Revisiting the mortality of France and Italy with the multiple-cause-of-death approach

Abstract

Abstract In this paper we revisit mortality profiles of France and Italy in 2003 using multiple-cause-of-death approach. The method leads to a substantial upward reassessment of role played by certain conditions - e.g. diseases of blood and diseases of skin - in overall mortality. Regarding associations of causes, we distinguish three patterns of pairwise joint occurrence of causes that are common to both countries. The numerous similarities that emerge from comparison of two countries are a positive signal of reliability of multiple-cause-of-death data. (ProQuest: ... denotes formula omitted.) 1. Introduction Although monitoring of mortality trends is mostly based on underlying cause of death - that is the disease or which initiated train of morbid events leading directly to death, or circumstances of accident or violence which produced fatal injury (WHO 1949), a growing number of studies use entire set of causes listed on death certificate, hereafter referred to as multiple causes of death (MCOD), to portray mortality profile of a country (Chamblee and Evans 1982; Manton and Stallard 1982; Manton 1986; Manton and Myers 1987; White, Selvin, and Merrill 1989; Mackenbach et al. 1995; Stallard 2002; Desesquelles and Mesle 2004; Redelings, Sorvillo, and Simon 2006; Redeling, Wise, and Sorvillo 2007; Frova et al. 2009) or to re-evaluate contribution of a specific cause (Wing and Manton 1981; Israel, Rosenberg, and Curtin 1986; Nizard and Munoz-Perez 1993; Coste and Jougla 1994; Mannino et al. 1998; Wise and Sorvillo 2005; Fuhrman et al. 2006; Romon et al. 2008). As first advocates of MCOD approach (Janssen 1940; Dorn and Moriyama 1964) have stressed, underlying-cause-of-death approach misdirects attention away from conditions that tend to be reported as contributory causes. As a consequence their contribution to overall mortality is underestimated. The MCOD approach should be especially useful for describing medical circumstances surrounding death of older people. At old ages, death is indeed often final stage of a long morbid process involving several conditions. Clearly MCOD approach is a potentially valuable tool for demographers, who are necessarily concerned with portraying mortality profiles of aging populations as accurately as possible. Notwithstanding these developments, studies that use multiple causes of death in order to compare a set of countries are still very scarce. This situation may be partly due to quite widely shared scepticism about quality, and consequently comparability, of multiple-cause-of-death data. To our mind, apart from certification issues, recent technological innovations in coding systems represent a major advance towards improved quality of cause-of-death data. In a growing number of countries recording of information on death certificates and coding of causes have been automated (optical recognition and automatic coding system). Human intervention is limited to problematic cases that cannot be processed automatically and, at least in theory, World Health Organization coding rules can be applied systematically and uniformly, irrespective of coding agent or country. Another consequence of these automated systems is that number of coded causes is no longer limited. Researchers often have access to all medical information reported on certificate instead of a limited selection of causes. In this paper we use MCOD approach in order to revisit mortality profiles of France and Italy in 2003. Our goals are both substantive and methodological. First we re-evaluate cause-specific mortality profiles of two countries, taking into account all conditions reported on death certificates. We then measure pairwise joint occurrence of any underlying and any contributory cause (i. …