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Objective: To assess the mortality profile of systemic lupus erythematosus (SLE) patients in France using multiple-cause-of-death analysis., Methods: Data were collected between 2000 and 2009 in the French Epidemiological Center for the Medical Causes of Death database, and death certificates issued upon the death of an adult for whom SLE was an underlying cause of death (UCD) or a non-underlying cause of death (NUCD) were evaluated using multiple-cause-of-death analysis. Sex, age, sex ratio, standardized mortality rates, as well as frequency of the various causes of death were assessed, at both a national and a regional level. For the main causes of death, the observed number of deaths in relation to the expected number of deaths (O:E ratio) (standardized for age and sex) was calculated., Results: During the study period, 1,593 deaths related to SLE were identified. The mean ± SD age at death was 63.5 ± 18.4 years and the sex ratio (female:male) was 3.5. The mean standardized mortality rate was 3.2 per 1 million people (range 2.7-4.1). When SLE was the UCD (n = 637), the main NUCDs were cardiovascular diseases (49.5%), infectious diseases (24.5%), and renal failure (23.2%). When SLE was an NUCD (n = 956), the most common UCDs were cardiovascular diseases (35.7%), neoplasms (13.9%), and infectious diseases (10.3%). The overall O:E ratio was >1 for infectious and cardiovascular diseases and renal failure (especially among people <40 years of age for the latter 2 causes), but was <1 for neoplasms., Conclusion: Cardiovascular disease is the leading cause of death associated with SLE in France., (Copyright © 2014 by the American College of Rheumatology.)

French uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: We developed a methodology using vital statistics to estimate the impact of osteoporotic fractures on the mortality of an entire population, and applied it to France for the period 2000-2004., Methods: Current definitions of osteoporotic fractures were reviewed and their components identified. We used the International Classification of Diseases with national vital statistics data for the French adult population and performed cross-classifications between various components: age, sex, I-code (site) and E-code (mechanism of fracture). This methodology allowed identification of appropriate thresholds and categorization for each pertinent component., Results: 2,625,743 death certificates were analyzed, 2.2% of which carried a mention of fracture. Hip fractures represented 55% of all deaths from fracture. Both sexes showed a similar pattern of mortality rates for all fracture sites, the rate increased with age from the age of 70 years. The E-high-energy code (present in 12% of death certificates with fractures) was found to be useful to rule-out non-osteoporotic fractures, and to correct the overestimation of mortality rates. Using this methodology, the crude number of deaths associated with fractures was estimated to be 57,753 and the number associated with osteoporotic fractures 46,849 (1.85% and 1.78% of all deaths, respectively)., Conclusion: Osteoporotic fractures have a significant impact on overall population mortality.

Objective: We studied the population-level influence of rheumatoid arthritis (RA) on the mortality of the French population and the pattern of associated causes between 1970 and 2002, using death certificates., Methods: All French death certificates (n=17,806,923) between 1970 and 2002 were analyzed. Mortality rates related to RA were studied using Poisson regression, and associated causes of death were estimated using the method of observed/expected pairs. Modifications of the International Classification of Diseases and coding methods were considered., Results: RA was mentioned in 0.22% of death certificates. The age-adjusted mortality rates declined during the initial period, but increased in the early 1990s, this trend being driven by the rise in mortality in older groups. The mean age at death was lower for RA-associated deaths than for the general population. Patterns of associated causes of death were identified: there was an increase of the associations with injury, poisoning, external causes, and immunosuppressive toxicities; and a decrease of the associations with endocrine diseases, decubitus ulcers, and glucocorticoid toxicities., Conclusion: RA has a significant impact on mortality in the French population, with a trend toward an increase of associated mortality rates in the older population groups starting in the 1990s.

Aim: To describe the burden of diabetes-related mortality in France., Methods: Underlying and multiple causes (all causes listed) of death were extracted from the 2002 French national mortality registry. Death rates were standardized on the age structure of the European population., Results: Diabetes was reported as the underlying cause of death in 11,177 certificates (2.1%), and as multiple causes in 29,357 certificates (5.3%), giving a ratio (multiple/underlying causes) of 2.6. When diabetes was a multiple cause, the mean age at death was 75 years in men, 81 years in women. The age-standardized mortality rates were 41.0/100,000 in men, 24.6/100,000 in women. The excess mortality observed in men (men/women ratio = 1.7) decreased with age. Geographic differences were observed: higher rates in the North-East, lower rates in the West of the country. In certificates mentioning diabetes, the most frequent cause of death was diseases of the circulatory system (76%). Coronary heart diseases, foot ulcers and renal diseases were more likely to be mentioned in certificates referring to diabetes than in those that did not., Discussion: The use of multiple rather than underlying causes of death more than doubled diabetes-related mortality rates. While probably still under-estimated, the burden of diabetes-related mortality corresponds to a high proportion of the total mortality, especially in men. Geographic differences partially reflect disparities in diabetes prevalence. Causes more frequently associated with diabetes include coronary heart disease and complications related to neuropathy and nephropathy.

Background In the age of big data in healthcare, automated comparison of medical diagnoses in large scale databases is a key issue. Our objectives were: 1) to formally define and identify cases of independence between last hospitalization main diagnosis (MD) and death registry underlying cause of death (UCD) for deceased subjects hospitalized in their last year of life; 2) to study their distribution according to socio-demographic and medico-administrative variables; 3) to discuss the interest of this method in the specific context of hospital quality of care assessment. Methods 1) Elaboration of an algorithm comparing MD and UCD, relying on Iris, a coding system based on international standards. 2) Application to 421,460 beneficiaries of the general health insurance regime (which covers 70% of French population) hospitalized and deceased in 2008-2009. Results 1) Independence, was defined as MD and UCD belonging to different trains of events leading to death 2) Among the deaths analyzed automatically (91.7%), 8.5% of in-hospital deaths and 19.5% of out-of-hospital deaths were classified as independent. Independence was more frequent in elder patients, as well as when the discharge-death time interval grew (14.3% when death occurred within 30 days after discharge and 27.7% within 6 to 12 months) and for UCDs other than neoplasms. Conclusion Our algorithm can identify cases where death can be considered independent from the pathology treated in hospital. Excluding these deaths from the ones allocated to the hospitalization process could contribute to improve post-hospital mortality indicators. More generally, this method has the potential of being developed and used for other diagnoses comparisons across time periods or databases. [ABSTRACT FROM AUTHOR]

Background: Electronic death certification was established in France in 2007. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates. Methods: All death certificates from the 2010 French mortality database were included. Three specific quality indicators were considered: (i) amount of information, measured by the number of causes of death coded on the death certificate; (ii) intrinsic consistency, explored by application of the International Classification of Disease (ICD) General Principle, using an international automatic coding system (Iris); (iii) imprecision, measured by proportion of death certificates where the selected underlying cause of death was imprecise. Multivariate models were considered: a truncated Poisson model for indicator (i) and binomial models for indicators (ii) and (iii). Adjustment variables were age, gender, and cause, place, and region of death. Results: 533,977death certificates were analyzed. After adjustment, electronic death certificates contained 19% [17%-20%] more codes than paper death certificates for people deceased under 65 years, and 12% [11%-13%] more codes for people deceased over 65 years. Regarding deceased under and over 65 respectively, the ICD General Principle could be applied 2% [0%-4%] and 6% [5%-7%] more to electronic than to paper death certificates. The proportion of imprecise death certificates was 51% [46%-56%] lower for electronic than for paper death certificates. Conclusion: The method proposed to evaluate the quality of death certificates is easily reproducible in countries using an automatic coding system. According to our criteria, electronic death certificates are better completed than paper death certificates. The transition to electronic death certificates is positive in many aspects and should be promoted. [ABSTRACT FROM AUTHOR]

After a brief presentation of the components and evolution of the French statistical health information system, this article goes on to describe the main sources of data from which public health indicators are derived. Among sources that cover the whole country, or those based on data collection that can be extrapolated to the whole French population, the article focuses on exhaustive health databases essentially those run by the administration: mortality data provided by death certificates, morbidity data collected from administrative patient management files, particularly from hospitals and health insurance organizations and other health data from compulsory reporting. It also presents other sources of data such as large national general population surveys, national surveys involving health professionals or structures, and health surveillance networks and registries. The article mentions two important problems faced by the French health statistics system, namely the linkage of different sources, while respecting legislation on personal privacy and the organisation of access to data for research, surveillance and public health purposes. [ABSTRACT FROM AUTHOR]

Aims Little is known regarding temporal trends in mortality attributed to heart failure (HF) from a population perspective. The aim of this study was to assess the mortality related to HF as an underlying cause during the last 20 years in seven European countries. Methods and results The number of deaths with HF as the underlying cause was collected in seven European states: Germany, Greece, England and Wales, Spain, France, Finland, and Sweden from 1987 to 2008. Disease coding for HF was based on the International Classification of Diseases (ICD 9th and 10th versions). We computed age-standardized death rates (SDRs) per 100 000 inhabitants. Mean age at death from HF was also calculated for the same period. In the seven studied countries, the HF SDR decreased continuously from 54.2 (1987) to 32.6 (2008). Despite differences in the early 1990s, SDRs related to HF seemed to converge, in these seven European countries, to ∼30 deaths per 100 000 population in the near future, for both men and women. During the study period, the mean age at death increased from 80.0 to 82.7 years. Half of the deaths from HF occurred in hospital, without change over time. Conclusion There has been a 40% reduction of the SDR due to HF in seven European countries during two decades and a concomitant increase in the mean age at death from HF. We hypothesize that these results may be related to a better management of chronic and acute HF patients over the past 20 years. [ABSTRACT FROM PUBLISHER]

Osteoporotic fractures are one of the leading causes of death in the elderly population, but mortality may have been reduced by the advances in management and prevention during recent decades. The authors analyzed the population-level impact of these fractures on mortality in France from 1968 to 2004. About 20 million death certificates registered in metropolitan France from 1968 to 2004 were analyzed. Osteoporotic fractures were identified by using a previously developed methodology. Age-specific and standardized mortality rates were calculated by site of fracture and sex, and time trends were evaluated. Associated causes of death were compared between the extreme periods of the study by the observed/expected pairs method; 440,890 (2.2%) death certificates reported an osteoporotic fracture. Osteoporotic fractures overall, particularly hip and skull fractures, declined by half during the study period, exceeding the decline in general mortality and resulting in fracture-deceased subjects being older. However, pelvis, vertebral, and rib fractures became more frequent. Associated causes of death increased with time, except for decubitus ulcers, indicating a change in the pattern of the death process. Despite a 50% decline, osteoporotic fractures still have a significant impact on mortality. The pattern of the death process has changed, with an increased role for comorbidities. [ABSTRACT FROM PUBLISHER]