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Mortality data
were obtained from the National Vital Statistics System (NVSS-M); Center for
Disease Control and Prevention, National Center for Health Statistics
(CDC/NCHS) and U.S. and the Census Bureau. The National Vital Statistics System
is an inter-governmental system of sharing data on the vital statistics,
mortality birth, marriage and divorce and other statistics of the population in
the United

States.15 It
involves coordination between different state health departments and the
National Center for Health Statistics, a division of the Center for Disease
Control and Preventions to produce critical information about important topics
such as mortality rate, leading cause of death and life expectancy.16

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A key strength of the National Vital Statistics System is that is provides the most complete and
continuous data available about vital statistics to public health officials at
the national state, local levels, and in the private sector. It is nationally representative,
and the data collected represents disease trends demographically and
geographically. In addition, the NVSS data are made publically available to be
used and accessed by scholars, scientist and public health organizations which
assist many epidemiological researches. It also uses systematic and standardized
methods of data collection. The National Vital Statistics Systems also compiles
statistical information to guide actions and policies to improve the health of
the population. The NVSS serves as a unique public resource for health information,
and a critical element for public health and health policy. However, it has several
limitations, the NVSS does not record the health-risk behavior that is
associated with heart disease, which limits the potentials for community-based
public health intervention and health promotion programs to prevent the disease
and limit its impact on the quality of life. A second limitation is that the
data source does not capture deaths from coronary heart disease that was
recorded outside the United States which could under-represent the actual rate
of mortality. In addition, the cause of death maybe coded inconsistently with
the actual cause of death which could miss-represent the actual trends and

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