Exposure, Risk Factors, and Underlying Health | Core Data Elements for Case Notification

Public health surveillance routinely collects data on exposures, risk factors, and underlying health conditions (ERU) to understand trends in disease transmission or prevalence.  Exposures describe specific settings, events, or activities where a person may have encountered a cause of disease, risk factors describe behavioral, social, or situational aspects of a person’s life, and underlying conditions describe existing medical or health-related conditions.  

What might fall into any of these three of these categories may vary across conditions. While not every condition will require transmitted data for all three data classes, establishing standardized definitions for each supports clearer, more consistent categorization across conditions and improves the quality of shared public health data.  

Core Surveillance Data Elements in the Death Data Class 

Data Element

Definition

Data Element

Exposure Data Class Indicator 

Definition

Indicator that the person experienced any listed exposure associated with the condition being reported 

Data Element

Exposure Data Class 

Definition

Within exposure window, either the person’s contact with an entity (person, animal, or substance) or presence at a location where exposure to an agent could have occurred (i.e., where did pathogen come from).  

Transmitted as a repeating group of two data elements: 

  • Exposure 
  • Exposure Indicator (Yes/No/Unknown) 

Data Element

Risk Factor Data Class Indicator 

Definition

Indicator that the person has any listed risk factor associated with the condition being reported 

Data Element

Risk Factor Data Class 

Definition

Characteristics, behaviors, or social/environmental factors that increase the likelihood of developing a disease or condition.  

Transmitted as a repeating group of two data elements: 

  • Risk Factor 
  • Risk Factor Indicator (Yes/No/Unknown) 

Data Element

Underlying Health Condition Data Class Indicator 

Definition

Indicator that the person has any listed underlying health condition associated with the condition being reported 

Data Element

Underlying Health Condition Data Class 

Definition

Pre-existing health conditions that may worsen the course or severity of the disease or health condition.  

Transmitted as a repeating group of two data elements: 

  • Underlying Health Condition  
  • Underlying Health Condition Indicator (Yes/No/Unknown) 

For complete definitions, value sets, data structure notes and implementation recommendations, please review the full document drafted by the Data Standardization Working Group (DSWG).