Mortality Surveillance for the COVID-19 Pandemic: Review of the Centers for Disease Control and Prevention’s Multiple System Strategy

Mortality surveillance systems can have limitations, including reporting delays, incomplete reporting, missing data, and insufficient detail on important risk or sociodemographic factors that can impact the accuracy of estimates of current trends, disease severity, and related disparities across subpopulations. The Centers for Disease Control and Prevention used multiple data systems during the COVID-19 emergency response—line-level case‒death surveillance, aggregate death surveillance, and the National Vital Statistics System—to collectively provide more comprehensive and timely information on COVID-19‒associated mortality necessary for informed decisions. This article will review in detail the line-level, aggregate, and National Vital Statistics System surveillance systems and the purpose and use of each. This retrospective review of the hybrid surveillance systems strategy may serve as an example for adaptive informational approaches needed over the course of future public health emergencies. ( Am J Public Health. 2024;114(10):1071–1080. https://doi.org/10.2105/AJPH.2024.307743 )