General Release Notes

2019 Death

New Primary Care Service Area Dimension

We have added a new geographic dimension to the Birth Module to cover primary care service areas. Primary care service areas were created to describe the delivery of primary health services in the State of Hawai'i through participation of multiple stakeholders in the early 1990's. The rural health associations of the Hawai'i, Maui and Kaua'i Counties delineated rational service areas under their respective jurisdictions. Neighborhoods were clustered into primary care service areas to provide information below the county or island level with demarcation between adjacent neighborhoods. Census tracts were used in defining these areas due to their availability in census and vital statistic data.

Here is a link to a document containing the Hawaii-IBIS Census Tract to Primary Care Service Area Crosswalk:

• Hawaii-IBIS Census Tract to Primary Care Service Area Crosswalk

Residence

Data can be analyzed geographically by decendent's residence or occurence of death. Decedent's residence is based on the address provided on the death certificate as the place where the decedent resided at the time of death. Military members and dependents who live in Hawaii at the time are classified as residents.

There are two measures for capturing geography in the Death Record - zip code and census tract. School complex and community are based on zip code and primary care service area is based on census tract.

Cell Suppression Criteria

In accordance with data use restrictions set forth by Hawaii State Department of Health (DOH) and the National Center for Health Statistics (NCHS), cell counts of fewer than 9 events and rates based on counts of 9 or fewer will be suppressed and denoted with a double asterisk (**).

The NCHS further recommends that rates based on death counts of less than 20 be marked as unreliable.

Additional information on national standards for the collection and analysis of mortality statistics from the NCHS, National Vital Statistics System can be accessed here.

Causes of Death

While more than one cause of death can be listed on the death certificate, this system is based on the underlying cause-of-death which 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-10 code, and associated selection rules and modifications.
If you are interested in underlying and contributing causes of death, please contact us or visit CDC WONDER to access the Multiple Cause of Death data file.

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.

Race/Ethnicity Data

The Death certificate allows for up to 4 race/ethnicities to be captured for the decedent. The DOH Office of Health Status Monitoring (OHSM) uses the following algorithm to code a single race/ethnicity for each individual.

Only one ethnicity is coded from the actual certificates. If more than one ethnicity is listed on the certificate, the following rules apply:

1. If Hawaiian is one of the multiple ethnicities listed, Part-Hawaiian is coded.
2. If a non-Caucasian ethnicity is listed with a Caucasian ethnicity, the non-Caucasian ethnicity is coded.
3. If there is more than one non-Caucasian ethnicity listed, the first one is coded.
4. If there is more than one Caucasian ethnicity listed, the first one is coded.

In IBIS, the most granular level is the program race/ethnicity (PRG) which rolls up into the DOH standard race/ethnicity (DOH), which rolls up into Census race reporting categories (Census). The table below illustrates how the data is aggregated.

Race/Ethnicity Classifications
Source Race/Ethnicity	Program Race/Ethnicity (PRG)	DOH Race/Ethnicity (DOH)	Census Race (Census)
Asian Indian	Asian Indian	Other Asian	Asian
Black	Black	Black	Black or African American
Caucasian	Caucasian	Caucasian	Caucasian
Chinese	Chinese	Chinese	Asian
Cuban	Cuban	Other	Other
Filipino	Filipino	Filipino	Asian
Guamanian	Guamanian	Other Pacific Islander	Native Hawaiian and Other Pacific Islander
Hawaiian	Hawaiian	Native Hawaiian	Native Hawaiian and Other Pacific Islander
Part Hawaiian	Part Hawaiian	Native Hawaiian	Native Hawaiian and Other Pacific Islander
Indian	Indian	Native Alaskan/American Indian	Native Alaskan/American Indian
Japanese	Japanese	Japanese	Asian
Korean	Korean	Other Asian	Asian
Mexican	Mexican	Other	Other
Portuguese	Portuguese	Caucasian	Caucasian
Puerto Rican	Puerto Rican	Other	Other
Samoan	Samoan	Other Pacific Islander	Native Hawaiian and Other Pacific Islander
Vietnamese	Vietnamese	Other Asian	Asian
Other Asian	Other Asian	Other Asian	Asian