Causal Pathway of Disease or Disability

1
Causal Pathway of Disease or Disability

• Environment (pre-exposure)
• Hazard/agent
• Behavior/risk factor
• Exposure
• Pre-symptomatic phase
• Apparent disease
• Death

2
Selected Sources of Data

• Environmental monitoring systems
• Animals/vectors
• Individuals
• Laboratories
• Medical records
• Administrative records
• Police records
• Birth/death certificates

3
Data Sources and Methods for Surveillance

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

4
Data Sources/Methods

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

5
Current Status National Notifiable Diseases
Surveillance System (NNDSS)

• CSTE/CDC collaboration
• List revised at annual CSTE meeting
• Voluntary reporting by states to CDC
• Reporting mandated at state level
• Reportable diseases vary by state

6
National Notifiable Disease Surveillance

• Reporting mandated by state law/regulation
• Health care providers, laboratories report to
  local HD (county)
• County HD submits reports to State
• Reports transmitted to CDC primarily through
  National Electronic Telecommunications System for
  Surveillance (NETSS)

7
MUMPS United States 1973-1998
MUMPS by year, United States, 19831998
Reported Cases per 100,000 Population
Reported Cases per 100,000 Population
Year
8
MEASLES (Rubeola) United States, 1963-1998
Vaccine licensed
Reported Cases (Thousands)
20
10
Year
9
Passive vs. Active Surveillance

• Passive
• - Provider-initiated
• Active
• - Health Department-initiated

10
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

11
Salmonellosis (excluding Typhoid Fever)United
States, 1967-1997
Year
12
Salmonellaserotypes of isolatesUnited States,
1973-1998
Reported isolates

• Typhimurium

• Enteritidis

Year
13
Blood Lead Measurements 1975-1981
110
18
Predicted blood lead
100
Lead used in gasoline (thousands of tons)
16
90
Mean blood lead levels ? g/dl
80
Gasoline lead
14
70
Observed blood lead
12
60
50
10
40
30
8
1975
1976
1977
1978
1979
1980
1981
Year
14
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

15
Use of NCHS Data Systems for Surveillance

• Vital Statistics
• National Infant Mortality Surveillance (NIMS)
• Linked
• birth records
• death records

16
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

17
Sentinel Surveillance

• Monitoring of key health events through sentinel
• Sites
• Events
• Providers
• Vectors/animals

18
SENSOR

• Sentinel
• Event
• Notification
• System for
• Occupational
• Risks

19
Lead PoisoningMichigan, 1990
NONE
1-25
26-100
100
20
Confirmed Work-Related Asthma PatientsBy
Industry Type 1988-1998Michigan
4
6
Manufacturing n960
16
Construction n36
Services n215
3
Trade N47
71
Miscellaneous N76
21
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

22
Lung and Bronchus Cancer (Invasive) United
States, 1973-1994 SEER Incidence and U.S.
Mortality
Year
23
Birth Defects Monitoring Programs

• Vital records
• Hospital discharge summaries
• Hospital records (active abstraction)

24
Prevalence of Anencephaly and Spina
BifidaMetropolitan Atlanta Congenital Defects
Program, 1968-2000
25
Prenatally Diagnosed Cases
Hospital-based. LB SB Babies
20
Before Fortification
After Fortifcation
15
Rate per 10,000
10

5
0
68
71
74
77
80
83
86
89
92
95
98
Year of Birth
25
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

26
Physical Inactivity
United States, 1998
27
Use of NCHS Data Systems for Surveillance

• Population-based surveys
• National Health Interview Survey
• National Health and Nutrition Examination Survey
• Provider-based surveys
• National Hospital Discharge Survey
• National Ambulatory Medical Care Survey

28
Median Serum Folate, NHANES III and 1999,
Nonpregnant Women, 15-44 years
4.8
14.5
50
40
Post fortification
30
Percentile
20
10
Prefortification
0
0
10
20
30
40
Serum Folate, ng/ml
29
Cesarean Deliveries United States, 1970-1992
Percentage
Year
30
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

31
Ectopic PregnanciesUnited States 1980-1996
100000
80000
Number of
60000
Ectopic
40000
Pregnancies in women 15-44
20000
0
80
82
84
86
88
90
92
94
96
Year
32
Data Sources

• Notifiable diseases
• Laboratory specimens
• Vital records
• Sentinel surveillance
• Registries
• Surveys
• Administrative data systems
• Other data sources

33
Other Data Useful for Surveillance

• Vaccine Adverse Event Reporting System
• CDC Drug Service
• Miscellaneous

34
Information Loop of Public Health Surveillance
Analysis