Cause Of Death Statistics Research Articles

Improvement of the reliability of the cause of death diagnoses by co-operation of public health authorities and the Central Statistical Office in Hungary

The diagnosis of cause of death is based on the sequence of diagnoses declared by the physician who completes the death certificate that is processed by Central Statistical Office in Hungary. The validity control of the data requires the active involvement of the public health authority. The authors analyzed the death certificates from Tolna county in order to elaborate and evaluate methods for cause of death data validity control. Diagnoses of cause of death declared by the physician, corrected by the social statistical review in the Central Statistical Office, and revised by public health authority were compared to evaluate the quality of cause of death data. It was found that 5-10% of the cause of death diagnoses declared by physicians required some modification, resulting more than 1% change in county specific mortality statistics of the main International Classification of Diseases groups. Physicians who reported inaccurate cause of death data were identified. 10 indicators were defined to monitor the process elaborated in the project. Co-operation between the Central Statistical Office and public health authorities to improve the quality of cause of death data should be continued because evaluation of public health interventions needs more and more reliable and detailed cause of death statistics.

Disability-adjusted Life Years (DALYs) for Mental and Substance Use Disorders in the Korean Burden of Disease Study 2012.

The purpose of this study was to estimate the national burden of mental substance disorders on medical care utilization in Korea using National Health Insurance System (NHIS) data and updated disability weight, in terms of disability-adjusted life years (DALYs). For each of the 24 disorders, the incident years lived with disability (YLDs) was calculated, using NHIS data to estimate prevalence and incidence rates. The DisMod-II software program was used to model duration and remission. The years of life lost (YLLs) due to premature death were calculated from causes of death statistics. DALYs were computed as the sum of YLDs and YLLs, and time discounting and age weighting were applied. The year examined was 2012, and the subjects were divided into 9 groups according to age. In 2012, the Korean burden of mental and substance use disorders was 945,391 DALYs. More than 98% of DALYs were from YLDs, and the burden in females was greater than that in males, though the burden in males aged less than 19 years old was greater than that in females. Unipolar depressive disorders, schizophrenia, and anxiety disorders were found to be major diseases that accounted for more than 70% of the burden, and most DALYs occurred in their 30–59. Mental and substance use disorders accounted for 6.2% of the total burden of disease and were found to be the 7th greatest burden of disease. Therefore, mental and substance use disorders need to be embraced by mainstream health care with resources commensurate with the burden.

Mortality Related to Alcohol and Tobacco Consumption - A Benchmarking of Regional Trends and Levels

Regional characteristics are being increasingly taken into account in studies on the determinants of health and health-care. A systematic observation and inclusion of regional particularities has, however, been absent from strategic planning and financing decisions to date. Furthermore, regional-level changes over time have, for the most part, not been considered in the existing studies. Accordingly, this article seeks to depict both the levels and trends in potentially avoidable mortality on the district level and to establish a benchmark that shows the theoretical goals for the reduction in avoidable deaths in each district. Gender-specific and age-standardised potentially avoidable deaths were determined for each of the 413 German districts in the period from 2000 to 2008 on the basis of cause of death statistics provided by statistical agencies of the German federal states. Deaths due to lung cancer and alcohol-related diseases were taken into account as these are considered to be avoidable through primary prevention. The district-specific benchmark values were ascertained using 2 linear hierarchic nested models and tested for significance using an F-test. Overall, the lung cancer mortality was found to have declined amongst men and gradually increased amongst women during the time period under consideration. The benchmark for deaths from lung cancer in women shows that the increase in mortality is principally observed in West German and urban districts. In relation to the alcohol-related deaths we also see an east-west divide, with higher rates in eastern Germany. Shrinking districts in eastern Germany were able, however, to record a big reduction in rates in recent years. An unfortunate development in the trend of alcohol-related mortality in women was notably observed in regional areas of Bavaria. The analysis offers decision makers the possibility of pinpointing regions with high intervention need. Increasing lung cancer mortality rates in women living in cities points to, for example, a heightened need for anti-smoking campaigns in urban areas. In relation to alcohol-related diseases, a heightened need for target group-specific prevention was identified in East German districts as well as some districts in Bavaria.

Reliable mortality statistics for Turkey: Are we there yet?

BackgroundThe Turkish government has implemented several reforms to improve the Turkish Statistical Institute Death Reporting System (TURKSTAT-DRS) since 2009. However, there has been no assessment to evaluate the impact of these reforms on causes of death statistics. This study attempted to analyse the impact of these reforms on the TURKSTAT-DRS for Turkey, and in the case of Izmir, one of the most developed provinces in Turkey.MethodsThe evaluation framework comprised three main components each with specific criteria. Firstly, data from TURKSTAT for Turkey and Izmir for the periods 2001–2008 and 2009–2013 were assessed in terms of the following dimensions that represent quality of mortality statistics (a. completeness of death registration, b. trends in proportions of deaths with ill-defined causes). Secondly, the quality of information recorded on individual death certificates from Izmir in 2010 was analysed for a. missing information, b. timeliness of death notifications and c. characteristics of deaths with ill-defined causes. Finally, TURKSTAT data were analysed to estimate life tables and summary mortality indicators for Turkey and Izmir, as well as the leading causes-of-death in Turkey in 2013.ResultsRegistration of adult deaths in Izmir as well as at the national level for Turkey has considerably improved since the introduction of reforms in 2009, along with marked decline in the proportions of deaths assigned ill-defined causes. Death certificates from Izmir indicated significant gaps in recorded information for demographic as well as epidemiological variables, particularly for infant deaths, and in the detailed recording of causes of death. Life expectancy at birth estimated from local data is 3–4 years higher than similar estimates for Turkey from international studies, and this requires further investigation and confirmation.ConclusionThe TURKSTAT-DRS is now an improved source of mortality and cause of death statistics for Turkey. The reliability and validity of TURKSTAT data needs to be established through a detailed research program to evaluate completeness of death registration and validity of registered causes of death. Similar evaluation and data analysis of mortality indicators is required at regular intervals at national and sub-national level, to increase confidence in their utility as primary data for epidemiology and health policy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1904-1) contains supplementary material, which is available to authorized users.

100 Clinical Information is Highly Specific but Lacks Sensitivity for Post-Mortem findings of Valvular Heart Disease: The Oxvalve-Advanced Study

<h3>Introduction</h3> Accurate information from routinely collected cause of death information is essential for epidemiological studies and for health systems planning. Given the relatively low sensitivity of clinical examination for the detection of valvular heart disease (VHD), we hypothesised that cause of death data based on clinical information would routinely underestimate deaths due to VHD. We therefore compared clinical information available pre-mortem with autopsy findings. <h3>Methods</h3> The OxVALVE Accuracy of Death certificates for Valvular heart disease as a Cause of Death (OxVALVE-ADVanCeD) study examined post-mortem reports for adults from 2004 to 2012. We calculated the sensitivity and specificity of the documented pre-mortem clinical information for predicting cause of death determined after the result of an autopsy (and any other supplementary investigations). Autopsies performed both on behalf of HM Coroner and on behalf of the hospital were included. <h3>Results</h3> There were 7324 post-mortem reports for adults aged 18 years and older from 1^st Jan 2004 until 31^st December 2012. Of these, 583 had any mention of VHD pre- or post-mortem (mean age 75 years, range 19–98 years, 48.2% female). 140 (1.9% of total cohort) had VHD as the primary cause of death, 273 (3.7%) had VHD as any cause of death, and 289 (3.9%) had VHD as an incidental rather than causal finding. Presence of VHD in the pre-mortem clinical information had a sensitivity of 73.6% and a specificity of 97.0% for VHD being listed as the primary cause of death after autopsy, and a sensitivity of 70.3% and specificity 98.2% for VHD being listed as any cause of death. A small number (21, 0.2%) of reports contained pre-mortem descriptions of VHD that were not found post-mortem, with the majority of these being regurgitant lesions that would be less reliably detected post-mortem. <h3>Conclusions</h3> Clinical information available before death is highly specific for cause of death established after autopsy, but has limited sensitivity. It is therefore likely that population-based cause of death statistics, which rely most commonly on clinical information, routinely underestimate the mortality burden of VHD.

Errors in cause-of-death statement on death certificates in intensive care unit of Kathmandu, Nepal.

BackgroundDeath certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC.MethodsA retrospective observational study was conducted at medical Intensive Care Unit (ICU) of Blue Cross Hospital, Kathmandu, Nepal within two years of study period. A total of 204 medical records of the deceased patients were reviewed. Three sub-headings of COD statement of DC- Part I Immediate COD (ICOD), Part I Underlying COD (UCOD), and Part II Other significant conditions (OSC) were extensively evaluated for the major medical errors.ResultsThe study found errors in 78.4 % of DCs. The highest number of errors was in UCOD (83 %). Most common errors were “Mechanism of Death- terminal event” in ICOD, “More than one competing causes” in UCOD, and “OSC present but not listed” in OSC. The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034). Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.ConclusionPrevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.

General practitioners' contribution to the management of community-acquired pneumonia in the Netherlands: a retrospective analysis of primary care, hospital, and national mortality databases with individual data linkage.

Background:Community-acquired pneumonia (CAP) is an important cause of hospital admission and death, but the extent of the problem of CAP at the primary healthcare level is largely unknown.Aims:To investigate the contribution of general practitioners (GPs) to the management of patients with CAP in the Netherlands.Methods:The study population consisted of all people enlisted in a GP network. We obtained information on CAP episodes from GP electronic records (using ICPC code R81) during the years 2002–2009. CAP registrations were also obtained from national hospital discharge data (ICD-9 codes) and cause of death statistics (ICD-10 codes). The three registration systems were linked at the individual level. We used descriptive analyses to estimate the annual number of CAP episodes (i.e. defined as a CAP diagnosis within 30 days).Results:From 2002 to 2009 the mean annual size of the study population was 395,039. For this population, 3,700 (0.9%) CAP episodes per year were registered in at least one of the registration systems, 2,933 (79%) of which were in the GP system only. Recovery within 30 days occurred on average in 95% (2,791/2,933) of the CAP episodes annually registered by a GP, while 2.3% (67/2,933) of patients with a GP-registered CAP episode were admitted to hospital within 30 days and 1% (26/2,933) had a fatal outcome within 30 days.Conclusions:The vast majority of CAP episodes registered in the Netherlands are managed successfully at the GP level without hospitalisation.

Variation and seasonal patterns of suicide mortality in Finland and Sweden since the 1750s

Suicide mortality varies in both the short and long term. Our study examines suicide mortality in Finland and Sweden from the 1750s until today. The aim of our study is to detect any seasonal peaks in suicide rates and examine their temporal evolution to suggest a mechanism that may explain such peaks. We acquired the study material from the Finnish and Swedish cause of death statistics (257,341 deaths by suicide) and the relevant population gender structure data. We then separately calculated the annual male and female suicide rates per 100,000 inhabitants. We analysed the suicide peaks, calculating factors of proportionality for the available data by dividing the suicide rates in the peak months (May and October) by the annual suicide rates. Suicide rates in Finland and Sweden peak twice a year. Both men and women in both countries most often commit suicide in May. There is another peak in October, with the exception of Finnish men. These suicide peaks coincide with a temperature increase in May and the biggest annual drop in temperature in October. We also observed a monotonic long-term change in the Swedish statistics, but not in the Finnish data. Our hypothesis is that seasonal variation in suicide rates may be caused by abrupt temperature changes twice a year that trigger the activity in brown adipose tissue and deepen depression. While the overall suicide mortality rates varied considerably, the monthly proportions in May did not. This finding suggests a routine factor underlying the spring peak in suicide mortality.

Death Certificate Surveillance: A Component of Death Investigation

Introduction Medical examiners/coroners serve various functions beyond the medicolegal framework, including making contributions to public safety and health. In order to effectively fulfill this role, it is essential to ensure accurate certification of each death. Materials and Methods In Vermont, the Department of Health, Vital Records Division has developed a death certificate surveillance program in which all registered deaths are reviewed by the Office of the Chief Medical Examiner (OCME). A death certificate is fagged by the OCME for further investigation when cause and manner of death statements are incomplete, erroneous, or suggest the possibility of an unnatural death. If necessary, after review, death certificates are amended. Death Certificate Review (DCR) cases between 2008 and 2011 were retrieved from the OCME database. Data were evaluated for amendments of cause and manner of death. Results The OCME reviewed all death certificates and further investigated 4.4% and amended 3.3% of all death certificates in Vermont between the years 2008–2011. Eighty-eight percent of the amended DCRs were for cause of death statements and 10% resulted in change of manner. For the latter, change from natural to accident was most frequent. Conclusions Death certificates are a major source of epidemiologic data. Ensuring complete and accurate death certification through death certificate surveillance is a small but significant contribution of the OCME to public health.

Har kvalitetskontroll av dødsmeldinger i sykehus betydning for dødsårsaksstatistikken?

The effects of inaccurate death certificates on cause of death statistics are uncertain. Since 2008, Akershus University Hospital has systematically corrected all death certificates. The effects of these corrections on the total cause of death statistics from the hospital were studied. ICD-10 codes for the underlying cause of death on the original and the corrected death certificates issued by Akershus University Hospital were retrieved from the Cause of Death Registry for the period 1 May 2008-31 December 2009, once the Cause of Death Registry had processed the death certificates with the aid of the computer program ACME (Automatic Classification of Medical Entities). Altogether 1,001 deaths were investigated (547 men and 454 women). A total of 223 death certificates were corrected. This entailed changing the underlying cause of death in 176 cases. Death certificates for women were corrected most frequently. In 121 cases, the changes entailed a change of disease chapter in ICD-10. The corrections caused a significant reduction in the number of unspecific diagnoses, such as sepsis, cardiac arrest, pneumonia with no further specification, renal failure and fractures without any specific cause. There was a significant exchange of individuals within all the large diagnostic groups, with the exception of cancer. Because of the balancing effect of exchanges within and between the disease chapters, this generated only minor effects on general statistics on causes of death. The continuous correction of death certificates in the hospital was important for adjustments at the individual level and as a quality control of cause of death statistics, but had only minor effects on the general statistics from the hospital.

Skull Base Fractures are Markers of Severe Forces in the First Two Years of Life

While experience indicates that basilar skull fractures are an uncommon injury in the first two years of life, an evidential basis for this observation is lacking in the forensic pathology literature. The aim of this study was to determine the incidence and forensic significance of basilar skull fractures in the first two years of life. This retrospective analysis reviewed pediatric deaths over a 17-year period in a large metropolitan medical examiner jurisdiction and included the deaths of infants and children under 24 months of age. All cases had a cause of death statement of “blunt head trauma”, “blunt head and neck trauma” or “blunt trauma”. Sixty-three cases were found, 23 of which had basilar skull fractures. The most common circumstance with basilar skull fracture was pedestrian versus motor vehicle accidents (57%), followed by inflicted injury (30%), and vehicle accidents in which the child was an occupant (13%). As such, basilar skull fractures are uncommon injuries that are the end result of the application of significant forces to the head. The discovery of a basilar skull fracture without an appropriate history of the accidental application of severe forces should cause those tasked with the investigation of child injuries and death to carefully consider inflicted head trauma.

Forensic autopsies in a naturalistic setting in Norway: Autopsy rates and toxicological findings

Autopsies can give valuable information about the cause of death, and represent an important tool for obtaining valid cause of death statistics. In particular, they may shed light on the circumstances of death in ambiguous and criminal cases. To address the need for information on current autopsy practices, forensic autopsy rates in two counties in Central Norway over the period 2007–2009 were assessed. To investigate toxicological findings that could possibly remain undisclosed without the performance of an autopsy, the impact of alcohol and drugs in forensic autopsy cases from this material was evaluated.The total forensic autopsy rate in this material was 3%. The forensic autopsy rates were low for natural deaths (1%), accidental falls (12%) and the heterogeneous category “other accidents” (21%), relatively high for accidental poisonings (84%), and less than adequate for road traffic accidents (57%). For suicides the forensic autopsy rate was 63%, and for recognized homicides 100%. The total forensic autopsy rate was higher for men than for women (5% vs. 2%), and decreased with age, being 38% in the age group <30 years, 23% in the age group 30–59 years, and 1% in the age group >59 years. Despite that Norwegian legislation and regulations regarding forensic autopsy requests are national, the forensic autopsy rates were generally lower in the county of Nord-Trøndelag than in Sør-Trøndelag, with most striking differences in suicide deaths (11% vs. 91%) and road traffic accidents (46% vs. 67%). This illustrates how autopsy rates, and possibly cause of death registries, might be susceptible to the influence of regional variations in law enforcement, with possible consequences for the quality and validity of cause of death statistics.Of the forensic autopsy cases where toxicological analysis was performed (361 of 364 cases) a total of 71% had positive toxicology results; 12% were positive for alcohol only, 44% were positive for drugs only, and 15% were positive for both alcohol and drugs. The toxicology results suggest that alcohol and drugs are important factors in sudden unexpected deaths, and that a thorough and comprehensive toxicological analysis is called for when investigating these deaths. Mean BAC in alcohol positive forensic autopsy cases was 1.7‰ (median 1.6‰, range 0.29-4.1‰). The average number of substances detected in toxicology positive cases was 2.6 (median 2, range 1–10). The by far most frequently detected classes of substances were (1) benzodiazepines, (2) opioids and (3) alcohol.

Reporting of incorrect cause-of-death causal sequence on death certificates in the USA: using hypertension and diabetes as an educational illustration

BackgroundLittle is known about the extent of reporting an incorrect cause-of-death (COD) causal sequence on death certificates.ObjectiveTo determine the frequency of incorrect reporting of hypertension as cause of diabetes on...

Reflections upon Forensic Pathophysiology: Mechanism of Death Does Matter

The primary responsibility of the forensic pathologist is to determine the cause of death. Inclusion of the mechanism of death is not required on death certificates, and therefore, forensic pathologists often (appropriately) do not include mechanisms in cause of death statements. When determining the cause of death; however, it is nonetheless important to consider the responsible physiologic mechanism. If the mechanism of death is not taken into account, an erroneous cause of death may be attributed. This review article will highlight examples of the types of cases in which this may occur.

Intracranial Hemorrhage: Traumatic Fall versus Terminal Collapse

When approaching a case in which a decedent's body is on the ground, death investigators collect circumstantial, historical, and clinical (radiographic) information to infer whether the person fell to the ground and sustained a head injury or simply experienced a terminal collapse due to a natural event. We have observed that cases presenting as presumed accidental head trauma, some of which have diagnosed subdural hematomas, are sometimes proven to be of natural causes following autopsy. Autopsies sometimes demonstrate that either 1) the intracranial hemorrhage is intracerebral rather than subdural, 2) the subdural hemorrhage is an extension from an intracerebral hemorrhage, or 3) there is no intracranial hemorrhage at all. In each of these examples, the autopsy established that the manner of death is natural rather than accidental, as originally presumed at the outset of the investigation. We performed a 5 year retrospective study on cases indicating intracranial hemorrhage in the cause of death statement in order to assess how often the cause and manner of death would have been incorrectly certified without an autopsy. We found that 6% of cases presumed at the time of initial investigation to represent falls with accidental head trauma (specifically, subdural hemorrhage) were proven by autopsy to represent intracranial hemorrhage of natural manner. Conversely, 7% of cases with intracranial hemorrhage that were presumed to be due to natural disease were proven by autopsy to represent accidental trauma. Proper certification of manner of death has important legal implications which may be of critical importance to family members.

Improper cause-of-death statements by specialty of certifying physician: a cross-sectional study in two medical centres in Taiwan

ObjectiveTo determine the frequency of various types of improper cause-of-death (COD) statements reported on death certificates and whether the frequency differed by specialty of the certifying physician.DesignCross-sectional descriptive study.Setting2 medical...

Fatal exsanguination from hemodialysis vascular access sites

Exsanguination from hemodialysis vascular sites may cause a rapid death. Due to extensive blood loss at the scene, investigators may initially suspect a homicide or suicide. We reviewed 100 deaths due to hemorrhage from hemodialysis shunt sites. The majority (81%) of these hemorrhages occurred at home and 44% subsequently died at home. Recognition of this medical complication at the scene is important to prevent the dispatch of the crime scene or homicide unit. In these instances, the common causes of kidney failure included hypertensive cardiovascular disease and diabetes mellitus. The manners of death were certified as therapeutic complication (93%), accident (5%), and suicide (2%). These fatal shunt hemorrhages are rapid and large due to their superficial subcutaneous locations and elevated shunt pressures from the arterial-venous anastamosis. The cause of death statement must include the proximate cause of death, which is usually the disease that resulted in kidney failure, if it is known.

Validation study of cause of death statistics in Cape Town, South Africa, found poor agreement

Objective The validity of the underlying cause of death on death notification forms was assessed by comparing it to the underlying cause determined independently from medical records. Study Design and Setting Retrospective study of 703 deaths in two suburbs of Cape Town, South Africa. Two medical doctors completed a medical review death certificate to validate the registration death certificate for each decedent. Agreement, sensitivity, and positive predictive value were measured for underlying causes of death using the World Health Organization (WHO) mortality tabulation list 1. Results Agreement was poor, with only 55.3% (95% confidence interval [CI]: 51.7, 59.0) of diagnoses matching at WHO mortality tabulation list 1 level. Validity of reported causes of death was poor for HIV, cardiovascular diseases, and diabetes. With correct reporting, the cause-specific mortality fraction for HIV increased from 11.9% to 18.3% (53.6%; 95% CI: 36.9, 77.6), for ischemic heart disease from 3.3% to 7.3% (121.7%; 95% CI: 53.5, 228.7), and for hypertensive diseases from 3.3% to 5.7% (73.9%; 95% CI: 14.4, 167.8). For diabetes, the mortality fraction decreased from 6.0% to 2.3% (−64.3%; 95% CI: −77.1, −37.8) and for ill-defined deaths from 7.4% to 2.3% (−69.2%; 95% CI: −81.0, −51.6). Conclusion Current cause-specific mortality levels should be cautiously interpreted. Death certification training is required to improve the validity of mortality data.

Improving the quality of medical certification of cause of death: the time is now!

Cause of death statistics are an essential data source for monitoring the health of populations, identifying health priorities and planning health service delivery. The case for improving the quality of cause of death statistics for South Africa (SA) has been echoed for the past decade.

Validity of underlying cause of death statistics in Hermosillo, Mexico

This paper assesses the quality of the underlying cause of death (COD) statistics in Hermosillo, Mexico in a random sample of 300 in-hospital adult deaths. A "gold standard" COD, determined by a systematic review of hospital medical charts, was compared to the COD reported by the vital registry system. Overall agreement between the reviewer and original COD at the ICD-10 chapter block was 69.2%, with a weighted kappa of 0.62. Agreement varied greatly by ICD-10 chapter. Mutual misclassification among common co-morbidities,such as diabetes mellitus and circulatory disease, minimized the net change in the mortality fraction assigned to each ICD-10 chapter after physician review. The ICD-10 chapter level underlying COD codes can be used to estimate disease burden in the population. Caution is recommended for use of vital registry statistics in Hermosillo for individual level or disease-specific analyses.