Leveraging Electronic Death Registration Systems for Disaster-related Mortality Surveillance

Background: Public health agencies must have the capability to rapidly analyze mortality data after disasters. Death certificates are used to collect national mortality data; deaths registered in state-based Electronic Death Registration Systems (EDRS) are electronically transferred to CDC. These systems can be leveraged for “near-real time” mortality surveillance.

Methods: We collated from the literature and state experiences the effectiveness of state-based mortality surveillance systems after recent natural disasters. We compared the number of deaths reported by various response agencies.

Results: Seventy-four Hurricane Ike deaths were captured in Texas’ active surveillance system whereas only four (5%) were retrospectively identified in their EDRS using key word search. Red Cross and National Weather Service reported 38 and 20 Ike deaths, respectfully. NYC rapidly reported 44 deaths associated with Sandy using their EDRS; Red Cross captured 93% of these deaths and among the 41 cases present in both systems, high agreement existed across variables. During the Moore tornadoes, response agencies and media reported 91 deaths but using their EDRS public health officials determined the number of deaths was 25.

Conclusion: We found the number of disaster-related deaths reported vary by agencies within states and the federal government. Enhanced EDRS could aid in gathering rapid and accurate preliminary death counts for immediate public health action.  A working group, comprised of local, state, federal agencies, has been established to address findings and develop a framework for adapting EDRS for disasters. Priorities are to define disaster-relatedness and prepare guidance documents for EDRS developers and death certifiers.