Evaluation of the quality of cause of death statistics of the last decades in the European Union

Abstract

Abstract Introduction The European Union (EU) do not publish the quality of cause-of-death statistics, when is possible to assess quality by reliability. Quality does not present consolidated indicators. Ill-defined and other inaccurate causes have presented different groupings. Objective To assess the quality of official cause-of-death statistics of the European Union by member states from 2006 to 2020. Methods Cases and population were from the WHO repertory. We selected causes in EU27 countries by up to fourth code-character of ICD10 -on the EuroStat website were not available-. Case counts were grouped into ill- defined, unspecific, less specific (the latter two, in inaccurate), and judicial (inaccurate external causes) categories, based on literature and expertise. We calculated age-adjusted rates to the Standard European Population by country, sex, period (2006-, 2011- and 2016-2020), and quality category. We tested the Comparative Mortality Ratio (CMR) of each country to the European Union median by a Bayesian approach, at 5% statistical significance. We plotted the rates proportion of each quality category in its all causes. Results We included 25 countries. Some did not report all years. Six countries showed >19% for ill-defined causes and 3 member states had <5% in both sex and last period. In inaccurate, for the same time period and sex, average pointed 10% with a range of 3-19%. In the same period, CMR exceeded significantly the EU median in 19 and 18 countries for women and men, respectively; and exceeded in unspecific causes in 12 countries for women and men. Discussion Literature showed that incorrect causes of death were random distributed. Probably major causes were biased and underestimated. Conclusions Quality of cause of death is a useful indicator of mortality statistics reliability. Quality indicators targeted national gaps across EU. We need a new EU task force on statistics of causes of death in accordance with the XXI century. Key messages • Quality indicators of causes of death statistics targeted national gaps across the European Union. • The statistics of death causes underestimated the main causes of death in the European Union.