Five Democratic senators sent a letter to Department of Health and Human Services Secretary Alex Azar on Friday, pressing the agency about issues with the nonfatal firearm injury estimates published by the Centers for Disease Control and Prevention. It’s the latest missive in an exchange that has left the lawmakers unsatisfied with the agency’s commitment to improve its data. “We believe the CDC’s explanation falls short,” the letter reads.

The inquiry, led by Democrat Bob Menendez of New Jersey, follows reporting by The Trace and FiveThirtyEight that revealed serious issues with the quality of the CDC’s estimates, which have grown increasingly unreliable in recent years.

In March, a group also led by Menendez sent a letter to Azar detailing concerns with the CDC’s gun injury estimates and the methodology used to generate them. CDC Director Robert Redfield responded in May, writing that the agency was “exploring ways to improve the precision and accuracy of [its] non-fatal firearm injury estimates.” Redfield acknowledged that the estimates are susceptible to distortion because of the small number of hospitals included in the database used to calculate them — one of the key problems identified in our investigation. “By expanding the roster of participating hospitals,” he wrote, “the influence of any one hospital should be reduced and more stable estimates should be attainable.”

Guohua Li, editor in chief of the medical journal Injury Epidemiology and director of Columbia University’s Center for Injury Epidemiology and Prevention, said the CDC could fix some of its data issues by using the larger and more reliable Healthcare Cost and Utilization Project (HCUP) database to adjust the current online estimate. Both databases are maintained by agencies under the Department of Health and Human Services, and while the estimates published online by the CDC draw from just 60 or so hospitals, HCUP data is collected from more than 950. “The data issue could be resolved within a few months,” Li told The Trace by email.

In his response to the senators, Redfield denied that HCUP would be an appropriate substitute for the current data source. He said that HCUP is not as timely, noting that the most recent data published on the free, public-facing HCUP data portal is from 2014.

The senators’ latest response pushes back against this statement, pointing out that more recent data is available through a separate HCUP website intended for use by researchers. “The Agency for Healthcare Research and Quality issued 2016 HCUP-NEDS data in September 2018, over six months before your May 3, 2019 letter,” the senators wrote. “Why did your response state that such data are unavailable when the data is indeed available?”

The letter, which was co-signed by Democratic Senators Mazie Hirono of Hawaii, Richard Blumenthal of Connecticut, and Amy Klobuchar and Tina Smith of Minnesota, asks Azar to respond by August 1.

The Trace and FiveThirtyEight identified at least 50 research papers that have cited the CDC’s unreliable gun injury estimates since 2010. According to Li, fixing the estimates is crucial to reducing gun violence. “Violence is an ongoing public health crisis facing this nation,” he said. “Without quality and timely surveillance data, the public health approach is blindfolded.”