Multiple Causes Of Death Approach Research Articles

Mortality related to different circulatory diseases: a multiple causes of death analysis, 2008-2022

Abstract Background Mortality from circulatory diseases significantly increased in 2020 compared to pre-pandemic years in many countries. However, data were mostly limited to the underlying cause of death and to the first phases of the pandemic. Analyses of any mention of a disease in death certificates (multiple causes of death approach, MCOD) are more robust to changes in coding rules/practices and to the role of COVID-19 as a competing cause of death. Methods Mortality records were extracted from 2008 to 2022 among residents of the Veneto Region (Northeastern Italy, 4.9 million population). Based on MCOD, age-standardized mortality rates (2013 European standard) were computed for ischemic heart diseases (IHD), cerebrovascular diseases (CVD), atrial fibrillation (AF), and hypertensive diseases (HD). The annual percent change (APC) was estimated through the pre-pandemic period (2008-2019), and change in rates during pandemic years were computed compared to 2019. Results Before the pandemic, rates were steeply declining for IHD (APC -5.1%; 95%CI -5.5, -4.6) and CVD (-4.0%; -4.4, -3.5); mortality related to HD reduced at a slower pace (-1.9%; -2.3, -1.4), whereas AF-related mortality was increasing (+1.0%; 0.1, 1.8). During the first year of the pandemic, the growth in mortality compared to 2019 was +26% for HD, +18% for AF, +13% for CVD and +12% for IHD. In 2021-2022, rates for CVD and IHD returned to pre-pandemic levels; rates for HD reduced with respect to 2020 but remained above the baseline; AF-related mortality was still increasing. Conclusions The pandemic differentially impacted mortality associated to different circulatory diseases, depending on pre-existing long-term trends (increasing for AF) and on susceptibility to severe COVID-19 disease (higher for HD). Continuous surveillance based on MCOD is warranted to properly assess changes in mortality associated to specific circulatory diseases after the end of the pandemic. Key messages • Multiple causes of death analyses are warranted to assess how the pandemic affected pre-existing long term trends in cause-specific mortality. • Mortality related to different circulatory diseases increased in 2020, but pre-pandemic trends, the extent of the increase in 2020, and further changes observed in 2021-2022 largely diverged.

Veneto Region dementia-related mortality during the COVID-19 pandemic: multiple causes of death and time series analysis.

Older individuals with dementia have been severely affected by the COVID-19 pandemic. There is a lack of in-depth evaluation of mortality trends using both the underlying cause of death (UCOD) and the multiple causes of death (MCOD) approaches. The objective of this study was to determine the impact of the COVID-19 pandemic on dementia-related deaths considering comorbidities and the place of death. This retrospective, population-based study was conducted in Veneto, Italy. All the death certificates of individuals aged ≥65 years issued from 2008 to 2020 were analyzed for dementia-related mortality using age-standardized sex-stratified rates of dementia as UCOD and MCOD. Excess in monthly dementia-related mortality in 2020 was estimated by applying Seasonal Autoregressive Integrated Moving Average (SARIMA) model. Overall, 70301 death certificates reported dementia (MCOD proportional mortality: 12.9%), and 37604 cases identified it as UCOD (proportional mortality: 6.9%). In 2020, the MCOD proportional mortality increased to 14.3% whereas that of UCOD remained static (7.0%). Compared to the SARIMA prediction, MCOD increased by 15.5% in males and 18.3% in females in 2020. Compared to the 2018-19 average, deaths in nursing homes increased by 32% in 2020, at home by 26% and in hospitals by 12%. An increase in dementia-related mortality during the first months of the COVID-19 pandemic could only be detected using the MCOD approach. MCOD proved to be more robust, and hence, should be included in future analyses. Nursing homes appeared to be the most critical setting which should guide establishing protective measures for similar situations.

Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach.

ObjectivesEstimate TB mortality rates, catalogue multiple causes on death certificates in which TB was reported and identify predictors of TB from reporting on death certificates in the State of Amazonas, Brazil, based on a multiple cause of death approach.MethodsThe death records of residents in the Amazonas state between 2006–2014 were analyzed and separated into three categories: TB not reported on the death certificate (TBNoR), TB reported as the underlying cause of death (TBUC) and TB reported as an associated cause of death (TBAC). Age standardized annual mortality rates for TBUC, TBAC and with TB reported (TBUC plus TBAC) were estimated for the State of Amazonas using the direct standardization method and World Health Organization 2000–2025 standard population. Mortality odds ratios (OR) for reporting of TBUC and TBAC were estimated using multinomial logistic regression.ResultsAge standardized annual TBUC and TBAC mortality rates ranged between 5.9–7.8/105 and 2.7–4.0/105, respectively. TBUC was associated with being a resident in the State capital (OR = 0.66), of female gender (OR = 0.87), having an education level of 8 to 11, or 12 or more school years (OR = 0.67 and 0.50 respectively), non-white race/skin color (OR = 1.38) and place of death reported as in the State capital (OR = 1.69). TBAC was related to the triennium in which death occurred (OR = 1.21 and 1.22 for the years 2009–2011 and 2012–2014 respectively), age (OR = 36.1 and 16.5 for ages 15–39 and 40–64 years respectively) and when death occurred in the State capital (OR = 5.8).ConclusionsTBUC was predominantly associated with predictors of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages which were typical of high HIV disease incidence.

Cuban Application of Two Methods for Analyzing Multiple Causes of Death

ABSTRACT INTRODUCTION Mortality analysis based on a single cause of death is not, in most cases, fully informative. There are several more illuminating procedures using a multiple cause of death approach; these are little known and rarely used in Cuba. The simplest of these methods, while methodologically limited, consists of summing all deaths from a specific cause mentioned on death certificates, regardless of whether the cause is listed as underlying or contributing. OBJECTIVE Using Cuban data, critically assess and implement two of the most recognized approaches to analyzing multiple causes of death. METHODS Multiple causes of death in Cuba were assessed for the years 2005, 2010 and 2015, employing death records from the National Medical Records and Health Statistics Bureau of Cuba’s Ministry of Public Health. With the example of diabetes mellitus as underlying cause, we explored connections between underlying and associated (antecedent and contributing) causes on death certificates using two approaches from the international literature: the simple method and the cause-of-death association indicator. RESULTS The study identified main trends in multiple causes of death identified in 2005, 2010 and 2015, overall and by age group and sex. We observed a trend to increasing mean number of causes of death per death certificate between 2005 and 2015. The number of causes reported showed no substantial differences by age group or sex. Diseases of the arteries, arterioles and capillaries were by far the most frequently associated with diabetes mellitus as underlying cause. CONCLUSIONS The multiple causes of death approach affords more nuanced understanding of patterns of disease, comorbidity and death in the Cuban population. The indicators used fulfill different roles: the simple method brings to light the full range of ways in which a given cause contributes to mortality, and the cause-of-death association indicator enables exploration of links between different causes of death, not possible with the simple method.

Mortality from infectious diseases in diabetes

Background and AimsTo investigate the risk of mortality from infections by comparing the underlying causes of death versus the multiple causes of death in known diabetic subjects living in the Veneto region of Northern Italy. Methods and ResultsA total of 185,341 subjects with diabetes aged 30–89 years were identified in the year 2010, and causes of death were assessed from 2010 to 2015. Standardized Mortality Ratios (SMRs) with 95% confidence intervals (CIs) were computed with regional mortality rates as reference. The underlying causes of death and all the diseases reported in the death certificates were scrutinized. At the end of the follow-up, 36,382 subjects had deceased. We observed an increased risk of death from infection-related causes in subjects with diabetes with a SMR of 1.83 (95% CI, 1.71–1.94). The SMR for death from septicemia was 1.91 (95% CI, 1.76–2.06) and from pneumonia was 1.47 (95% CI, 1.36–1.59). The use of the multiple causes of death approach emphasized the association of infectious diseases with mortality. ConclusionThe results of the present study demonstrate an excess mortality due to infection-related diseases in patients with diabetes; more interestingly, by routine mortality analyses, the results show a possible underestimation of the effect of these diseases on mortality.

Cuban Application of Two Methods for Analyzing Multiple Causes of Death.

INTRODUCTION Mortality analysis based on a single cause of death is not, in most cases, fully informative. There are several more illuminating procedures using a multiple cause of death approach; these are little known and rarely used in Cuba. The simplest of these methods, while methodologically limited, consists of summing all deaths from a specific cause mentioned on death certificates, regardless of whether the cause is listed as underlying or contributing. OBJECTIVE Using Cuban data, critically assess and implement two of the most recognized approaches to analyzing multiple causes of death. METHODS Multiple causes of death in Cuba were assessed for the years 2005, 2010 and 2015, employing death records from the National Medical Records and Health Statistics Bureau of Cuba's Ministry of Public Health. With the example of diabetes mellitus as underlying cause, we explored connections between underlying and associated (antecedent and contributing) causes on death certificates using two approaches from the international literature: the simple method and the cause-of-death association indicator. RESULTS The study identified main trends in multiple causes of death identified in 2005, 2010 and 2015, overall and by age group and sex. We observed a trend to increasing mean number of causes of death per death certificate between 2005 and 2015. The number of causes reported showed no substantial differences by age group or sex. Diseases of the arteries, arterioles and capillaries were by far the most frequently associated with diabetes mellitus as underlying cause. CONCLUSIONS The multiple causes of death approach affords more nuanced understanding of patterns of disease, comorbidity and death in the Cuban population. The indicators used fulfill different roles: the simple method brings to light the full range of ways in which a given cause contributes to mortality, and the cause-of-death association indicator enables exploration of links between different causes of death, not possible with the simple method. KEYWORDS Mortality, multifactorial causality, causes of death, diabetes mellitus, Cuba.

Fracture-related mortality in southern Sweden: A multiple cause of death analysis, 1998–2014

PurposeTo assess fracture-related mortality among adults (aged ≥20years) in southern Sweden using multiple causes of death approach. MethodsAll death certificates (n=201 488) in adults recorded in the region of Skåne from 1998 to 2014 were examined. We identified fracture-related deaths and computed mortality rates by sex, age group, and fracture site. Temporal trends were evaluated using joinpoint regression and associated causes were identified by age- and sex-adjusted observed/expected ratios. ResultsFractures were mentioned on 6 226 (3.1%) death certificates, with majority of these occurred among women (60%) and those aged≥80years (77%). While hip was the most common site overall (61% of all fracture-related deaths), skull was the most common site in people <60years (60% of all fracture-related deaths). Proportion of death certificates mentioning fracture was stable in women but increased by 0.4% (95% CI: 0.1 to 0.6) in men between 1998–2002 and 2010–2014. The mean age at death was higher in death certificates mentioning fracture than those without and this gap widened over time. The mean age-standardized fracture-related mortality rate was 18.8 (14.0) per 100 000 person-year in men (women) and declined by 1.5% (1.3%) per year during 1998–2014. Injuries (84.6%) and cardiovascular disorders (64.6%) were the most common comorbidities on death certificates mentioning fracture. ConclusionsFracture is a contributing cause of death in more than 3% of all deaths in southern Sweden with hip in lead among older and skull fracture among younger people. There was a slight increase in proportion of deaths associated with fracture in men but not women during the study period.

Increase in Parkinson's disease-related mortality among males in Northern Italy

BackgroundAccording to standard mortality statistics based on the underlying cause of death (UCOD), mortality from Parkinson's disease (PD) is increasing in most European countries. However, mortality trends are better investigated taking into account all the diseases reported in the death certificate (multiple causes of death approach, MCOD). MethodsAll deaths of residents in the Veneto Region (Northern Italy) aged≥45 years with any mention of PD were extracted from 2008 to 2015. The Annual Percent Change (APC) in age-standardized mortality rates was computed both for PD as the UCOD, and by MCOD. The association with common chronic comorbidities and acute complications was investigated by log-binomial regression. The frequency of the mention of PD in death certificates was investigated through linkage with an archive of patients with a previous clinical diagnosis of the disease. ResultsPD was reported in 2.1% of all deaths, rising from 1.9% in 2008 to 2.4% in 2015. Among males, age-standardized rates increased over time both in analyses based on the UCOD (APC +4.1%; Confidence Interval +1.5%,+6.7%), and on MCOD (APC +2.2%; +0.2,+4.2%). Among females time trends were not significant. Mention of PD was associated with that of dementia/Alzheimer and acute infectious diseases. Among known PD patients, the disease was reported only in 60.2% of death certificates. ConclusionsMortality associated to PD is steeply increasing among males in Northern Italy; further investigations on time trends for PD, both through all available electronic health archives and clinical studies, should be set as a priority for epidemiological research.

Causas múltiplas de óbitos relacionados ao HIV/AIDS nas capitais das regiões Sul e Sudeste do Brasil, 2011

Objective: To propose two indicators to assess gain in information through the multiple causes of death approach, using data from the capital of the South and Southeast regions, by sex, age groups and capital of residence. Methods: Data were gathered from the National Mortality Information System. Death certificates of individuals aged 13 or more were selected mentioning HIV/AIDS in any field of the death certificate, whose residence capital was one of the capitals of the South or Southeast. Indicators proposed were: (i) the difference between the number of times a cause was mentioned as a multiple cause (CM) and the number of times it was mentioned as the underlying cause (CB), i.e., (CM-CB), indicating how many additional causes would be obtained if the cause was counted in a model of multiple causes; (ii) the ratio (CB/CM): the closer to 1, the more often the disease is classified as an underlying cause. Indicators were calculated for deaths by sex, age and capital according to CM and CB. Results: When analyzed the deaths that have HIV/AIDS as an CB, 2,456 was obtained. However, when considering deaths with mention of HIV/AIDS in any field of the death certificate, the analysis of CM shows a total of 2,508 deaths. The major information gain with the analysis of CM occurred for men, patients aged 50 years or older and residents of Rio de Janeiro. Conclusion: The analysis by CM considers other conditions mentioned in the death certificate. Therefore, it may help to understand the population’s disease process, contributing to HIV/AIDS surveillance.

Sex Differences in Diabetes Mellitus Mortality Trends in Brazil, 1980-2012

AimsTo investigate the hypothesis that the change from the female predominance of diabetes mellitus to a standard of equality or even male preponderance can already be observed in Brazilian mortality statistics.MethodsData on deaths for which diabetes mellitus was listed as the underlying cause were obtained from the Brazilian Mortality Information System for the years 1980 to 2012. The mortality data were also analyzed according to the multiple causes of death approach from 2001 to 2012. The population data came from the Brazilian Institute of Geography and Statistics. The mortality rates were standardized to the world population. We used a log-linear joinpoint regression to evaluate trends in age-standardized mortality rates (ASMR).ResultsFrom 1980 to 2012, we found a marked increment in the diabetes ASMR among Brazilian men and a less sharp increase in the rate among women, with the latter period (2003–2012) showing a slight decrease among women, though it was not statistically significant.ConclusionsThe results of this study suggest that diabetes mellitus in Brazil has changed from a pattern of higher mortality among women compared to men to equality or even male predominance.

Mortality from myelodysplastic syndromes: A multiple causes of death approach

Mortality from myelodysplastic syndromes: A multiple causes of death approach

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

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. …

Multiple cause of death approach to analyze mortality patterns

The mortality analysis normally refers to the underlying cause of death but often death can be caused by a variety of factors, especially at older ages. Multiple cause of death approach allows to take into account all the information reported on the death certificate. This approach was utilized for analyzing the mortality of 70 years and over old people in Italy in 2001. A descriptive analysis was carried out and several indicators widely used in literature were computed: for example the average number of causes per death or the cause-specific ratio of the frequency of the cause as underlying and its frequency as multiple cause (underlying or associated). A cluster analysis was done to explore the existence of some particular morbid contexts, individuating eight clusters that presented particular profiles regarding underlying and associated causes of death . Multivariate odds ratios were then computed to evaluate the associations between morbidity patterns and underlying cause by means of different logistic regression models. The conclusion is that multiple cause of death data represent a very useful instrument to study the interaction of diseases leading to death, also if much still need to be done to increase the quality of death certificate completion.

Multiple causes of death due to non-communicable diseases: a multidimensional analysis

This study approaches multiple causes of death to analyze the associations between causes of death from non-communicable diseases, age, and gender in 3,106 death certificates issued in 1998, comprising individuals who were 20 years old or over and resided in Belo Horizonte, Minas Gerais State, Brazil. The multiple cause of death approach, by considering all the diagnoses mentioned in the death certificate, highlights conditions that are underestimated by the underlying-cause approach that has traditionally been used in mortality statistics. Association of causes of death was analyzed using the multidimensional data analysis method with the multiple correspondence factor analysis technique. The results reinforce the usefulness of the multiple causes approach to improve information on mortality and demonstrate important associations, such as hypertension and cerebrovascular diseases, obesity and diabetes or ischemic heart diseases, allowing to plan, prioritize, and reevaluate health actions.