID-19 New causes of death in 2019ICD-10 CodeTitleU07.0 Vaping related disorder New causes of death in 2011ICD-10 CodeTitle B17.9 Acute viral hepatitis, unspecified D68.5 Primary thrombophilia D68.6 Other thrombophilia D89.3 Immune reconstitution syndrome E88.3 Tumor lysis syndrome G14 Postpolio syndrome G21.4 Vascular parkinsonism H54.9 Unspecified visual impairment (binocular) I72.5 Aneurysm and dissection of other precerebral arteries J12.3 Human metapneumovirus pneumonia J21.1 Acute bronchiolitis due to human metapneumovirus K12.3 Oral mucositis (ulcerative) K35.2 Acute appendicitis with generalized peritonitis K35.3 Acute appendicitis with localized peritonitis K35.8 Acute appendicitis, other and unspecified L89.0 Stage I decubitus ulcer and pressure area L89.1 Stage II decubitus ulcer L89.2 Stage III decubitus ulcer L89.3 Stage IV decubitus ulcer L89.9 Decubitus ulcer and pressure area, unspecified N18.1 Chronic kidney disease, stage 1 N18.2 Chronic kidney disease, stage 2 N18.3 Chronic kidney disease, stage 3 N18.4 Chronic kidney disease, stage 4 N18.5 Chronic kidney dis


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