Multiple causes of death analysis of chronic diseases: the example of diabetes.

Ugo Fedeli,Giacomo Zoppini,Mario Saugo,Carlo Alberto Goldoni,Francesco Avossa,Giuseppe Mastrangelo

doi:10.1186/s12963-015-0056-y

Ugo Fedeli, Giacomo Zoppini + Show 4 more

Open Access

https://doi.org/10.1186/s12963-015-0056-y

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Abstract

BackgroundIdentifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases.MethodsThe whole mortality archive of the Veneto Region-Italy was extracted from 2008 to 2010. Mortality rates and proportional mortality were computed for diabetes as the UCOD and as MCOD. The position of the death certificate where diabetes was mentioned was analyzed. Conditional logistic regression was applied with chronic liver diseases (CLD) as the outcome and diabetes as the exposure variable. A subset of 19,605 death certificates of known diabetic patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of diabetes as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors.ResultsIn the whole mortality archive, diabetes was mentioned in 12.3 % of death certificates, and selected as the UCOD in 2.9 %. The death rate for diabetes as the UCOD was 26.8 × 105 against 112.6 × 105 for MCOD; the UCOD/MCOD ratio was higher in males. The major inconsistencies of certification were entering multiple diseases per line and reporting diabetes as a consequence of circulatory diseases. At logistic regression the mention of diabetes was associated with the mention of CLD (mainly non-alcohol non-viral CLD). In the subset of known diabetic subjects, diabetes was reported in 52.1 %, and selected as the UCOD in 13.4 %. The probability of reporting diabetes was higher with coexisting circulatory diseases and renal failure and with long duration of diabetes, whereas it was lower in the presence of a neoplasm.ConclusionsThe use of MCOD makes the analysis of mortality data more complex, but conveys more information than usual UCOD analyses.

Highlights

Cause-specific mortality data are of paramount importance to describe the health profile of a population, to set priorities for health policy makers, and can be used to evaluate the impact of preventive interventions
Reported mortality data are limited to a single cause of death, the underlying cause of death (UCOD), which is selected from all diseases mentioned in the death certificate according to international coding rules
Due to different types of inconsistencies in the certification, standard mortality statistics are based on internationally adopted algorithms which identify the UCOD from all the conditions reported in the certificate

Summary

Introduction

Cause-specific mortality data are of paramount importance to describe the health profile of a population, to set priorities for health policy makers, and can be used to evaluate the impact of preventive interventions. Cause-specific mortality represents a commonly adopted end-point for epidemiologic studies and clinical trials, and constitutes an essential information source to build disease registries. Reported mortality data are limited to a single cause of death, the underlying cause of death (UCOD), which is selected from all diseases mentioned in the death certificate according to international coding rules. An additional approach is represented by the analysis of all conditions reported in the certificate (multiple causes of death – MCOD), to assess any mention of a disease irrespective of its selection as the UCOD. Identifying a single disease as the underlying cause of death (UCOD) is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death (MCOD) approach examines any mention of a disease in death certificates. Taking diabetes as an example, the study investigates: patterns of death certification, differences in mortality figures based on the UCOD and on MCOD, factors associated to the mention of diabetes in death certificates, and potential of MCOD in the analysis of the association between chronic diseases

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Results

Conclusion