摘要：Objectives. We evaluated the use of New York City’s (NYC’s) electronic death registration system (EDRS) to conduct mortality surveillance during and after Hurricane Sandy. Methods. We used Centers for Disease Control and Prevention guidelines for surveillance system evaluation to gather evidence on usefulness, flexibility, stability, timeliness, and quality. We assessed system components, interviewed NYC Health Department staff, and analyzed 2010 to 2012 death records. Results. Despite widespread disruptions, NYC’s EDRS was stable and collected timely mortality data that were adapted to provide storm surveillance with minimal additional resources. Direct-injury fatalities and trends in excess all-cause mortality were rapidly identified, providing useful information for response; however, the time and burden of establishing reports, adapting the system, and identifying indirect deaths limited surveillance. Conclusions. The NYC Health Department successfully adapted its EDRS for near real-time disaster-related mortality surveillance. Retrospective assessment of deaths, advanced methods for case identification and analysis, standardized reports, and system enhancements will further improve surveillance. Local, state, and federal partners would benefit from partnering with vital records to develop EDRSs for surveillance and to promote ongoing evaluation. New York City’s (NYC’s) Health Department introduced an electronic death registration system (EDRS) in 2005, allowing medical providers, funeral directors, and Health Department registration staff to voluntarily report deaths and access death records through a Web-based system. Since then, local mandates for EDRS use and timeliness resulted in nearly complete electronic reporting and accelerated the processing of death certificates and the availability of population mortality data. 1 Across the United States, 46 of 57 vital event jurisdictions have implemented EDRSs, creating new opportunities to use mortality data for the timely surveillance of emerging public health concerns. 2,3 For example, fatalities are a commonly used indicator of the public health impact of natural disasters, including extreme heat events, floods, tornadoes, and hurricanes. 4 Recently, lead US health agencies have called for greater research and evaluation of disaster-related systems and processes to address challenges faced by government and public health agencies, hospitals and clinicians, and academic researchers. 5 The evaluation of local systems after disasters is therefore critical for identifying and addressing knowledge gaps for future events. On October 29, 2012, posttropical cyclone Sandy (Hurricane Sandy) made landfall approximately 100 miles south of NYC, causing a record-breaking storm surge throughout coastal areas of the city. 6 Extensive flooding and wind damage caused widespread power outages, transportation shutdowns, medical facility and residential evacuations, and disruptions to health care access. 7 Environmental risks persisted in the days and weeks following the storm, especially in residential buildings with damage to electrical, heating, elevator, and potable water systems. This raised concerns not only for direct-injury–related fatalities but also for all-cause deaths attributable to hazardous conditions. In response, the NYC Health Department used its EDRS to conduct mortality surveillance during and after Hurricane Sandy. Surveillance objectives were to (1) identify and characterize Sandy-related deaths, and (2) examine all-cause mortality during the storm and identify poststorm hazards. To assess performance of the disaster mortality surveillance system, we evaluated key system attributes, identified strengths and limitations, and made recommendations for system improvements.
