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The National Spanish Institute of Statistics (INE) website is the main means of communication for official statistics in Spain. The INE publishes the annual statistics of deaths according to the cause of death. This vital statistic has improved a lot in recent years; also, thanks to the collaboration from the Autonomous Communities. There are certain areas that could optimize its usefulness. Indicator improvements could include provisional case-counts by causes of death, besides the age-standardization of specified causes of death and the Potential Years of Life Lost by cause of death, for territorial comparison. Meanwhile, the usefulness of social indicators applied to the statistics of death causes could be enhanced, as is the case of education. By updating the databases, it would be possible to maintain the registries of deceased and their causes of death without an annual closure before the statistical publication. Moreover, we could link the databases of demographic records of the population to their health files, to obtain individually the people at risk of sickness or death, and to enable their respective vital, social, health trajectories for statistics. In this way, the INE would increase its leadership and reference on mortality statistics in Spain and EuroStat, as well. Furthermore, the State, Autonomous and municipal administrations could redefine their publication offer into a more specified or innovative statistics of death causes.

Objective: After the return of Spain to democracy and the regional assumption of government powers, actions were initiated to improve the mortality statistics of death causes. The objective of this work was to describe the evolution of the quality activities improvements into the statistics of death causes on Murcia's region during 1989 to 2011., Methods: Descriptive epidemiological study of all death documents processed by the Murcia mortality registry. Use of indicators related to the quality of the completion of death in medical and judicial notification; recovery of information on the causes and circumstances of death; and impact on the statistics of ill-defined, unspecific and less specific causes., Results: During the study period, the medical notification without a temporary sequence on the death certificate (DC) has decreased from 46% initial to 21% final (p less than 0.001). Information retrieval from sources was successful in 93% of the cases in 2001 compared to 38%, at the beginning of the period (p less than 0.001). Regional rates of ill-defined and unspecific causes fell more than national ones, and they were in the last year with a differential of 10.3 (p less than 0.001) and 2.8 points (p=0.001), respectively., Conclusions: The medical death certification improved in form and suitability. Regulated recovery of the causes of death and circumstances corrected medical and judicial information. The Murcia's region presented lower rates in less specified causes and ill-defined entities than national averages., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT., Methods: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according to previous guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and age-specific rates from 1999 to 2009 (uncorrected and corrected) for DM and HT were calculated., Results: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 for DM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions., Conclusions: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DM AND HT came from the new death certificate.

Background: Different countries have conducted comparability studies between Revisions 10 and 9 of the International Classification of Diseases for aggregate lists of causes of death. In Spain, the COMPARA project was aimed at evaluating the impact of the revision change., Methods: Descriptive cross-sectional epidemiological study of 88,048 deaths recorded in Spain in 1999 with the underlying cause of death doubled coded in ICD-9 and ICD-10. The theoretical correspondences between the ICD on the lists of the National Institute of Statistics and Murcia are established. The comparability rates and their confidence intervals, and the total kappa index were calculated., Results: A decline in infectious diseases (-1.7%) and viral hepatitis, (-12.3%) declined under Tenth revision, while AIDS showed an increase (5.7%). Neoplasms increased a little (0.3%) with the inclusion of the Mielodisplasic Syndrome (55.2%). Diabetes mellitus is increased (2.1%). Mental disorders declined on dementia being shifted to Alzheimer's disease (28.6%). Cardiovascular diseases dropped slightly (-1.4%), without any impact on cerebrovascular diseases, although acute myocardial infarct decreased (-0.6%) while ischemic heart disease increased (0.3%). Pneumonia decreased (-12.5%) and hepatic cirrhosis grows (4.3%). Ill-defined conditions increased due to cardiorespiratory insufficiencies. The external causes show no change without including the accuracy of ICD-9. The National Institute of Statistics 102 groups list obtained a total kappa index of 95.4%, similar to the Murcia variants., Conclusions: Although ICD-10 has a lesser overall impact, the significant comparability rates of the causes of death groups between the revisions with important absolute differences should be taken into account.

The aim of this study is to Mortality show the protocol of analysis which was set out as part of the EMECAM Project, illustrating the application thereof to the effect of pollution has on the mortality in the city of Valencia. The response variables considered will be the daily deaths rate resulting from all causes, except external ones. The explicative variables are the daily series of different pollutants (black smoke, SO2, NO2, CO, O3). As possible confusion variables, weather factors, structural factors and weekly cases of flu are taken into account. A Poisson regression model is built up for each one of the four deaths series in two stages. In the first stage, a baseline model is fitted using the possible confusion variables. In the second stage, the pollution variables or the time legs thereof are included, controlling the residual autocorrelation by including mortality time lags. The process of fitting the baseline model is as follows: 1) Include the significant sinusoidal terms up to the sixth order. 2) Include the significant temperature or temperature squared terms with the time lags thereof up to the 7th order. 3) Repeat this process with the relative humidity. 4) Add in the significant terms of calendar years, daily tendency and tendency squared. 5) The days of the week as dummy variables are always included in the model. 6) Include the holidays and the significant time lags of up to two weeks of flu. Following the reassessment of the model, each one of the pollutants and the time lags thereof up to the fifth order are proven out. The impact is analyzed by six-month periods, including interaction terms.

Background: The problems of air pollution became noticeable in Cartagena in the seventies, high SO2 and particle levels having been reached from time to time. Our aim is to assess, using the EMECAM methodology, the acute impact of SO2 and particle air pollution on the daily death rate of the city of Cartagena in the 1992-1996 period., Methods: A daily listing is provided of the total number of non-accidental deaths within the population as a whole and for those over age 70, the cardiovascular and the respiratory deaths due to dioxide and particle air pollution for the 1992-1996 period using autoregressive Poisson models which control seasonality, weather, time of year, flu, special events, and time lags., Results: In the period under study, there has been a drop in the SO2 air pollution as compared to previous years, which was not as marked for the particles. The analyses reveal significant relationships in the total non-accidental deaths in those over age 69, with the average particle count and those particles with cardiovascular deaths for the months of May to October. In the six-month period of the year, when the weather is cold, we found a positive statistically significant relationship to exist in the maximum daily hourly value of the particles and the deaths due to cardiocirculatory and respiratory diseases. However, there is no consistency in the between on assessing the reliability of the models.

Background: To broaden the experiences of evaluation of the learning and satisfaction of the workshops of pre and postgraduates of medicine for the improvement in the certification of the causes of death with contributions from the Region of Murcia, 1992-1996., Methods: With a quasi-experimental pre-posttest epidemiological design, a workshop is given, being both theoretical and practical of 2 hours addressed to students of medicine, interns in Family and Community Medicine and doctors in the course of obtaining said specialty. The goal of the workshop is to teach the usefulness of Mortality Statistics and the International WHO norms of certification. At start and finish we evaluated the formation by research, using indicators of formal quality, concept and result of the completion. Also, we administrate a questionnaire of satisfaction., Results: In five years 23 workshops with 646 assistants were given, including 472 pairs of exercises and 586 satisfaction's questionnaires. In the pretest, more than 78% of the individual indicators were correct and 52.3% of the participants completed everything well. There were statistically significant improvements in the groups of indicators of concept and result, but not that of form, which showed a high qualification from the beginning (77.5%). The assignation of cause of death has improve more with the students (24.6%) than in physicians (14.4%). The contents of the course are very adequate/adequate (92.7%), without difference among the types of helpers. There is an equilibrium between theory and practice (64.7%). Eighty-one point three of physicians and 80.2% of the students stated that the workshop was useful for correctly certifying a death, independent of the previous background., Conclusions: The good initial qualifications were improved after the educational intervention. In accordance with workshops demonstrated efficacy, we propose their generalization and to follow its impact on Mortality Statistics.