Abstract
BackgroundElectronic death certification was established in France in 2007. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates.MethodsAll death certificates from the 2010 French mortality database were included. Three specific quality indicators were considered: (i) amount of information, measured by the number of causes of death coded on the death certificate; (ii) intrinsic consistency, explored by application of the International Classification of Disease (ICD) General Principle, using an international automatic coding system (Iris); (iii) imprecision, measured by proportion of death certificates where the selected underlying cause of death was imprecise. Multivariate models were considered: a truncated Poisson model for indicator (i) and binomial models for indicators (ii) and (iii). Adjustment variables were age, gender, and cause, place, and region of death.Results533,977death certificates were analyzed. After adjustment, electronic death certificates contained 19% [17%-20%] more codes than paper death certificates for people deceased under 65 years, and 12% [11%-13%] more codes for people deceased over 65 years. Regarding deceased under and over 65 respectively, the ICD General Principle could be applied 2% [0%-4%] and 6% [5%-7%] more to electronic than to paper death certificates. The proportion of imprecise death certificates was 51% [46%-56%] lower for electronic than for paper death certificates.ConclusionThe method proposed to evaluate the quality of death certificates is easily reproducible in countries using an automatic coding system. According to our criteria, electronic death certificates are better completed than paper death certificates. The transition to electronic death certificates is positive in many aspects and should be promoted.
Highlights
Causes of death statistics are essential data to monitor population health, undertake epidemiological studies, and international comparisons
In compliance with the World Health Organization (WHO) international standards, are composed of two parts: Part I is dedicated to the reporting of diseases related to the train of events leading directly to death, and Part II is dedicated to the reporting
The death certificates are coded automatically by the international software international automatic coding system (Iris) (Additional file 1: Iris software) in order to select the underlying cause of death (UCD); complex cases are reviewed by nosologists
Summary
Causes of death statistics are essential data to monitor population health, undertake epidemiological studies, and international comparisons. In compliance with the World Health Organization (WHO) international standards, are composed of two parts: Part I is dedicated to the reporting of diseases related to the train of events leading directly to death, and Part II is dedicated to the reporting. One single underlying cause is selected for each death, following the General Principle and rules described on the International Statistical Classification of Diseases (ICD) and Related Health Problems, 10th revision [2] (Additional file 2: Rules for mortality coding). The poor quality and comparability of medical cause of death data are mainly due to the lack of training of certifiers. The death certificate, the underlying cause concept, and the rules that are applied to determine it, are all defined by WHO, following an international standard that ensures quality and comparability. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates
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