Data glitch leaves Arizona without public health tool that tracks deaths

In the midst of its worst flu season in years, Arizona is without a key public health surveillance tool used to track deaths caused by diseases circulating in the community.

Arizona and its counties haven't had the death-surveillance data since the state switched to a new database of births and deaths in October.

Arizona health officials said the temporary absence of the death-surveillance database stems from a technical error in how the state reports death records to the federal Centers for Disease Control and Prevention.

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States send updates on death records to the CDC, which returns the data to states in a robust form that includes diagnostic codes linking deaths to health conditions. The Arizona Department of Health Services shares the data files with county health officials to research and monitor death trends.

But since Oct. 1, when Arizona launched a birth and death records database called the Database Application for Vital Events, or DAVE, Arizona and its counties have not had access to the CDC data.

The Maricopa County Department of Public Health this month sent an email to high-ranking county officials informing them that it no longer has access to timely death data. In the email, the department said it had no access to current CDC data on deaths from the flu, opioid overdoses, diabetes and cancer.

Maricopa County Public Health, which has been at odds with the state over the new birth and death database, declined interview requests and referred questions to a county spokesman, Fields Moseley, who responded with written answers.

"Maricopa County Public Health has not been able to track real-time cause of death information since the rollout of the new DAVE records system," Moseley said. "In the previous system we received nightly files which allowed us to review and identify potentially unreported infectious diseases resulting in death and to monitor death reports for potential unidentified public health threats."

Fixing a glitch

The Arizona Department of Health Services is working closely with the CDC and expects to fix the data-reporting glitch by February.

The department provides the CDC with regular reports on death data. As part of Arizona's switch to the new birth and death database, the state merged old data files into the new system and sent the data to the CDC's National Center for Health Statistics.

However, the CDC rejected Arizona's weekly data submissions because they included files the federal agency did not want. As a result, the CDC has not provided the robust data reports to Arizona since October.

When the problem is resolved, the state will resume its regular data updates that can be accessed by county health officials.

Health Services officials emphasized that the data glitch does not affect people getting medical care at hospitals, doctors' offices or clinics.

"It's not information for medical care or a death certificate issue," said Dr. Cara Christ, director of the Health Services Department. The CDC "is getting a couple of Arizona-specific reports that they don't need, and we are trying to remove them."

State health officials said the CDC data is one of several reporting tools for public-health surveillance.

For tracking the flu, Arizona gets updates from doctors, hospitals and laboratories. The state Department of Health Services issues weekly reports that include the overall number of flu cases, including cases by county and age.

'One layer of information'

The CDC requires states to report all deaths of children who have lab-confirmed flu. In Arizona, one child in Maricopa County has died of the flu this season.

There is no federal requirement that states report flu-related deaths of adults, but the CDC uses statistical models based on death certificate data to estimate all flu-related deaths.

While the Arizona Department of Health Services typically does not use the CDC death data for its weekly flu updates, the agency incorporates the data into an end-of-season report, according to Christ.

"It is one layer of information but not what we use on day-to-day surveillance," Christ said.

Arizona also has bolstered its reporting of opioid overdoses under Gov. Doug Ducey's emergency declaration last year.

Under the emergency order, law enforcement, emergency medical workers, health providers and administrators, and medical examiners must report suspected opioid-related overdoses to the Health Services Department within five business days.

Although these deaths must be reported within five days, if often takes county medical examiners several months to confirm opioid-related deaths based on toxicology reports and ongoing investigations.

Arizona health officials said Ducey's emergency order allows the state timely access to accurate data.

"The opioid-associated deaths reported under the enhanced surveillance provides us with a real-time picture of suspected deaths," said Health Services spokesman Chris Minnick.

Maricopa County's epidemiology team tracks disease and public-health threats in the community. The county routinely checks lab-confirmed flu cases against death certificates to track the severity of a flu season, but it hasn't been able to track these deaths since October.

"The CDC death reports are one of several measures we use," said Moseley. "They are just as important as other sources as we try to paint an accurate picture of what is happening in Maricopa County, but in some cases, they are our only source."

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