Official Death Research Articles

Understanding Geographic Disparities in Mortality

A rich literature shows that early-life conditions shape later-life outcomes, including health and migration events. However, analyses of geographic disparities in mortality outcomes focus almost exclusively on contemporaneously measured geographic place (e.g., state of residence at death), thereby potentially conflating the role of early-life conditions, migration patterns, and effects of destinations. We employ the newly available Mortality Disparities in American Communities data set, which links respondents in the 2008 American Community Survey to official death records, and estimate consequential differences based on the method of aggregation we use: the unweighted mean absolute deviation of the difference in life expectancy at age 50 measured by state of birth versus state of residence is 0.58 years for men and 0.40 years for women. These differences are also spatially clustered, and we show that regional inequality in life expectancy is higher based on life expectancies by state of birth, implying that interstate migration mitigates baseline geographic inequality in mortality outcomes. Finally, we assess how state-specific features of in-migration, out-migration, and nonmigration together shape measures of mortality disparities by state (of residence), further demonstrating the difficulty of clearly interpreting these widely used measures.

Underestimation in Reporting Excess COVID-19 Death Data in Poland during the First Three Pandemic Waves.

The issue whether official Polish COVID-19 death statistics correctly reflect the actual number of deaths is a contentious issue in public discourse and an important policy-wise question in Poland although it has not been the subject of thorough research so far. There had been clearly elevated excess mortality—5100 (death rate of 2.3 per 10,000) during the first wave, 77,500 (21.0 per 10,000) during the second one, and 48,900 (13.5 per 10,000) in the third. This study finds that during the second and the third pandemic wave, our data on excess mortality will match very well the somewhat belatedly officially reported COVID-19 deaths if we assume that only 60% of cases were officially detected. Based on principal component analysis of death timing, except for the age bracket below 40, where COVID-19 deaths calculated on the basis of our model explain 55% of excess mortality, for the remaining age groups, combined COVID-19 deaths explain 95% of excess mortality. Based on the share of excess mortality attributable to COVID-19 during the second wave, this infection in Poland caused the death of 73,300 people and not of 37,600 as officially reported. The third wave caused 46,200 deaths instead of the reported 34,700. The first wave was, indeed, as officially reported, very mild, and the number of excess deaths was too low to be used to calculate COVID-19 deaths directly. However, assuming that the detection rate remained comparable to the average in subsequent waves, we can set the number of deaths at 3500 instead of the reported 2100.

2022 Alzheimer's disease facts and figures.

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.

Mortality due to road traffic injuries in older adults in the Republic of Ecuador between 1990 and 2018: a descriptive study

Mortality due to road traffic injuries in older adults in the Republic of Ecuador between 1990 and 2018: a descriptive study

Excess Mortality Data Analysis of COVID-19 Infections and Fatalities in Ecuador

The global COVID-19 pandemic has shocked the world. Since the virus gave rise to health problems and often ended in deaths, the count of the contagion and the deceased has been an open issue. Such statistics are vital for every nation and even every city or district and suburb as these numbers decide the level of intervention and the subsequent reduction of its given spread. Worldwide data show a mortality rate of around two percent prior to successful vaccination campaigns. However, Ecuador's statistical data indicate an abnormal amount of excess mortality, which is officially denied in each of the studied countries. These numbers have been projected on a monthly basis and exceed up to 300% of the official COVID-19 deaths. In particular, the average mortality rate in Ecuador, prior to and close to the pandemic, has been about 6083.4±234.6, while in the worst month during the sanitary crisis, deaths piled up to 21,000 people, and only 1180 were recognized as deceased by COVID-19. The reasons are widespread but based on an insufficient financed health sector, political incompetence, lack of leadership, and a long-lasting economic crisis. Therefore, premature endings of confinements or lockdowns have contributed to an accelerated contagion and seem to even counteract the vaccination phase, in middle 2021, shortly before excess mortality ceased completely.

Infant deaths from respiratory syncytial virus in Lusaka, Zambia from the ZPRIME study: a 3-year, systematic, post-mortem surveillance project

SummaryBackgroundRespiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections and a key driver of childhood mortality. Previous RSV burden of disease estimates used hospital-based surveillance data and modelled, rather than directly measured, community deaths. Given this uncertainty, we conducted a 3-year post-mortem prevalence study among young infants at a busy morgue in Lusaka, Zambia—the Zambia Pertussis RSV Infant Mortality Estimation (ZPRIME) study.MethodsInfants were eligible for inclusion if they were aged between 4 days and less than 6 months and were enrolled within 48 h of death. Enrolment occurred mainly at the University Teaching Hospital of the University of Zambia Medical School (Lusaka, Zambia), the largest teaching hospital in Zambia. We extracted demographic and clinical data from medical charts and official death certificates, and we conducted verbal autopsies with the guardian or next of kin. RSV was identified using reverse transcriptase quantitative PCR and stratified by age, time of year, and setting (community vs facility deaths). By combining the PCR prevalence data with syndromic presentation, we estimated the proportion of all infant deaths that were due to RSV.FindingsThe ZPRIME study ran from Aug 31, 2017, to Aug 31, 2020, except for from April 1 to May 6, 2020, during which data were not collected due to restrictions on human research at this time (linked to COVID-19). We enrolled 2286 deceased infants, representing 79% of total infant deaths in Lusaka. RSV was detected in 162 (7%) of 2286 deceased infants. RSV was detected in 102 (9%) of 1176 community deaths, compared with 10 (4%) of 236 early facility deaths (<48 h from admission) and 36 (5%) of 737 late facility deaths (≥48 h from admission). RSV deaths were concentrated in infants younger than 3 months (116 [72%] of 162 infants), and were clustered in the first half of each year and in the poorest and most densely populated Lusaka townships. RSV caused at least 2·8% (95% CI 1·0–4·6) of all infant deaths and 4·7% (1·3–8·1) of community deaths.InterpretationRSV was a major seasonal cause of overall infant mortality, particularly among infants younger than 3 months of age. Because most RSV deaths occurred in the community and would have been missed through hospital-based surveillance, the global burden of fatal RSV has probably been underestimated.FundingBill & Melinda Gates Foundation.

Epidemiology of cholangiocarcinoma

Aim: We aimed to analyze temporal trends in mortality from intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma in selected countries worldwide. Methods: Official death certification data for ICC and ECC and populations estimates for 29 countries worldwide (17 from Europe, 8 from the Americas, and 4 from Australasia) and for Hong Kong Special Administrative Region of the People’s Republic of China (SAR), from 1995 to 2018, were extracted from the World Health Organization and the Pan American Health Organization databases. Age-standardized mortality rates were computed. A joinpoint regression analysis was performed. Results: In both sexes, ICC mortality rates increased in most countries considered, including the USA, the UK, and Australia; in some countries, including Italy and France, the increasing trends leveled off over the most recent years. In men, around 2016, the highest rates (1.7-2.3/100,000) were observed in Hong Kong SAR, Portugal, France, Spain, Australia, Austria, the UK, and Canada; Latin American countries and some eastern European countries had the lowest rates (0.2-0.8/100,000). A similar pattern was observed in women, but with lower rates (from 1.7/100,000 in Hong Kong SAR to 0.14/100,000 in Argentina). ECC mortality declined in most European and Australasian countries, but it tended to increase in Americas. In both sexes, rates were below 1/100,000 around 2016, with the only exceptions being Japan (2.6/100,000 men and 1.2/100,000 women) and Hungary (1.5/100,000 men and 1.1/100,000 women). Conclusion: ICC mortality increased in most areas of the world, likely due to increased prevalence of risk factors and improved cancer recognition and classification. ECC mortality fell in most countries, largely due to the widespread use of cholecystectomy.

Natural population movement and COVID-19: data from Russia

The COVID-19 pandemic is highly infectious, so it paralyzed the health systems of many countries causing a high mortality rate. Official data on COVID-19 deaths at many sites are questioned, and the figures are considered several times higher than official data. In this sense, the objective of the study was to determine the impact of the COVID-19 pandemic on the natural movement of the population and, in addition, to evaluate the real mortality rate from COVID-19 in Russia from the construction of predictive mortality models. The study used data from the World Health Organization and the Statistical Service of the Federal State of Russia; se used linear and polynomial models to construct mortality models. The study revealed an underestimation of the official COVID-19 death rate by 2.4 to 6.8 times, depending on the data source. There was a sharp increase in mortality in Russia in 2020 among people over 50 years of age, and with the increase in age, mortality increased. The main reasons for the sharp increase in mortality were coronary heart disease, cerebrovascular diseases, and respiratory diseases, among others.

The unequal burden of the Covid-19 pandemic: Capturing racial/ethnic disparities in US cause-specific mortality

Despite a growing body of literature focused on racial/ethnic disparities in Covid-19 mortality, few previous studies have examined the pandemic's impact on 2020 cause-specific mortality by race and ethnicity. This paper documents changes in mortality by underlying cause of death and race/ethnicity between 2019 and 2020. Using age-standardized death rates, we attribute changes for Black, Hispanic, and White populations to various underlying causes of death and show how these racial and ethnic patterns vary by age and sex. We find that although Covid-19 death rates in 2020 were highest in the Hispanic community, Black individuals faced the largest increase in all-cause mortality between 2019 and 2020. Exceptionally large increases in mortality from heart disease, diabetes, and external causes of death accounted for the adverse trend in all-cause mortality within the Black population. Within Black and White populations, percentage increases in all-cause mortality were similar for men and women, as well as for ages 25–64 and 65+. Among the Hispanic population, however, percentage increases in mortality were greatest for working-aged men. These findings reveal that the overall impact of the pandemic on racial/ethnic disparities in mortality was much larger than that captured by official Covid-19 death counts alone.

A Pitești-i Református Egyházközség első tíz évének demográfiai adatsorai a halálozási anyakönyvek tükrében

Abstract. Demographic Data of the First Ten Years of Existence of the Pitești Reformed Church in the Light of the Official Death Registries. In the last three centuries, many Hungarians in Transylvania went to work and live in the southern part of the Carpathians. At first, they went just for seasonal work, but later they become permanent migrants. They founded new Reformed parishes and schools in the new locations. We have data on the population of Pitești from 1844, when Sándor Ürmösy described the ethnic and confessional composition of the town for the first time, and he mentions 1,500 Hungarians in Pitești. As result of the Reformed missionary work, the first Reformed churches were established in the most important towns of old Romania in the mid-19th century. The documents of those times reveal to us data on the demographic, confessional, and ethnic composition of the population. In this study, I attempted to find the most important data on the first ten years in the life of the Pitești Reformed community linked to its members’ age of death, cause of the death, and occupation. Keywords: mission, Pitești, Reformed Church, old Romania, official death registries

Feasibility of using death certificates for studying place of death in Latin America.

ABSTRACTObjective.This paper assesses the availability and quality of death certificate data in Latin America and the feasibility of using these data to study place of death and associated factors.Methods.In this comparative study, we collected examples of current official death certificates and digital data files containing information about all deaths that occurred during 1 year in 19 Latin American countries. Data were collected from June 2019 to May 2020. The records for place of death and associated variables were studied. The criteria for data quality were completeness, number of ill-defined causes of death and timeliness.Results.All 19 countries provided copies of current official death certificates and 18 of these registered the place of death. Distinguishing among hospital or other health care institution, home and other was possible for all countries. Digital data files with death certificate data were available from 12 countries and 1 region. Three countries had data considered to be of high quality and seven had data considered to be of medium quality. Categories for place of death and most of the predetermined factors possibly associated with place of death were included in the data files.Conclusions.The quality of data sets was rated medium to high in 10 countries. Hence, death certificate data make it feasible to conduct an international comparative study on place of death and the associated factors in Latin America.

Association between self-reported depression and risk of all-cause mortality and cause-specific mortality

BackgroundDepression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Past evidence suggests that depression could be associated with the all-cause mortality and other disease mortality in Western populations, but little is known about the relationship in the Chinese population. Therefore, we investigated the associations between self-reported depression and all-cause and specific-cause mortality in Chinese adult populations. MethodsThe Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms among 8,151 adult participants drawn from the general population of Guizhou province, China. Participants death and cause of death were determined by linking with the official death records and certificates up to June 2021. Cause of death was coded according to ICD-10 then categorized as either cardiovascular disease (CVD, I00-I99), cancer (C00-C97) or other cause. Cox proportional hazard regression was used to examine the associations of self-reported depression with all-cause mortality and cause-specific mortality. ResultsWith a median follow-up of 7.4 years, 8,151 participants (52.6% women) at baseline were included in the analysis. The multivariable cox hazard regression models showed that participants with moderate and major depression had the highest hazard ratio (HR) for risk of all-cause mortality (HR=5.65, 95% CI 3.09–10.33), CVD mortality (HR=5.66, 95% CI 2.02–15.84), and cancer mortality (HR=7.21, 95% CI 2.00–25.99), compared with participants had no or mild depression. ConclusionOur findings suggested that depression was a risk factor for mortality, with greater risk for greater severity. Clinicians should be aware of the increased risk of mortality in populations with depression.

Geographic footprints of life expectancy inequalities in the state of Geneva, Switzerland

Though Switzerland has one of the highest life expectancies in the world, this global indicator may mask significant disparities at a local level. The present study used a spatial cluster detection approach based on individual death records to investigate the geographical footprint of life expectancy inequalities in the state of Geneva, Switzerland. Individual-level mortality data (n = 22,751) were obtained from Geneva’s official death notices (2009–2016). We measured life expectancy inequalities using the years of potential life lost or gained (YPLLG) metric, defined as the difference between an individual’s age at death and their life expectancy at birth. We assessed the spatial dependence of YPLLG across the state of Geneva using spatial autocorrelation statistics (Local Moran’s I). To ensure the robustness of the patterns discovered, we ran the analyses for ten random subsets of 10,000 individuals taken from the 22,751 deceased. We also repeated the spatial analysis for YPLLG before and after controlling for individual-level and neighborhood-level covariates. The results showed that YPLLG was not randomly distributed across the state of Geneva. The ten random subsets revealed no significant difference with the geographic footprint of YPLLG and the population characteristics within Local Moran cluster types, suggesting robustness for the observed spatial structure. The proportion of women, the proportion of Swiss, the neighborhood median income, and the neighborhood median age were all significantly lower for populations in low YPLLG clusters when compared to populations in high YPLLG clusters. After controlling for individual-level and neighborhood-level covariates, we observed a reduction of 43% and 39% in the size of low and high YPLLG clusters, respectively. To our knowledge, this is the first study in Switzerland using spatial cluster detection methods to investigate inequalities in life expectancy at a local scale and based on individual data. We identified clear geographic footprints of YPLLG, which may support further investigations and guide future public health interventions at the local level.

Opioid abuse and austerity: Evidence on health service use and mortality in England

Opioid abuse has become a public health concern among many developed countries, with policymakers searching for strategies to mitigate adverse effects on population health and the wider economy. The United Kingdom has seen dramatic increases in opioid-related mortality following the financial crises in 2008. We examine the impact of spending cuts resulting from government prescribed austerity measures on opioid-related hospitalisations and mortality, thereby expanding on existing evidence suggesting a countercyclical relationship with macroeconomic performance. We take advantage of the variation in spending cuts passed down from central government to local authorities since 2010, with reductions in budgets of up to fifty percent in some areas resulting in the rescaling of vital public services. Longitudinal panel data methods are used to analyse a comprehensive, linked dataset that combines information from spending records, official death registry data and large administrative health care data for 152 local authorities (i.e., unitary authorities and county councils) in England between April 2010 and March 2017. A total of 280,827 people experienced a hospital admission in the English National Health Service because of an opioid overdose and 14,700 people died from opioids across the study period. Local authorities that experienced largest spending cuts also saw largest increases in opioid abuse. Interactions between changes in unemployment and spending items for welfare programmes show evidence about the importance for governments to protect populations from social-risk effects at times of deteriorating macroeconomic performance. Our study carries important lessons for countries aiming to address high rates of opioid abuse, including the United States, Canada and Sweden.

1925 Tri-State Tornado Damage Path and Associated Storm System

The “Tri-State tornado” event of 18 March 1925, with an official death toll of 695 people, generally is accepted as the deadliest single tornado in United States recorded history. The officially accepted damage path is 352 km (219 mi) long. The entire damage path was not surveyed by the Weather Bureau in 1925 to determine if it truly was continuous, and the nature of the tornado event and the storm that produced it are not well known. Therefore, as much new data as possible have been gathered about this event in all three states along and near the purported damage path. Detailed information about the locations where damage was reported and the type of damage (recorded as “damage points”) was obtained from: interviews and driving surveys with first- and secondhand eyewitnesses, many local 1925 and later newspapers, local books, and photographs and other materials found in local libraries and genealogy centers.&#x0D; After plotting all damage points, a potential damage path of 378 km (235 mi) was indicated. However, 32 gaps ≥1.6 km (1 mi) appeared between consecutive damage points. This paper presents all the damage points, and indicates which of the gaps might be “real” (i.e., where one tornado ended and another tornado developed), as well as those gaps more likely to have been a continuous tornado. We speculate that path segments at the beginning of the potential damage path in eastern Shannon County, MO, and at the end of the potential path in central Pike County, IN, were both likely from separate tornadoes. In the very rural and hilly terrain of southeast Missouri, there were areas with a minimum of human development and no known witnesses to the tornado (parts of Reynolds, Iron and Madison Counties). This led to several relatively long damage path gaps &gt;3.2 km (2 mi). The existence of relatively long gaps prevents confidence in the continuity of the first section of the path. Beginning in central Madison County, MO, and continuing to Pike County, IN, a distance of 280 km (174 mi), there are no gaps &gt;3.2 km (2 mi), more strongly suggesting that the tornado was likely continuous for that path segment. Because of having the highest density of damage reports and the most eyewitness reports, the part of the main damage path that is 243 km (151 mi) long from central Bollinger County, MO to the west edge of Pike County, IN can be considered likely a continuous path.&#x0D; The tornado event was associated with what began as a classic supercell in Missouri, transitioning to high-precipitation mode in Illinois and Indiana. Witnesses saw a wedge tornado along most of the damage path and a large multivortex tornado in some areas. At two places in Illinois, a satellite tornado may have appeared at about the same time as the primary tornado was passing nearby. Another previously unreported tornado with a 32-km (20-mi) damage path occurred in Washington and Jackson Counties, IN, whose path and trajectory suggests that it may also have been produced by the same supercell. This new tornado started about 75 min later and about 105 km (65 mi) east-northeast of the apparent end of the Tri-State tornado damage path in Pike County, IN.

Hospital Avoidance and Unintended Deaths during the COVID-19 Pandemic

The COVID-19 pandemic significantly altered individual behaviors, including the consumption of health care. I study utilization and mortality in the largest integrated health-care system in the United States, the Veterans Health Administration, and find that between the middle of March and the beginning of May 2020, emergency department and inpatient hospital visits declined by 37 percent and 46 percent, and remained 10 percent and 17 percent below expected levels by the end of October. Declines were more pronounced for nonurgent and non-life-threatening conditions, although urgent and life-threatening conditions also dropped by a quarter during the early months. Conditional on arrival at the emergency department, conditions were more severe at presentation. In the first two months of the pandemic, veteran mortality increased by 19.5 percent, yet non-COVID-19 mortality in VA inpatient settings declined. I find suggestive evidence that hospital avoidance may have resulted in higher non-COVID-19 mortality. By focusing on counties with no official COVID-19 deaths by May 19, 2020, I estimate that an upper bound of 7.9 percent of excess veteran deaths in the first two months of the pandemic were due to hospital avoidance.

Cancer mortality predictions for 2021 in Latin America.

We estimated cancer mortality statistics for the current year in seven major Latin American countries, with a focus on colorectal cancer. We retrieved official death certification data and population figures from the World Health Organization and the Pan American Health Organization databases. We analysed mortality from all neoplasms combined and for selected cancer sites. We estimated numbers of deaths and age-standardized mortality rates for the year 2021 using a logarithmic Poisson count data joinpoint model. Total cancer mortality is predicted to decline in all countries considered for both sexes, with the exception of Argentinian women. The lowest total mortality rates were predicted in Mexico (65.4/100 000 men and 62.3 in women), the highest ones were in Cuba (133.3/100 000 men and 91.0 in women). Stomach cancer rates have been decreasing since 1970 in all countries; colorectal cancer started to decline over recent calendar periods. Rates for this cancer were unfavourable in the youngest age group. Lung cancer trends declined in males and remained comparatively low in all countries except Cuba. In Cuba, lung cancer rates in women overtook those for breast. Mortality from cancers of the breast, (cervix) uterus, ovary, prostate and bladder, as well as leukemia mostly showed favourable trends. A marked variability in rates across Latin American countries persists, and rates were relatively high for stomach, uterus, prostate and lung cancers, as compared to Europe and North America, suggesting the need to improve preventive strategies. Colorectal cancer mortality was relatively low in Latin America, except in Argentina, and short-term predictions remain moderately favourable.

'Wish to die' is independently associated with cardiovascular mortality in later life. Data from TILDA.

There is an established bidirectional relationship between mental and heart health in later life but the link between wish to die (WTD) and cardiovascular mortality is less well-defined. This is a longitudinal study examining the association between WTD and mortality over 9-year follow-up in a large population-representative sample of older adults. Individual-level survey data was linked to official death registration data, divided into cardiovascular and noncardiovascular causes. WTD was defined as answering affirmatively when asked 'In the last month, have you felt that you would rather be dead?' Regression models were used to obtain hazard ratios for the association between WTD at Wave 1 and mortality. Kaplan-Meier plots were used to compare survival across groups. Just over 3% (275/8124) of participants reported WTD. Mortality data was available for 9% of participants (755/8124). WTD was significantly associated with all-cause mortality, with a hazard ratio of 1.41 (95% confidence interval [CI]: 1.00-1.99). Findings were attenuated and no longer significant after excluding participants with heart disease or depression/anxiety/other psychiatric illness. WTD was significantly associated with cardiovascular mortality (hazard ratio: 2.14 [95% CI: 1.21-3.78]), even after excluding participants with depression/anxiety/other illnesses but not heart disease. WTD was not associated with an increased risk of death due to non-cardiovascular causes. Older people who report a wish to die have double the risk of death from cardiovascular disease in the following 9 years, even when those with depression, anxiety or other mental health problems are excluded.

Death Certificate-Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance - United States, January-December 2020.

Approximately 375,000 deaths during 2020 were attributed to COVID-19 on death certificates reported to CDC (1). Concerns have been raised that some deaths are being improperly attributed to COVID-19 (2). Analysis of International Classification of Diseases, Tenth Revision (ICD-10) diagnoses on official death certificates might provide an expedient and efficient method to demonstrate whether reported COVID-19 deaths are being overestimated. CDC assessed documentation of diagnoses co-occurring with an ICD-10 code for COVID-19 (U07.1) on U.S. death certificates from 2020 that had been reported to CDC as of February 22, 2021. Among 378,048 death certificates listing U07.1, a total of 357,133 (94.5%) had at least one other ICD-10 code; 20,915 (5.5%) had only U07.1. Overall, 97.3% of 357,133 death certificates with at least one other diagnosis (91.9% of all 378,048 death certificates) were noted to have a co-occurring diagnosis that was a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), a significant contributing condition (e.g., hypertension or diabetes), or both. Overall, 70%-80% of death certificates had both a chain-of-event condition and a significant contributing condition or a chain-of-event condition only; this was noted for adults aged 18-84 years, both males and females, persons of all races and ethnicities, those who died in inpatient and outpatient or emergency department settings, and those whose manner of death was listed as natural. These findings support the accuracy of COVID-19 mortality surveillance in the United States using official death certificates. High-quality documentation of co-occurring diagnoses on the death certificate is essential for a comprehensive and authoritative public record. Continued messaging and training (3) for professionals who complete death certificates remains important as the pandemic progresses. Accurate mortality surveillance is critical for understanding the impact of variants of SARS-CoV-2, the virus that causes COVID-19, and of COVID-19 vaccination and for guiding public health action.

Health care services utilization and cost in the last year of life in Colombia: a retrospective study

Introduction: Health care costs at the end of life cause a high expenditure on health care resources. The implementation of integrated palliative care programs has proven to be cost-efficient. The study aimed to analyze the consumption and cost of health care resources during the last year of life of patients who are not part of a palliative care program. Methods: A descriptive, longitudinal and retrospective study was conducted in patients of a Colombian health insurance company who died in 2013 due to pathologies that were susceptible and non-susceptible to palliative care. Causes of death were obtained from official death certificates. McNamara et al. strategy of classification was applied and adapted to assess services received during the last year of life. Analysis of costs was conducted by pathologies at different levels of care. Results: 3,392 deaths in 2013 (70% susceptible to palliative care and 30% non-susceptible to palliative care). Total health care cost: USD 47,550,155. Patients susceptible to palliative care were responsible for 84% of the year’s expenditure (the annual expenditure) (USD 40 million). There were significant differences between the average costs for susceptible and non-susceptible palliative care patients (USD 16,878 versus USD 7,433 per year, p &lt; 0.001). The average cost per patient for the last three months of life represented 52% of the expenditure during the last year of life (USD 8,754). The last month of life was 25.6% of the expenditure during the last year of life (USD 4,324). Conclusions: Cost of care for the last three months of life of susceptible palliative care patients generates a huge health care expenditure, mainly attributable to hospital care cost. The implementation of a palliative care program could decrease these assistance costs.