Education Reporting and Classification on Death Certificates in the United States

1. Education Reporting and Classification on Death Certificates in the United States Brian L. Rostron, Ph.D. National Center for Health Statistics John L. Boies, Ph.D. US Census Bureau Elizabeth Arias, Ph.D. National Center for Health Statistics

2. Background • Studies show large disparities in mortality by educational attainment • Persons with lower education generally have higher levels of mortality • Mortality differentials by educational attainment vary by sex, race and ethnicity • Differences are greater for men than women and for African American than White persons

3. Background • The death certificate is a prime source of information about the relationship between education and mortality • As a result, we first need to explore the accuracy of education information on death certificates • How does reporting on death certificate compare with reporting on population Census and Surveys? • Why is comparison important? • Death rates are prime mortality measure and are estimated using two distinct data systems • Death certificate & Census/Survey Population Estimates

4. Distinct Reporting Methods • Numerator of rate • Death Certificate= Educational attainment is recorded by funeral director as per family member report or, often, as result of his/her observation of decedent. • Denominator of rate • Census or Survey= Educational attainment is self-reported or reported by family/household member while individual is still alive.

5. Distinct Classification Systems • Death Certificate= Year-based classification of educational attainment & Degree-based classification. • 1989 Standard Death Certificate Revision • Year – Based • 2003 Standard Death Certificate Revision • Degree –Based • Current Population Survey = Degree-based classification. • Since 1992 Degree - Based

6. Evaluation of Education Reporting on Death Certificate • The National Longitudinal Mortality Study • Current Population Surveys (CPS) & 1980 Census Data linked, using the NDI, to NCHS Mortality Data • 25 Annual March CPS (1973, 1979-1998) and 1980 US Census sub-sample (~2.3 million records) • CPS: National Sample of Households (60,000-80,000), Non-Institutionalized Population, 96% Response Rate • Deaths Occurring between 1979-1998 (~253,000) • For this study: Sample of Decedents in NLMS who responded to 1992 – 1998 CPS Surveys, and who were age 25 and older at time of Survey • Total Sample Size of 10,570 after removal of States that did not include Education item on Death Certificate

7. Evaluation of Education Reporting on Death Certificate • Record-level agreement between CPS and death certificates of individual decedents: • Percent of respondents in a CPS self-identified Educational attainment who are correctly identified on the death certificate • Classification Ratios: Ratios of CPS Educational Attainment counts to death certificate counts for sample of identified decedents

8. Classification Ratios • Less than HS Graduate = • CPS: Less than HS Graduate / DC: Less than 4 yrs of HS completed • HS Graduate = • CPS: HS Graduate / DC: 4 yrs of HS completed • Some College = • CPS: Some College, no degree / DC: 1-3 yrs of college • Bachelor’s degree = • CPS: Bachelor’s degree / DC: 4 yrs of college • Graduate degree = • CPS: Graduate degree / DC: More than 4 yrs of college

9. Adjustment Process Classification Ratio 1989 Unrevised States 2003 Revised States Classification Ratio Inexact Adjustment

10. Record-Level Percent Agreement (Sensitivity)

11. Record-Level Percent Agreement (Sensitivity) by Age at Death

12. Record-Level Percent Agreement (Sensitivity) by Hispanic Origin

13. Record-Level Percent Agreement (Sensitivity) by Race

14. Classification Ratios by Sex

15. Life expectancy for males age 25, Unrevised States

16. Life expectancy for males age 25, Revised States

17. Life expectancy for females age 25, Unrevised States

18. Life expectancy for females age 25, Revised States

19. Summary Findings validate concerns about the validity of mortality measures by education level from unadjusted death certificate data. Identified specific patterns of differential education reporting on death certificate. *common for those not completing HS to have them classified as HS graduates on death certificate *black and Hispanic high school grads in CPS were more likely to than white and non-Hispanic high school grads to have their educational attainment underreported on death certificate. API high school grads in CPS were more likely have their education over reported on death certificate.

20. Summary Findings also support general pattern of mortality differentials by educational attainment observed in other studies: *life expectancy in the US consistently increases with greater education and differences in life expectancy by education are greater for men than women. Finally, study also highlights the complications produced by the use of different classification systems for educational attainment in the data sources.