Real-time mortality surveillance during and after Hurricane Sandy in New York City: Methods and lessons learned
Tuesday, November 5, 2013
: 12:30 p.m. - 12:50 p.m.
Background: In New York City (NYC), 94% of deaths are reported via an electronic death registration system (EDRS). During Hurricane Sandy and its aftermath, the NYC Health Department conducted real-time mortality surveillance to identify directly hurricane-related deaths and other excess mortality. Objectives: Describe NYC's real-time mortality surveillance methods and lessons learned. Methods: We reviewed surveillance methods, measured reporting timeliness, and identified challenges. System Description: NYC mandates death certification (clinician's report of decedent's name, sex, time/date/place of death, and free-text cause of death) within 24 hours and registration (includes decedent's address and demographics) within 72 hours. For this event, ad hoc SQL queries were required to extract needed EDRS data. Newly developed mortality reports compared daily certified death counts with 20102011 averages, categorized registered deaths by cause and flood levels, and provided additional descriptive tables. Aside from free-text searches for injury-related terms, cause-of-death analyses occurred after registration and on-site ICD-10 coding. To categorize deaths by census-tract flooding levels, timely address geocoding was conducted post-registration. Results: EDRS remained operational during and after the hurricane. For Oct 29Nov 10, 2012, average time to certification was 0.5 vs. 1.5 days for 20102011, while average time to registration was 4.6 vs. 3.6 days for 20102011. Analytical challenges included restricting 20102011 comparison data by certification/registration date due to reporting lag and accounting for nursing home evacuations in geographic comparisons. Free-text searches for injury-related terms only identified deaths already reported as hurricane-related outside of EDRS by the medical examiner's office. Operational challenges included staff displacement and duplicate pre-registration death certifications. Discussion: Timely EDRS data allowed for NYC's successful real-time mortality surveillance. Jurisdictions conducting such surveillance should mandate rapid death certification/registration; retain nosologists for timely ICD-10 coding; ensure adequate staff to extract, geocode, and analyze data; and use pre-registration death certificates to enhance timeliness.
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Environmental health sciences
Describe the methods of mortality surveillance in New York City during Hurricane Sandy
Identify challenges and best practices for conducting mortality surveillance during a disaster
Discuss role of health information technology in mortality surveillance
Keyword(s): Disasters, Surveillance
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I am currently a CSTE/CDC Applied Epidemiology Fellow with the Bureau of Vital Statistics and have been involved with the evaluation of mortality surveillance in response to Hurricane Sandy.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.