Brandon Ramsey Improving Pneumonia and Influenza Mortality Surveillance

Brandon Ramsey Improving Pneumonia and Influenza Mortality Surveillance: Using Literal Cause of Death Fields to Improve Accuracy and Timeliness Methods Background Results Mortality Data for Influenza Surveillance • DOH uses pneumonia and influenza (P&I) mortality as an indicator for influenza severity and for situational awareness. • International Classification of Disease (ICD-10) codes are the most commonly used cause of death field. • Proportion of P&I Deaths Underlying ICD codes process slowly (see chart below) and can change over time. • • P&I "Literals" Deaths, Week 1, 2016 through Week 17, 2016 with an Underlying ICD Code Queries for influenza and pneumonia death detection were created (see below); one for underlying ICD code and one for “literals. ” 100% The number of death records detected using the “literals” queries were compared to the number of deaths detected using the underlying cause of death ICD queries. 50% 0% 1 6 Week 11 Deaths with Underlying ICD Code Deaths without Underlying ICD Code 16 DOH has access to the less commonly used literal cause of death (“literals”) fields via the state syndromic surveillance system (ESSENCE-FL), which are available 24 -48 hours after death. “Literals” are causes of death that are physician-recorded at time of death (see comparison below). Example Death Record: “Literals” and Underlying ICD Code Underlying "literal" 1 "literal“ 2 "literal" 3 "literal" 4 Cause J 110 Pneumonia Flu COPD None (Influenza with Pneumonia) Research Question • What are the benefits of using “literals” as opposed to underlying ICD code for mortality surveillance? Deaths detected using the “literals” query were examined further to determine which ICD code they most frequently obtained as an Underlying Cause of Death (UCOD). Queries Used in Analysis UCOD Query for “Literals” Query for Influenza* Influenza Terms Negations Influenza, H 1 N 1 Haemophilus, Fluid, Flutter, Non-flu, J 09, J 10, Bacteremia, Flur, Conflu, J 11 Fluo “Literals” Query for Pneumonia* Terms Negations Pneumonia Aspir, Pneumonitis, Pneumococcal *Misspelled words excluded from table - UCOD Query for Pneumonia Terms Negations J 12, J 13, J 14, J 15, J 16, J 17, J 18 Heather Rubino Florida Department of Health Janet Hamilton Florida Department of Health David Atrubin Florida Department of Health Discussion Influenza Deaths Identified by Querying “Literals” Compared to Querying UCOD All death records from 2010 to 2014 (N=917, 683) were obtained from Vital Statistics data using ESSENCE-FL. Florida Department of Health 603 487 Literals UCOD 77% of influenza deaths detected with a “literals” query had a matching underlying influenza ICD code. Top 5 ICD-10 Codes for Deaths with Influenza "Literals“ (Bold indicates “literals” and UCOD do not match) ICD-10 Underlying ICD-10 Code Deaths Code Type J 110 -With Pneumonia 168 Influenza J 111 -With Other Respiratory Manifest 90 Influenza J 09 -Influenza due to identified avian 87 Influenza influenza virus J 100 -With Pneumonia Influ Virus 64 Influenza J 101 -With Other Resp Manifest Influ Virus 46 Influenza CONCLUSIONS • Using the “literals” can increase the total number of pneumonia and influenza deaths identified. • Although the “literals” query for pneumonia is likely too broad, queries can be created to limit noise while still capturing all deaths of interest. • Creating specific queries makes it possible to include P&I-associated deaths even when they do not receive a P&I UCOD. • The “literals” help explain what caused a death with an “unspecified UCOD. ” • Greater detail about deaths can improve analytic capacity to understand these events in terms of other conditions (see chart below). Words within “Literals” of Influenza Deaths Pneumonia Deaths Identified by Querying “Literals” Compared to Querying UCOD 49, 074 11, 773 Literals UCOD 24% of pneumonia deaths detected with a “literals” query had a matching underlying pneumonia ICD code. Top 5 ICD-10 Codes for Deaths with Pneumonia "Literals“ (Bold indicates “literals” and UCOD do not match) ICD-10 Code Underlying ICD-10 Code Deaths Type J 189 -Unspecified 10, 413 Pneumonia J 440 -With Acute Lower 5, 704 Not Pneumonia Respiratory Infection F 03 -Unspecified Dementia 2, 833 Not Pneumonia C 349 -Unspecified 2, 513 Not Pneumonia I 251 -Atherosclerotic Heart Disease 1, 730 Not Pneumonia Real-World Epidemiologic Applications • DOH uses a daily query of the literals to identify pediatric influenza deaths; often before ICD underlying cause of death is established. • Early detection of pediatric mortality increases the chance of retrieving and testing samples. • General P&I mortality is monitored weekly as a measure of influenza season severity.