The NMFS program, begun in the 1960’s, uses a sample of United States residents who die in a given year to supplement the death certificate with information from the next of kin or another person familiar with the decedent’s life history. This information, sometimes enhanced by administrative records, provides a unique opportunity to study the etiology of disease, demographic trends in mortality, and other health issues.

The first mortality followback survey, conducted in 1961, featured information on hospital and institutional care in the last year of life. Information from the 1962-63 survey permitted an extensive analysis of socioeconomic differentials in mortality. Data from the 1964-65 survey included expenditures for health care during the last year of life, sources of payment, and health insurance coverage of decedents. The 1966-68 survey provided information on the link between smoking and cancer mortality. In 1986 the survey provided data on co-morbid conditions, disabilities, alcohol use, and access to health care services.

The 1993 survey samples individuals aged 15 years or over who died in 1993. Forty- nine of the 50 State vital registration areas granted approval to sample their death certificates, as well as the independent vital registration areas of the District of Columbia and New York City. South Dakota declined to participate in the NMFS due to State law restricting the use of death certificate information. A sample of 22,957 death certificates from the Current Mortality Sample was drawn. To meet specific research needs, the sample included 9,636 death certificates selected with certainty. There is an over-sample of death certificates to obtain reliable numbers for important population subgroups; persons under age 35, women, and the black population. The 1993 NMFS focused on five subject areas: (1) socioeconomic differentials in mortality, (2) associations between risk factors and cause of death, (3) disability, (4) access and utilization of health care facilities in the last year of life, (5) reliability of certain items reported on the death certificate.