The way forward.

Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights. However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run.

Civil registration systems and vital statistics: successes and missed opportunities.

Vital statistics generated through civil registration systems are the major source of continuous monitoring of births and deaths over time. The usefulness of vital statistics depends on their quality. In the second paper in this Series we propose a comprehensive and practical framework for assessment of the quality of vital statistics. With use of routine reports to the UN and cause-of-death data reported to WHO, we review the present situation and past trends of vital statistics in the world and note little improvement in worldwide availability of general vital statistics or cause-of-death statistics. Only a few developing countries have been able to improve their civil registration and vital statistics systems in the past 50 years. International efforts to improve comparability of vital statistics seem to be effective, and there is reasonable progress in collection and publication of data. However, worldwide efforts to improve data have been limited to sporadic and short-term measures. We conclude that countries and developmental partners have not recognised that civil registration systems are a priority.

Diabetes hospitalization at the U.S.-Mexico border.

INTRODUCTION: The diabetes hospitalization rate for the region along the U.S. side of the U.S.-Mexico border is unknown, a situation that could limit the success of the Healthy Border 2010 program. To remedy this problem, we analyzed and compared hospital discharge data for Arizona, California, and Texas for the year 2000 and calculated the diabetes hospitalization rates. METHODS: We obtained hospital-discharge public-use data files from the health departments of three U.S. border states and looked for cases of diabetes. Only when diabetes was listed as the first diagnosis on the discharge record was it considered a case of diabetes for our study. Patients with cases of diabetes were classified as border county (BC) or nonborder county (NBC) residents. Comparisons between age-adjusted diabetes discharge rates were made using the z test. RESULTS: Overall, 1.2% (86,198) of the discharge records had diabetes listed as the primary diagnosis. BC residents had a significantly higher age-adjusted diabetes discharge rate than NBC residents. BC males had higher diabetes discharge rates than BC females or NBC males. In both the BCs and the NBCs, Hispanics had higher age-adjusted diabetes discharge rates than non-Hispanics. CONCLUSION: The results of this study provide a benchmark against which the effectiveness of the Healthy Border 2010 program can be measured.

Vital and health statistics: Russian Federation and United States, selected years 1985-2000 with an overview of Russian mortality in the 1990s.

This report provides comparative vital and health statistics data for recent years for the Russian Federation and the United States. Statistical data for Russia and from the Ministry of Health of Russia and from Goskomstat, the central statistical organization of Russia. Information for the United States comes from various data systems of the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) as well as other parts of the Department of Health and Human Services. The initial section of the report summarizes information on recent mortality trends in the Russian Federation. During the 1990s, Russia experienced a major increase in mortality from 1990 to 1994, a substantial reduction in mortality from 1994 to 1998, and another major increase from 1998 to 2000. The mortality overview uses tables and figures to describe mortality changes by age group, sex, and cause of death, and to determine the contribution of each of these to changes in life expectancy. The overview also considers risk factors and other issues underlying these trends, in an attempt to understand the impact of major mortality determinants on changes in life expectancy. The section on vital and health statistics uses tables, figures, and commentary to present information on many different health measures for the populations of the two countries. Topics covered include population size, fertility, life expectancy, infant mortality, death rates, communicable diseases, and various health personnel and health resource measures. The commentary includes a discussion of data quality issues that affect the accuracy and comparability of the information presented. Data are provided for selected years from 1985 to 2000. In addition to national data, mortality information on urban and rural subgroups in Russia is provided. A glossary of terms at the end of the report provides additional information on definitions and data sources and limitations.