Abstract
BackgroundAccurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. Incorrectly or vaguely assigned deaths, defined as garbage-coded deaths, mask the true cause distribution. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. We identify the pattern of garbage-coded deaths in the world and present the methods used to determine their redistribution to generate more plausible cause of death assignments.MethodsWe describe the methods developed for the GBD 2019 study and subsequent iterations to redistribute garbage-coded deaths in vital registration data to plausible underlying causes. These methods include analysis of multiple cause data, negative correlation, impairment, and proportional redistribution. We classify garbage codes into classes according to the level of specificity of the reported cause of death (CoD) and capture trends in the global pattern of proportion of garbage-coded deaths, disaggregated by these classes, and the relationship between this proportion and the Socio-Demographic Index. We examine the relative importance of the top four garbage codes by age and sex and demonstrate the impact of redistribution on the annual GBD CoD rankings.ResultsThe proportion of least-specific (class 1 and 2) garbage-coded deaths ranged from 3.7% of all vital registration deaths to 67.3% in 2015, and the age-standardized proportion had an overall negative association with the Socio-Demographic Index. When broken down by age and sex, the category for unspecified lower respiratory infections was responsible for nearly 30% of garbage-coded deaths in those under 1 year of age for both sexes, representing the largest proportion of garbage codes for that age group. We show how the cause distribution by number of deaths changes before and after redistribution for four countries: Brazil, the United States, Japan, and France, highlighting the necessity of accounting for garbage-coded deaths in the GBD.ConclusionsWe provide a detailed description of redistribution methods developed for CoD data in the GBD; these methods represent an overall improvement in empiricism compared to past reliance on a priori knowledge.
Highlights
Accurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide
We provide a detailed description of redistribution methods developed for cause of death (CoD) data in the Global Burden of Disease (GBD); these methods represent an overall improvement in empiricism compared to past reliance on a priori knowledge
This paper provides further detail on the most current methods developed to account for garbage-coded deaths in vital registration (VR) data using the detailed International Classification of Diseases (ICD)-9 and ICD-10 nosological classification systems, as these data represent the vast majority of GBD’s mortality data (Additional file 1: Figure 1)
Summary
Comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. The highest-quality CoD data are reported via vital registration (VR) systems, through which “the continuous, permanent, compulsory and universal” recording of vital demographic events occurs “in accordance with the legal requirements of a country” [2, 3]. The process of completing and accurately coding a death certificate according to the international standard established by the International Statistical Classification of Diseases and Related Health Problems (ICD) is challenging for all countries, regardless of income status [7]
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