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Death Data Release Notes

General Release Notes

2022 Death

Population Estimates

HHDW has two population rates available. The Population Rates module should be used to examine cause of death by sex, age, and geography (state and county) and has annually updated Census data as the denominator. The Population Rates by DOH race/ethnicity (only) module allows users to examine cause of death by Hawaiʻi specific race/ethnicity and is based on a 5-year aggregate population that is held constant across years. The population estimates for both modules come from the U.S. Census. The population data in the Population Rates module come from the American Community Survey 1-year estimates. The population data in the DOH race/ethnicity (only) module are based on a special 5-year aggregate created for HHDW by the Census to approximate the race/ethnicity algorithm used by the Department of Hawaiʻi State Department of Health's Office of Health Status Monitoring to assign a single race/ethnicity to each person (see here).

With the 2022 death record data, new Census data was uploaded for 2020, 2021 and 2022, and a new DOH race/ethnicity data file was loaded for 2016-2020. The HHDW team compared the race/ethnicity population estimates from the 1-year and 5-year aggregates and determined that the Census race population estimates are not comparable to the way race/ethnicity is coded on the death certificate. Therefore this option has been temporarily removed from the Population Rates module. These updates to the population reference files may result in population rate changes from 2020 and 2021 and race/ethnicity rate changes from 2016 forward.

Race/Ethnicity Data

HHDW has been working on standardizing the category descriptions across data sets. As part of this standardization the display order for DOH Race/Ethnicity has been changed to be the same across all data sets. The new display order is:

The display order for Census Race has also been changed. The new display order is:

2021 Death

Race/Ethnicity Data

HHDW has been working on standardizing the category descriptions across data sets. As part of this standardization the category for "White" has been made the standard category title, replacing "Caucasian" in some data sets. Also, a standard description of "American Indian or Alaska Native" has been set to replace a variety of category names. See the table below for the updated mapping of Program Race/Ethnicity, DOH Race/Ethnicity and Census Race.

2020 Death

COVID-19 Cause of Death

We have added the COVID-19 cause of death to the death module reports. COVID-19 related deaths are available for the year 2020 foward. COVID-19 cause of death can be accessed through the leading causes of death categories or by entering custom ICD-10 code U071.

2019 Death

New Primary Care Service Area Dimension

We have added a new geographic dimension to the Death Module to cover primary care service areas. Primary care service areas were created to describe the delivery of primary health services in the State of Hawaiʻi through participation of multiple stakeholders in the early 1990's. The rural health associations of the Hawaiʻi, Maui and Kauaʻi Counties delineated rational service areas under their respective jurisdictions. Neighborhoods were clustered into primary care service areas to provide information below the county or island level with demarcation between adjacent neighborhoods. Census tracts were used in defining these areas due to their availability in census and vital statistic data.

Here is a link to a document containing the Census Tract to Primary Care Service Area Crosswalk:

All Years

Population Estimates for Population-based Rates

Annual population estimates are extracted each year from the U.S. Census, Population Division, Annual County Resident Population Estimates. These estimates change each year and provide the denominator for the crude death rates, by age, sex and census race.

However, population estimates for Hawaiʻi-specific race/ethnicities (DOH Race/Ethnicity) are not reportable for individual years, so special 5 year aggregate population estimate files were created for Hawaiʻi, by the Data Products Development Branch, American Community Survey Office, U.S. Census Bureau. These 5 year aggregate (2010-2014 and 2016-2020) files were used to create two average annual population estimates: the 2010-2014 file was used to create the population estimates for the years 2010-2015 and the 2016-2020 file was used to create the population estimates for the years 2016-2022. These estimates are used for all population-based rates by DOH Race/Ethnicity for the years 2010 forward.

Because HHDW uses two different population estimate files, death rates may vary slightly depending on which category you select your death rate indicator from - Population Rates with Census Race vs Population Rates by DOH Race/Ethnicity ONLY. Census Race and DOH Race/Ethnicity rates should not be compared directly.


Data can be analyzed geographically by decendent's residence or occurence of death. Decedent's residence is based on the address provided on the death certificate as the place where the decedent resided at the time of death. Military members and dependents who live in Hawaiʻi at the time are classified as residents.

There are two measures for capturing geography in the Death Record - zip code and census tract. Island, school complex and community are based on zip code and county and primary care service area are based on census tract.

Cell Suppression Criteria

Cell suppression criteria have changed. In accordance with data use restrictions set forth by Hawaiʻi State Department of Health (DOH) and the National Center for Health Statistics (NCHS), cell counts of fewer than 9 events and rates based on counts of 9 or fewer will be suppressed, and rates based on counts of less than 20 will be regarded as unreliable and will also be suppressed. Suppressed data is denoted with a double asterisk (**).

Additional information on national standards for the collection and analysis of mortality statistics from the NCHS, National Vital Statistics System can be accessed here.

Causes of Death

While more than one cause of death can be listed on the death certificate, this system is based on the underlying cause-of-death which is defined by the World Health Organization (WHO) as "the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury." Underlying cause-of-death is selected from the conditions entered by the physician on the cause of death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the ICD-10 code, and associated selection rules and modifications.
If you are interested in underlying and contributing causes of death, please contact us or visit CDC WONDER to access the Multiple Cause of Death data file.

Beginning with data for 2006, the valid ICD-10 codes used to classify causes of death changed. Effective with the 2006 data year, 18 codes were introduced as valid causes of death, and 4 codes were discontinued. Effective with the 2007 data year, 4 codes were introduced as valid causes of death, and 2 codes were discontinued. See ICD-10 Changes for more information.

Race/Ethnicity Data

The death certificate allows for up to 4 race/ethnicities to be captured for the decedent. The DOH Office of Health Status Monitoring (OHSM) uses the following algorithm to code a single race/ethnicity for each individual.

Only one ethnicity is coded from the actual certificates. If more than one ethnicity is listed on the certificate, the following rules apply:
In HHDW, the most granular level is the program race/ethnicity (PRG) which rolls up into the DOH standard race/ethnicity (DOH), which rolls up into Census race reporting categories (Census). The table below illustrates how the data is aggregated.

Race/Ethnicity Classifications
Source Race/EthnicityProgram Race/Ethnicity (PRG)DOH Race/Ethnicity (DOH)Census Race (Census)
American Indian or Alaska NativeAmerican Indian or Alaska NativeAmerican Indian or Alaska NativeAmerican Indian or Alaska Native
Asian IndianAsian IndianOther AsianAsian
BlackBlackBlackBlack or African American
GuamanianGuamanianOther Pacific IslanderNative Hawaiian and Other Pacific Islander
HawaiianHawaiianNative HawaiianNative Hawaiian and Other Pacific Islander
Part HawaiianPart HawaiianNative HawaiianNative Hawaiian and Other Pacific Islander
KoreanKoreanOther AsianAsian
Other AsianOther AsianOther AsianAsian
Puerto RicanPuerto RicanOtherOther
SamoanSamoanOther Pacific IslanderNative Hawaiian and Other Pacific Islander
VietnameseVietnameseOther AsianAsian


Documentation is available here to describe how we collect and map race/ethnicity, geography, and poverty level.

HHDW Race/Ethnicity Documentation

HHDW Geography Documentation