Use of Vital Records in the Study of Congenital Heart Disease

Abstract

CONGENITAL heart disease is responsible for one-half of all deaths from congenital malformations in Oregon. Improvement in diagnosis and treatment over the pa,st decade, including spectacular and costly surgical advances, has developed. The-se advances raise many economic and sociologic questions which may be answered through an epidemiologic study. The only populations readily available for a study of congenital malformations were those of single institutions, and these were not representative of the population of the entire State. Thus, the birth a,nd death certificates identifying congenital malformations were selected as the starting point in developing a population for study representative of the State as a whole. Fetal death certificates were not used because autopsies of fetuses were seldom performed, and prematurity was recorded most frequent,ly as the cause of fetal death, a term giving no information about congenital malformations. The epidemiologic investigation of congenital heart disease was started as a retrospective and descriptive study for the yea,rs 1957-61. The period was selected because in 1956 specific space for recording congenital malformations was designated in the confidential medical data section of the Oreigon birth certificate, but the reporting during that first year was scanty. This paper is presented to demonstra,te some of the values as well as some of the ina,dequacies of vital records in an epidemiologic study of congenital anomalies. The purpose of this study was to investigate congenital heart disease and congenital malformations in Oregon and to study differences in the disease in population groups. With the original objectives established, the initial phase of the study directed toward ascertaining if data from vital records would be adequate or if other sources of data would be necessary to meet these obj ectives: 1. To establish the recorded incidence, and prevalence if possible, of congenital heart disease in Oregon. 2. To establish prognoses for different types of congenital heart disease. 3. To identify types of congenital heart disease in which the prognoses are most favorable for surgery. 4. To establish the various types of congenital heart defects that are diagnosable in early infancy and those that are not rea,dily recognizable until later or at death, and t,o ascertain how the types are associated with other congenital malformations. 5. To establish, as a, byproduct of this investigation, the reported incidence, and prevalence if possible, of the various categories of congenital malformations (other than heart defects) specified on birth and death certificates in Oregon. Dr. Osterud is associate professor, department of public health and preventive medicine, and Dr. Menashe is associate professor of pediatrics, crippled children's division, University of Oregon Medical School, Portland. Miss Martin is State registrar of vital statistics, Oregon State Board of Health. The investigation was supported by research grant HE-06336-04 from the National Heart Institute, Public Health Service.