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Background In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh. Methods Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool. Results Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates. Conclusions Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems.

Objectives Cause-of-death information, reported by frontline clinicians after a patient’s death, is an irreplaceable source of public health data. However, systematic bias in cause-of-death reporting can lead to over- or underestimation of deaths attributable to different causes. New York City consistently reports higher rates of deaths attributable to pneumonia and influenza than many other US cities and the country. We investigated systematic erroneous reporting as a possible explanation for this phenomenon. Methods We reviewed all deaths from 2 New York City hospitals during 2013-2014 in which pneumonia or influenza was reported as the underlying cause of death (n = 188), and we examined the association between erroneous reporting and multiple extrinsic factors that may influence cause-of-death reporting (patient demographic characteristics and medical comorbidities, time and hospital location of death, type of medical provider reporting the death, and availability of certain diagnostic information). Results Pneumonia was erroneously reported as the underlying cause of death in 163 (86.7%) reports. We identified heart disease and dementia as the more likely underlying cause of death in 21% and 17% of erroneously reported deaths attributable to pneumonia, respectively. We found no significant association between erroneous reporting and the multiple extrinsic factors examined. Conclusions Our results underscore how erroneous reporting of 1 condition can lead to underreporting of other causes of death. Misapplication or misunderstanding of procedures by medical providers, rather than extrinsic factors influencing the reporting process, are key drivers of erroneous cause-of-death reporting.

Paediatric strokes are a different entity owing to the difference in pathological entity causing the stroke as well as difficulty in treatment and management due to the presence of a growing brain and small vascular volume making surgery and endovascular intervention dangerous. Yet, the high neuronal plasticity coupled with unique surgical and endovascular procedures makes surgery in these conditions rewarding with improving morbidity and mortality statistics. The field is young and dynamic leading to constant change and updating. We attempt to review the current recommendations with our own experience in paediatric neurosurgery for paediatric strokes and present an overview of common conditions causing paediatric strokes. A brief review of the literature is also supplied for reference.

Aim. For the purpose of ensuring the reliability of national mortality statistics, the present regulations set out to generalize current information on the preparation of primary medical documentation on the basis of requirements for filing death certificates, ICD-10 rules and recommendations by the Russian Ministry of Health.Material and methods. Existing requirements for filing death certificates, ICD-10 rules updated by WHO in 1996–2019 and recommendations by the Russian Ministry of Health were analysed.Results. The preparation of primary medical documentation, formulation of the concluding clinical, pathological, anatomical and forensic post-mortem diagnosis, issuance of death certificates, selection and coding of the primary cause of death should be carried out in accordance with the unified ICD-10 rules. Postmortem diagnosis should correspond to Volume 3 of ICD-10.Due to the pandemic of a new coronavirus infection, referred to as COVID-19, in 2019, WHO introduced changes to the ICD-10. COVID-19 was included in ICD-10 chapter XXII and received the codes of U07.1 and U07.2. COVID-19-accosiated deaths were divided into those where COVID-19 is determined to be the primary cause of death and those where COVID-19 falls into the category “other” causes.COVID-19 with fatal complications is most frequently selected as the primary cause of death in acute conditions, with concurrent chronic diseases (cancer, diabetes, chronic forms of ischemic and cerebrovascular diseases, etc.) being indicated as “other” causes of death in Part II of the death certificate. In the presence of trauma, poisoning, bleeding and conditions requiring emergency medical care, these conditions are selected as the primary cause of death, with COVID-19 being recorded in part II of the certificate.Conclusion. To provide reliable statistical information about mortality rates, executive authorities require the primary medical documentation filed in strict accordance with established rules.

Introduction Appropriate cause of death reporting is vital in the pandemic circumstance for effective planning of the control measures. Accurate reporting and registration of the reason for death are crucial in planning of health programs in turn contributing for the national development. Background All births and deaths occurring across India should be mandatorily registered per the Registration of Births and Deaths Act passed in the year 1969. The act also requires the issuance of cause of death certificate by the doctor attending the departed during his last illness. Data obtained from the cause of death certificate provides cause-specific mortality profile, which is required to analyze the health trends of the population. Review results This article discusses the available guidelines on the appropriate documentation of cause of death in the confirmed or suspected coronavirus disease-2019 (COVID-19) infection resulting into death. Conclusion Proper certification of the cause of death leads to better epidemic surveillance. Scrutiny of the clinical sequences from the cause of death certificate is useful to prioritize the allocation of resources for critical care management and to augment our knowledge about underlying causes resulting in mortality from COVID-19. Clinical significance Dissemination of available guidelines on proper documentation of the cause of death in confirmed/suspected COVID-19 cases will reduce the errors in cause of death reporting. How to cite this article Veeranna CH, Rani S. Cause of Death Certification in COVID-19 Deaths. Indian J Crit Care Med 2020;24(9):863-867.

Absztrakt: A krónikus obstruktív tüdőbetegség (COPD) világszerte előkelő helyet foglal el a morbiditási és mortalitási statisztikákban. A COPD megelőzhető és kezelhető betegség, kialakulásáért döntően a dohányzás tehető felelőssé. A prevenció kulcsfontosságú, de korlátozottan kivitelezhető, így a rizikó meghatározása és a korai noninvazív diagnosztika révén lehetne tovább csökkenteni a COPD miatti halálozást. A fejlődő diagnosztikus technikák ellenére az optimális szűrővizsgálat felfedezése még várat magára. Kellően szenzitív és specifikus biomarkerek felfedezése megfelelő eszközt adhat a klinikus kezébe a betegség korai diagnosztizálásához, a differenciáldiagnosztikához, a fenotipizáláshoz és a prognózis becsléséhez. Közleményünkben a COPD vonatkozásában a közelmúltban felfedezett potenciális fehérje és glikán biomarkereket foglaljuk össze. Orv Hetil. 2020; 161(4): 123–128.

Malaria is responsible for majority of the morbidity and mortality statistics reflected by tropical diseases. Whilst effectively managed in most parts of the globe, it remains a scourge on the African continent where most cases of the disease are diagnosed annually. Plants have played a leading role as a source of malarial drugs which continue to dominate the clinical landscape today. Most if not all of these discoveries have as their basis evidence which can be traced back to traditional medicine. There is likewise precedence for the use of Amaryllidaceae plants in traditional medicinal approaches towards malaria. The chief phytochemical principles of the Amaryllidaceae are its isoquinoline alkaloids which are responsible for its diverse biological properties. These alkaloids may be divided into major and minor groups based on their distinguishing structural features as well as their natural abundance and distribution in the family. Whilst much has been written about the biological and chemical properties of the major alkaloid groups of the Amaryllidaceae, relatively little is known or understood about its minor alkaloid groups. This review focuses on the antiplasmodial activities described in the literature for the minor alkaloid group members of the Amaryllidaceae against various strains of the malarial pathogen Plasmodium falciparum . Three database platforms (Google Scholar, SciFinder and Scopus) were utilized for the literature search. Articles were accessed from journals licensed to the University of KwaZulu-Natal, or directly via the respective corresponding authors. Also considered are structural elements of these alkaloids which may be used to explain such activities as well as to provide a foundation in attempts to modulate activities. In addition, evidence is provided on the molecular basis to these effects which could guide efforts in drug discovery.

Background The vital registration system is universally recognized as the main source of mortality data which is essential for policy formulation, proper interventions and resource allocation to address priority health challenges. To improve availability and quality of mortality statistics by strengthening the vital registration system, understanding the current vital registration system is essential. This study identified challenges in generating reliable mortality statistics in the vital registration system of Myanmar. Methods Qualitative methods were used to collect data in two selected townships of Mandalay Region. Grey literature related to the management of mortality registration was reviewed; in-depth interviews of sixteen key informants and fourteen focus group discussions were conducted with those involved in death registration at the local level, such as healthcare providers, local administrators and knowledgeable adults in households where deaths occurred during the past three years. Thematic analysis was performed to identify system barriers in the death registration process. Results Weaknesses in the death registration system are classified in three areas: a) administrative which includes the lack of enforcement of mandatory death registration, limited issuance of death certificates and no formal mandatory notification of death events by households and; b) technical which includes absence of proper and regular on-the-job trainings, ineffective cause-of-death certification practice for deaths in the communities and the absence of routine data plausibility checks at the local level; and c) societal which includes poor community awareness and inadequate participation in death registration. Conclusion The study highlighted challenges in the death registration system at the operational level, which undermines the achievement of a satisfactory level of completeness and accuracy of mortality data. We recommend establishing a strong legal framework, improving technical capacities and raising public awareness and cooperation to strengthen the system that can generate reliable mortality statistics. Electronic supplementary material The online version of this article (10.1186/s12889-019-6671-y) contains supplementary material, which is available to authorized users.

Background Despite the well-recognised benefit for individuals and communities of increased active travel, cycling remains a minority travel mode in many high income countries. Fear of injury is often cited as a reason. Campaigns to promote cycle helmet wear are alleged to contribute to this. However, there is little information on whether head injuries to cyclists are an important cause of death in road travel fatalities, compared with other road users. Methods We examined secondary causes of death for road travel deaths in England 2007–2012, comparing travel modes and grouped causes of death (from national mortality statistics) as numbers and as rates, using distance travelled and time spent travelling by mode, age, and sex from National Travel Surveys for the same six years. Results Head injury was the main cause of death for 269 cyclists, 1324 pedestrians and 1046 drivers, accounting for 46%, 42% and 25% of road travel deaths at all ages in each mode respectively. Head injury was the commonest cause of death in cyclists, but most pedestrian and driver fatalities were from multiple injuries. Rates of fatal head injury per bnkm in males aged 17+ for cycling, walking, and driving were 11.2(95% CI 9.7–12.9), 23.4(21.8–25.0) and 0.7(0.6–0.7) respectively. Female fatality rates were 8.8(6.2–12.0), 9.6(8.7–10.7) and 0.4(0.4–0.5) per bnkm respectively. Using time as the denominator, rates were 0.16(0.14–0.19),0.10(0.10–0.11) and 0.03 (0.028–0.032) respectively in men and 0.10 (0.07–0.14), 0.04(0.037–0.045), and 0.01(0.012–0.016) respectively in women, per million hours travelled. Conclusion Answering the question ‘How important are head injuries in cyclists as a cause of road travel death?’ depends on the metric used for assessing importance. Pedestrians and drivers account for five and four times the number of fatal head injuries as cyclists. The fatal head injury rate is highest for cyclists by time travelled and for pedestrians using distance travelled.

Simone de Vries,1 Michael Schaapveld,1 Jan WPF Kardaun,2,3 Kim H de Bruin,2 Augustinus DG Krol,4 Pieternella J Lugtenburg,5 Judy N Jacobse,1 Berthe MP Aleman,6 Flora E van Leeuwen1 1Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; 2Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands; 3Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands; 4Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands; 5Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; 6Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands Objective: Obtaining accurate data about causes of death may be difficult in patients with a complicated disease history, including cancer survivors. This study compared causes of death derived from medical records (CODMR) with causes of death derived from death certificates (CODDC) as processed by Statistics Netherlands of patients primarily treated for Hodgkin lymphoma (HL) or breast cancer (BC).Methods: Two hospital-based cohorts comprising 1,215 HL patients who died in the period 1980–2013 and 714 BC patients who died in the period 2000–2013 were linked with cause-of-death statistics files. The level of agreement was assessed for common underlying causes of death using Cohen’s kappa, and original death certificates were reviewed when CODDC and CODMR showed discrepancies. We examined the influence of using CODDC or CODMR on standardized mortality ratio (SMR) estimates.Results: Agreement for the most common causes of death, including selected malignant neoplasms and circulatory and respiratory diseases, was 81% for HL patients and 97% for BC patients. HL was more often reported as CODDC (CODDC=33.1% vs. CODMR=23.2%), whereas circulatory disease (CODDC=15.6% vs. CODMR=20.9%) or other diseases potentially related to HL treatment were more often reported as CODMR. Compared to SMRs based on CODDC, SMRs based on CODMR complemented with CODDC were lower for HL and higher for circulatory disease.Conclusion: Overall, we observed high levels of agreement between CODMR and CODDC for common causes of death in HL and BC patients. Observed discrepancies between CODMR and CODDC frequently occurred in the presence of late effects of treatment for HL. Keywords: cause of death, Hodgkin lymphoma, breast cancer, mortality statistics

Bath-related death occurs relatively frequently in Japan; however, there is room for improvement in the investigation of such deaths. Here, we describe four autopsy cases of bath-related death (one case of drowning; one of drowning under the influence of drinking; and two cases of sudden cardiac death without drowning) in which postmortem computed tomography (PMCT) was performed before autopsy. Based on analysis of autopsy and PMCT findings of these cases, we further discuss the utility and limitation of PMCT when applied to bath-related death. Comparison of the autopsy findings and PMCT findings between the cases suggests that combinations of several PMCT findings in bath-related death cases (e.g., signs suggestive of overinflated lungs, hemodilution, and excessive water intake in the gastrointestinal tract) can serve to distinguish drowning cases from non-drowning cases. Many bath-related deaths have been reported to have drowning signs at autopsy, although elderly victims with cardiovascular diseases tend to be diagnosed as death due to disease without employing PMCT or autopsy. Therefore, this case series suggests that implementation of PMCT in bath-related death might prevent underestimation of drowning as a cause of death. Although PMCT alone has several limitations, such as inability to evaluate toxicology or heart pathology, implementation of PMCT may trigger a more detailed investigation of the background regarding bath-related death, especially in drowning cases. Based on this case report, we emphasize that PMCT should be performed routinely in bath-related death for compilation of accurate mortality statistics of bath-related death for developing future prevention strategies.

Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk.To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015.Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography.There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Morans I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors.The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.El cáncer de mama es la neoplasia maligna más común en las mujeres en todo el mundo y en Chile, siendo la primera causa de muerte oncológica femenina. Se ha reportado amplia variación en la mortalidad, con focos geográficos de mayor riesgo.Analizar espacialmente la mortalidad por cáncer de mama en mujeres de la Región Metropolitana en 2015.Estudio ecológico. Se utilizaron los datos de los registros de defunciones del año 2015 (C50 según CIE10), y las proyecciones poblacionales del Instituto Nacional de Estadísticas. Se calcularon tasas de mortalidad por cáncer de mama brutas y razones de mortalidad estandarizadas. Se realizó un análisis epidemiológico espacial estimando el índice I de Moran Global y Local para evaluar autocorrelación espacial. Los resultados se presentan en mapas (cartografía pre-censo 2016).Se registraron 622 defunciones por cáncer de mama en la Región Metropolitana en 2015. La edad promedio de las mujeres fallecidas fue de 66 años (desviación estándar: 15,5). El 92,4% de las muertes se registró en zonas centrales o urbanas. Sin embargo, las mayores tasas de mortalidad se observaron en comunas periféricas. No se observó autocorrelación espacial global en la región (I de Moran de 0,007; p = 0,134). A nivel local, cuatro comunas se diferencian de forma significativa de sus vecinas.El riesgo de morir por cáncer de mama en la Región Metropolitana de Chile se concentra en comunas periféricas. Cuatro comunas de la región presentan riesgos diferentes de sus comunas vecinas, por lo que es necesario explorar factores que explican la desigual distribución de las muertes.

RESUMO: Objetivo: Descrever os óbitos com menção de sepse pulmonar, medir a associação entre sepse pulmonar e pneumonia, assim como avaliar o impacto da regra de codificação no perfil de mortalidade, com a inclusão simulada do diagnóstico de pneumonia, nas declarações de óbito (DO) com menção de sepse pulmonar, no Rio de Janeiro, em 2011. Métodos: Foram identificados os óbitos com menção de sepse pulmonar independentemente da causa básica. Aos médicos atestantes, aplicou-se questionário medindo a associação entre sepse pulmonar e pneumonia. O registro de pneumonia nos prontuários dos óbitos com menção de sepse pulmonar e sem menção de pneumonia na DO foi investigado. Foi descrito o perfil de mortalidade após a inclusão simulada do código de pneumonia nas declarações com sepse pulmonar. Resultados: Sepse pulmonar correspondeu a 30,9% das menções de sepse e a menção de pneumonia estava ausente em 51,3% dessas declarações. Pneumonia constava em 82,8% da amostra de prontuários investigados. Dos médicos entrevistados, 93,3% relataram pneumonia como a mais frequente causa de sepse pulmonar. A simulação revelou que a inclusão da pneumonia alterou a causa básica de 7,8% dos óbitos com menção de sepse e 2,4% de todos os óbitos, independentemente da causa original. Conclusão: Sepse pulmonar está associada à pneumonia e a simples inclusão do código de pneumonia nas declarações de óbito com menção de sepse pulmonar impactaria o perfil de mortalidade, apontando necessidade de aprimoramento das regras de codificação na Classificação Internacional de Doenças (CID-10).

Worldwide, an estimated 415 million people have diabetes mellitus, which results in extensive morbidity and mortality. In order to track the effect of diabetes on mortality statistics, deaths in which diabetes mellitus caused or contributed to death must be recognized, included on the death certificate, and then properly coded for vital statistic purposes. For public health policy, this will help determine the extent of the disease and follow whether deaths increase or decrease. There is variation among death certifiers for when and how diabetes is included on the death certificate and among vital records bureaus as how to code diabetes-related deaths. Case scenarios are presented to highlight the certification issues that arise with deaths related to diabetes mellitus. This area of death certification may benefit from a consensus effort to standardize and enhance certification and coding of deaths due to diabetes in order to improve the reliability of these mortality statistics.

The authors review data sources related to death arising from myocardial infarction, as well as the major elements of the Hungarian data collection of the Central Statistical Office, the National Health Insurance Fund and the National Registry of Myocardial Infarction. They also discuss conclusions which can be drawn from the data. It was found that the financial database – in accordance with its purpose – is suitable for monitoring the costs arising during the treatment of patient, but the quality and efficiency of treatment cannot be judged on the basis of this database. The Central Statistical Office compiles mortality data on the basis of international conventions, the basis of which is the autopsy report. However, the validity of statistical data depends on the correct completion of this report. Therefore. it is not possible to judge treatment of patients with myocardial infarction simply on the basis of mortality statistics. Considering national databases, only patient registries are suitable for monitoring the quality and efficiency of treatment currently. It is recommended that data of the National Registry of Myocardial Infarction should be used when the quality of treatment of patients with myocardial infarction is evaluated. Orv. Hetil., 2016, 157(3), 89–93.

Climate variability and change is a major driver of infectious diseases around the world. This study sought to investigate the role of climate variability on the emergence of malaria in the North West region of Cameroon. Both biophysical and socio-economic data were collected for this study. Biophysical data, mainly secondary, was collected from meteorological stations (rainfall and temperature data) and hospitals (malaria morbidity and mortality statistics) in the study area. Socio-economic data were collected from primary sources, mainly, survey of households and hospitals, using semi-structured questionnaires. A total of 164 questionnaires were distributed amongst medical personnel and the general public (aged 18-70 years). Data obtained were analyzed using descriptive and inferential statistics. Findings revealed that patterns of fluctuation in climate parameters did not have a perfect match with rates of prevalence of malaria. However, some relatively significant correlation was found to exist between certain aspects of climate and rates of prevalence of malaria. It was noted that other drivers are involved in influencing rates of prevalence of malaria besides climate variability and change. Amongst the impacts of malaria prevalence on the population were high rates of morbidity and mortality. The population employed treated mosquito bed nets as the main coping strategy for fighting against malaria. The study recommends that the health sector should incorporate the phenomena of climate variability and change into its policy framework, and more research should be conducted to assess other drivers of malaria prevalence in north western Cameroon.

Brain tumors are fatal diseases that are spread worldwide and affect all types of age groups. Due to its direct impact on Central Nervous System if tumor cells prevail at certain locations in the brain, the overall functionality of the body is disturbed and chances of a person approaching death accelerate. Tumors can be cancerous or non-cancerous but in many cases, the chances of complete recovery are less and as a result death rate has increased all over the world despite recent advancements in technology, equipment and awareness. So the main concern is to detect brain related diseases at early stages so that it does not spread into vital parts of brain and disrupt body functions. Also, more precise and accurate technologies are required to serve as aid in diagnosis, treatment and surgery of brain. Therefore, its high alarming time to monitor mortality statistics and develop faster and accurate methods to curb the situation by simulating tissue deformation and locating cancerous nodes which is a good area of research. A brain tumor is used to design the deformation model. Early stage detection of tumors is difficult from images. Moreover, the accuracy involved is less. Keeping all this into consideration, a machine learning approach has been developed to detect and model tissue deformation with classification of soft and hard tissues so that the tissues having risk of future problem can also be recognized. The machine learning is the approach which learns from the existing patterns and derives new patterns based on their input parameters. This approach can be used in real time for modeling of tissue deformation in image guided neurosurgery. The patient's deformation model can be designed and brain tumor patterns are given as input on the basis of which tumor in the brain is marked.

Aim Modern EMS provides a range of response options including management by: telephone, management and discharge or referral at scene or transport to hospital. We used linked data of ambulance records, hospital records and national mortality statistics for all calls to one ambulance service in England in a 6 month period to assess the costs associated with each response option. Method We calculated costs for each type of EMS response using the linked data and NHS Reference Costs. We then used two risk adjusted indicators measuring: rates of telephone or at scene management attending ED or admitted to hospital within 3 days and rates of patients taken to hospital and discharged from ED without treatment to identify matched cases of correct and incorrect response decisions to compare costs of each decision type. Results 1 82 566 cases were included with 5.6% managed by telephone (mean cost £125), 28% discharged at scene (mean cost £415) and 66.4% transported to hospital (mean cost £1745). Mean cost of an incorrect transport decision was an additional £313 and an incorrect non-transport decision £237 per case. Conclusion The main reason for differences in response types is inpatient costs for admitted patients. Improvement in decision making about whether or not to take people to hospital could potentially result in substantial savings in urgent care system costs. Conflict of interest None Funding NIHR Programme Grants for Applied Research.

For our master thesis in medicine, we aimed to determine how many deaths were caused by and with dementia in 2014 and we compared our results with figures from abroad. The mortality rates of 2014 in Flanders were used to determine the amount of deaths related to dementia. These figures are collected by Vlaams Agentschap Zorg & Gezondheid (VAZG) and coded per ICD-10 classification. Of all deaths in Flanders in 2014, 6.60% were caused by dementia and 4.29% were caused by another condition, while also suffering from dementia. Data from abroad are ambiguous. While working on our thesis about "death & dementia", we questioned the reliability of mortality statistics. Possible explanations could be; the complexity of completing death certificates correctly and the challenges involved in properly constructing a chain of causes of death. The accuracy of mortality data can be improved by training and redrafting death certificates. ispartof: ARCHIVES OF PUBLIC HEALTH vol:76 issue:1 ispartof: location:England status: published

Statistical information such as death risk estimates is frequently used for illustrating the magnitude of a problem. Such mortality statistics are however easier to evaluate if presented next to an earlier estimate, as the two data points together will illustrate an upward or downward change. How are people influenced by such changes? In seven experiments, participants read mortality statistics (e.g., number of yearly deaths or expert-estimated death risks) made at two points of time about various cancer types. Each cancer type was manipulated to have either a downward trajectory (e.g., the estimated death risk was 37% in 2012, and was adjusted downward to 22% in 2014), an upward trajectory (e.g., 7% -amp;gt; 22%), or a flat trajectory (e.g., 22% -amp;gt; 22%). For each cancer type, participants estimated future mortality statistics and rated the perceived severity. They also allocated real money between projects aimed at preventing the different cancer types. Participants responses indicated that they thought that a trend made out of two data points would continue in the future. People also perceived cancer types with similar present mortality statistics as more severe and allocated more money to them when they had an upward trajectory compared to a flat or downward trajectory. Although there are boundary conditions, we conclude that peoples severity ratings and helping behavior can be influenced by trend information even when such information is based on only two data points. Funding Agencies|Vetenskapsradet [2017-01827]; Riksbankens Jubileumsfond [P14-0978:1]

Aims and methods: Being easily available and having good coverage and comparability, official mortality statistics are used very widely. This in turn is because the definitions of mortality and methods of pertinent data collection are coordinated worldwide by the World Health Organization. In Estonia, registered cerebrovascular mortality has dropped 50% since 2000. A less dramatic decrease has been observed in nearly all EU Member States. To find out if this development can be explained by changing certification and coding practices, we counted all mentions of cerebrovascular diseases in the Estonian Causes of Death Registry database between 2004 and 2013 and analyzed the selection of the underlying cause of death. Results: We found that the sharp decrease in registered cerebrovascular mortality was by a half due to an increased selection of hypertension as the underlying cause of death. In cases where a cerebrovascular disease was mentioned and selected the underlying cause of death, the mean number of diagnoses per record was 2.45, in cases where a cerebrovascular disease was mentioned, but hypertension selected the underlying cause of death, the mean number of diagnoses was 3.15. Conclusions: The choice of the underlying cause of death registered in official statistics depends on the level of details provided in a death certificate, as well as updates to coding rules and use of modern quality assurance instruments in data production.

Background An accurate estimate of TB mortality is required to monitor progress towards the end TB goal of reducing deaths by 95% by 2035. In England and Wales (E and W), treatment outcome, including death from all causes, is reported for TB cases notified to the Enhanced Tuberculosis Surveillance system (ETS). The UK Office for National Statistics (ONS) compiles TB mortality statistics from death certificates. We compared data collected in ETS and ONS to inform how best to estimate TB mortality. Methods TB cases notified in ETS were probabilistically matched to ONS deaths (DONS) between 2005 and 2015 which had ICD-10 codes indicating TB caused or contributed to the death. Deaths reported in ETS (DETS) were identified in DONS to assess if ONS captured all TB deaths. DONS were identified in ETS data to determine if all people dying with TB were notified. Data from ETS and death certificates enabled stratification of deaths into: active TB, TB sequelae and not TB. Risk factors for deaths recorded in only one system were identified with multivariable analysis. Results In E and W, the number and proportion of DETS (2005: 470 (6.0%), 2014: 364 (5.5%)) was lower than the number of DONS (2005: 654, 2014: 587). 57% of deaths from all causes reported as DETS were recorded as DONS. 53% of DONS were notified as DETS. In total 9289 deaths were identified in one or both systems: 64% were active TB, 23% TB sequelae, 7% were not TB and in 6% TB was incidental. DETS not recorded in ONS were more likely to be culture and smear negative and diagnosed post-mortem. DONS not notified to ETS were more likely to be female, over 65 years old and born in the UK. Conclusions Data on TB deaths captured in ETS and ONS differ significantly, suggesting neither system captures all TB deaths. Almost one third of TB deaths recorded by ONS are not active TB, and coding changes in ONS could resolve much of this. Further work, including an audit to determine whether there is under notification of TB or incorrect completion of death certificates or both is needed.

Introduction Respiratory disease consistently ranks among the most fatal disease processes globally. Previous reports from Global Burden of Disease have identified higher burden of respiratory disease in the UK compared to similar health systems. Methods We compared UK to EU15 +countries (i.e., Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, and Sweden, Australia, Canada, United States, and Norway) because of similar or higher health expenditure in these countries. We obtained respiratory-related, sex-specific mortality data from countries of interest from the WHO World Mortality database between 1985 and 2013 and covariate data from the World Bank’s Development Indicators DataBank. Age-standardised death rates (ASDR) were computed using the WHO World standard population. We used Joinpoint regression analysis to test changes in trends for respiratory disease. We used Poisson regression to test the difference between UK and EU15 +countries after controlling for smoking and pollution factors. Results In the UK, there was a significant decreasing trend in respiratory-related mortality between 1985 and 1991 with an estimated annual percentage change (EAPC) of −0.89 and −1.70, for men and women respectively. Between 1994 and 2013, there was a steady decline in ASDR with EAPC −2.06 and −0.85, for men and women, respectively. For EU15 +men, there was a decreasing trend in ASDR between until 1999 with EAPC −0.81 and from 1999 onwards the EAPC was −2.14. For EU15 +women, there was an increasing trend in ASDR until 2002 with EAPC of +1.48 which was followed by overall decreasing trend with EAPC −0.44 until 2013. After multivariable adjustment for pollution exposure and smoking prevalence in each country there was a persistent significant difference in ASDR with approximately 20% higher mortality in UK compared to EU15+ (p=0.009). Conclusion There was significantly greater mortality from respiratory-related illnesses in UK compared to EU15 +over the period from 1985 to 2013 after controlling for smoking and pollution exposure. System-level and population-level factors may contribute to this difference and additional investigations are necessary to further explain these differences. Reference Murrayet al. Lancet 2013;997.

Purpose– The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.Design/methodology/approach– The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays’ root causes in the entire emergency care system were investigated. Event time-lines that disrupted patient flow and patient mortality statistics were compared.Findings– Data showed that patient mortality increases at times when accident and emergency (A&E) department staff were struggling to admit patients. Four delays influenced mortality: first, volume increase and mixed admissions; second, process delays; third, unplanned hospital capacity adjustments and finally, long-term capacity restructuring downstream.Research limitations/implications– This is an observational study that uses process control data to find times when mortality increases coincide with other events. It captures contextual background to whole system issues that affect patient mortality.Practical implications– Managers must consider cost-decisions and flow in the whole system. Localised, cost-focused decisions can have a detrimental effect on patient care. Attention must also be paid to mortality reports as existing data-presentation methods do not allow correlation analysis.Originality/value– Previous studies correlate A&E overcrowding and mortality. This method allows the whole system to be studied and increased mortality root causes to be understood.

Since the initial publication of a landmark Newsday article [(1)][1] on mortality statistics for coronary artery bypass graft surgery (CABG) by surgeon and by hospital in New York State, public reporting of outcomes data for CABG and for percutaneous coronary intervention (PCI) has been adopted by

Whilst global asthma mortality seems to be decreasing, childhood asthma incidence is rising, and early warnings from Australia show an increase in asthma-related deaths in under-15s; this article considers whether we should view the future impact of asthma with trepidation. Age-adjusted mortality statistics for asthma have been reevaluated to provide an international standard. Comparisons across regions and time are complex, yet over the last two decades asthma mortality has clearly decreased, coinciding with a significant change in asthma management. The majority of remaining asthma deaths are preventable. Nonetheless, ongoing vigilance is required. Asthma remains under-diagnosed and under-treated. Childhood asthma has become more common; it is a matter of debate whether it is also more severe. Rather than being encouraged by the fall in numbers of asthma deaths, we should focus on the surging numbers of children suffering from the disease - and the worrying increase in asthma death rates in Australian children - and work to avert future issues.

O estudo das causas múltiplas de óbitos permite conhecer a extensão real das estatísticas de mortalidade. O objetivo desta pesquisa foi avaliar a tendência das taxas de mortalidade relacionada à asma, no Município do Rio de Janeiro, Brasil, no período de 2000-2009, com dados obtidos no Sistema de Informações de Mortalidade (SIM), de indivíduos com um ano ou mais de idade, em que a asma foi mencionada em qualquer linha ou parte do atestado médico da declaração de óbito. Para análise de dados foi utilizada a técnica de regressão linear. A série histórica mostrou tendência ao declínio nas taxas de mortalidade padronizadas relacionada à asma como causa básica e múltipla, com redução entre os homens e estabilidade entre as mulheres. Quando a asma foi a causa básica, as causas associadas mais frequentes foram doenças do aparelho respiratório. A mortalidade relacionada à asma foi subestimada quando considerada apenas como causa básica, o que poderia ser evitado com a utilização da metodologia de causas múltiplas nas estatísticas de mortalidade por asma.

In compiling official mortality statistics, rules for selecting the underlying cause of death have changed twice in the last 20 years in England. Mortality statistics for most types of cancer were not greatly affected, but there were significant effects on coding for cancers of colon, liver, breast, prostate, testis and bladder, and for lymphoma and leukaemia.

Craniopharyngioma is histologically benign and associated with high survival rates but poor quality of life. The SEER Program is among the most cited data sources regarding malignancies in the United States. SEER began collecting data regarding craniopharyngiomain 2004. SEER-STAT v7.0.5 was utilized to identify patients (January 1, 2004–December 31, 2008) with ICD-O-3 codes for craniopharyngioma. Age was categorized into 3 groups: ≤19, 20–34, and ≥35 years, as was surgical intervention: none, subtotal resection, and gross total/radical resection. Demographic, initial treatment, and follow-up data were collected. 635/662 (95.9 %) patients had complete data. Incidence per million patient-years by age group was 1.9, 1.1, and 1.9, respectively (p

Death certificates are the source for mortality statistics and are used to set public health goals. Accurate death certificates are vital in tracking outcomes of cancer. Deaths may be certified by physicians or other medical professionals, coroners, or medical examiners. Idaho is one of 3 states that participated in a Centers for Disease Control and Prevention-funded study to assess the concordance between cancer-specific causes of death and primary cancer site among linked cancer registry/death certificate data. We investigated variability in the accuracy of cancer death certificates by characteristics of death certifiers, including certifier type (physician vs coroner), physician specialty, years of experience as death certifier, and number of deaths certified. This study showed significant differences by certifier type/physician specialty in the accuracy of cancer mortality measured by death certificates. Nonphysician coroners had lower accuracy rates compared with physicians. Although nonphysician coroners certified less than 5% of cancer deaths in Idaho, they were significantly less likely to match the primary site from the cancer registry. Results from this study may be useful in the future training of death certifiers to improve the accuracy of death certificates and cancer mortality statistics.

Mortality statistics represent important endpoints in epidemiological studies. The diagnostic validity of cerebral stroke and ischemic heart disease recorded as the underlying cause of death in Norwegian mortality statistics was assessed by using mortality data of participants in the Bergen Clinical Blood Pressure Study in Norway and autopsy records from the Gade Institute in Bergen. In the 41 years of the study (1965-2005) 4,387 subjects had died and 1,140 (26%) had undergone a post mortem examination; 548 (12%) died from cerebral stroke and 1,120 (24%) from ischemic heart disease according to the mortality statistics, compared to 113 (10%) strokes and 323 (28%) coronary events registered in the autopsy records. The sensitivity and positive predictive value of fatal cerebral strokes in the mortality statistics were 0.75, 95% confidence interval (CI) [0.66, 0.83] and 0.86 [0.77, 0.92], respectively, whereas those of coronary deaths were 0.87 [0.84, 0.91] and 0.85 [0.81, 0.89] respectively. Cohen's Kappa coefficients were 0.78 [0.72, 0.84] for stroke and 0.80 [0.76, 0.84] for coronary deaths. In addition to female gender and increasing age at death, cerebral stroke was a negative predictor of an autopsy being carried out (odds ratio (OR) 0.69, 95% CI [0.54, 0.87]), whereas death from coronary heart disease was not (OR 1.14, 95% CI [0.97, 1,33]), both adjusted for gender and age at death. There was substantial agreement between mortality statistics and autopsy findings for both fatal strokes and coronary deaths. Selection for post mortem examinations was associated with age, gender and cause of death.

Cancer is characterized by disturbed homeostasis of self-renewing cell populations, and their ability to seed and grow in multiple microenvironments. This overarching cellular property of metastatic cancer emerges from the contentious cancer stem cell hypothesis that underpins the more generic hallmarks of cancer (Hanahan and Weinberg, 2000) and its subsequent add-ons. An additional characteristic, metabolic flexibility, is related to concepts developed by Warburg and to subsequent work by mid 20th century biochemists who elucidated the bioenergetic workings of mitochondria. Metabolic flexibility may circumvent limitations inherent in the increasingly popular but erroneous view that aerobic glycolysis is a universal property of cancer cells. Cancer research in the second half of the 20th century was largely the domain of geneticists and molecular biologists using reductionist approaches. Integrated approaches that address cancer cell hierarchy and complexity, and how cancer cells adapt their metabolism according to their changing environment are now beginning to emerge, and these approaches promise to address the poor mortality statistics of metastatic cancer.

Background Despite the well-recognised benefit for individuals and communities of increased active travel, cycling remains a minority travel mode in many high income countries. Fear of injury is often cited as a reason. Campaigns to promote cycle helmet wear may contribute to this. However, there is little information on the importance of head injuries to cyclists and other road users as a cause of death for road travel fatalities. Methods Using national mortality statistics, we identified fatalities in England 2007–2012 among: pedestrians who were walking for travel (whether they were hit by a vehicle or fell); cyclists who were travelling; and drivers of cars or vans. We examined 'secondary causes' of death for those road travel fatalities, comparing travel modes and grouped causes of death (from national mortality statistics) as numbers and as rates. For rates, we used as denominators distance travelled and time spent travelling by mode, age, and sex from National Travel Surveys for the same six years. Results Head injury was the secondary cause of death for 269 cyclists, 1324 pedestrians and 1046 drivers, accounting for 46%, 42% and 25% of road travel deaths at all ages in each mode respectively. Head injury was the commonest cause of death in cyclists, but most pedestrian and driver deaths were from multiple injuries. Rates of fatal head injury per bnkm in males aged 17+ for cycling, walking, and driving were 11.2 (95% CI 9.7–12.9), 23.4 (21.8–25.0) and 0.7 (0.6–0.7) respectively. Female fatality rates were 8.8 (6.2–12.0), 9.6 (8.7–10.7) and 0.4 (0.3–0.4) per bnkm respectively. Using time as the denominator, rates were 0.16 (0.14–0.19),0.10 (0.10–0.11) and 0.03 (0.028–0.032) respectively in men and 0.10 (0.07–0.14), 0.04 (0.037–0.045), and 0.01 (0.012–0.016) respectively in women, per million hours travelled. Conclusions Head injuries in cyclists are often considered to be an important cause of road travel death, but this depends on the metric used for assessing importance. Pedestrians and drivers account for five and four times the number of fatal head injuries as cyclists. No-one is calling for pedestrians to wear helmets although the fatal head injury rates are similar for cyclists and pedestrians. The rate is higher for cyclists than pedestrians by time travelled and is higher for pedestrians than cyclists using distance travelled.

This article reports on social inequalities in female mortality by region and cause of death for women aged 25-59 years in England and Wales in the period 2001-03. It is the first official compilation of detailed mortality statistics for women based on the National Statistics Socio-economic Classification (NS-SEC). It is part of a series of articles measuring inequalities in adult mortality. The results demonstrate a strong socio-economic effect on the mortality of women in all regions. This pattern remained consistent between regions. There were marked differences in the socio-economic gradient by cause. Mortality rates for women in the least and most advantaged NS-SEC classes were similar for breast cancer. In contrast, compared to women in the most advantaged class, mortality rates were three times as high for the least advantaged women for lung cancer and cerebrovascular disease, around five times as high for ischaemic heart disease and all digestive diseases, and six times as high for respiratory diseases.

Objective Mortality statistics are important for epidemiological research. We examine if discrepancies between death certificate (DC) and hospital discharge condition (HDC) indicate certification errors. Study Design and Setting From 39,872 hospital deaths in Sweden in 1995, we randomly selected 600 “cases,” where DC and HDC were incompatible, and 600 compatible “controls,” matched on sex, age, and underlying cause of death. We obtained case summaries for 1,094 (91%) of these. Using a structured protocol, we assessed the accuracy of DCs. Results Regression analysis indicated diagnostic group and “case” or “control” as the variables that most affected the accuracy. Malignant neoplasm “controls” had the highest accuracy (92%), and benign and unspecified tumor “cases,” the lowest (20%). For all diagnostic groups except one, compatible “controls” had better accuracy than incompatible “cases.” The exception, chronic obstructive lung disease, had low accuracy for both “cases” (54%) and “controls” (52%). Conclusion Incompatibility between DC and HDC indicates a greater risk of certification errors. For some diagnostic groups, however, DCs are often inaccurate even when DC and HDC are compatible. By requesting additional information on incompatible cases and all deaths in high-risk diagnostic groups, producers of mortality statistics could improve the accuracy of the statistics.

Objective The purpose of this study is to determine whether the statistics from three published reports on Parkinson's disease (PD) are mutually interrelated and to clarify the relationship between the prevalence statistics and mortality statistics of PD. These statistics included data on "number of patients with PD (PD Patients)", "number of patients with PD receiving financial aid for treatment (PD Recipients)" as an indicator showing the prevalence of PD, and "number of deaths from PD (PD Deaths, i.e., mortality)". Methods The data on PD Patients, PD Recipients and PD Deaths were cited from "Patient Survey" by Ministry of Health, Labour and Welfare, a report by the Research Committee on Epidemiology of Intractable Diseases and "Vital Statistics of Japan" by Ministry of Health, Labour and Welfare, respectively. The expected PD Patients, PD Recipients and PD Deaths were calculated as products of their respective rates for the entire country and prefecture population, adjusting for a difference in population composition. Observed/expected number ratios (O/E ratio) of PD Patients, PD Recipients and PD Patients were calculated by prefecture. The correlation between the O/E ratios was examined. In addition, the relationships of the O/E ratios with the number of hospitals or physicians per person were examined. Results There were no significant correlations between the O/E ratios of PD Patients, PD Recipients or PD Deaths. The O/E ratio of PD Recipients significantly correlated with the numbers of hospitals and physicians per person. Conclusion PD Patients and PD Recipients were included in number of people with PD and PD Deaths was derived from people with PD. However, these statistics do not necessarily reflect the prevalence of PD in each prefecture. When using these published statistics as an indicator of the prevalence of PD, it is necessary to clarify the purpose of their use and to comprehend their characteristics.

Este artículo tiene como objetivo comparar la mortalidad atribuible al sobrepeso y la obesidaden personas mayores de 20 años de Argentina, según sexo y grupo de edad, entre los años2005 y 2009. Para este propósito se utilizaron fuentes de datos secundarias: la EncuestaNacional de Factores de Riesgo (ENFR) de 2005 y 2009 y estadísticas vitales. Para la estimaciónde la mortalidad atribuible al sobrepeso y la obesidad se empleó el método dependiente dela prevalencia, basado en el cálculo de la Fracción Atribuible Poblacional (FAP), mientras quepara determinar el impacto en la esperanza de vida se calcularon los Años de Esperanza deVida Perdidos (AEVP). Los principales resultados indican que, en 2005, el 5,2% de las muertesde varones y el 6,1% de las de mujeres se debieron al exceso de peso; en 2009 disminuyeronal 4,9% y al 5,5%, respectivamente. En 2009 se produjo además un descenso de las muertespor enfermedades cardiovasculares y diabetes en ambos sexos, al tiempo que aumentaron lasneoplasias. Los AEVP atribuibles al exceso de peso fueron de 0,33 años en 2005 y 0,30 años en2009 en el caso de las mujeres, y de 0,45 años en 2005 y 0,43 años en 2009 en el de los varones.Además, se observó un aumento de los AEVP en las edades más jóvenes. Contrariamente a lahipótesis planteada, no se encontró un aumento de la mortalidad atribuible al sobrepeso y laobesidad en el período analizado, aunque se incrementó la mortalidad por esta causa en losmás jóvenes. Este artigo objetiva comparar a mortalidade atribuível ao sobrepeso e à obesidade na Argentina entre 2005 e 2009, em pessoas com mais de 20 anos, segundo sexo e grupo de idade. Foram utilizadas fontes de dados secundários: Pesquisa Nacional de Fatores de Risco (PNFR 2005 e 2009) e estatísticas vitais. Para a estimação da mortalidade atribuível ao sobrepeso e à obesidade, empregou-se o método dependente da prevalência, fundamentado no cálculo da fração atribuível populacional (FAP). Para determinar o impacto na esperança de vida, foram calculados os anos de esperança de vida perdidos (AEVP). Os principais resultados indicam que, em 2005, 5,2% das mortes em homens e 6,1% das mortes em mulheres foram atribuíveis ao excesso de peso. Em 2009, em ambos os sexos observa-se um descenso das mortes por enfermidades cardiovasculares e diabetes, ao mesmo tempo que aumentaram as neoplasias. Os AEVP atribuíveis ao excesso de peso, para as mulheres, foram de 0,33 ano em 2005 e 0,30 ano em 2009 e, para os homens, de 0,45 e 0,43 ano em 2005 e 2009, respectivamente. Por faixa etária, verifica-se um aumento dos AEVP em idades mais jovens. Ao contrário da hipótese formulada, não se constata aumento da mortalidade atribuível ao sobrepeso e à obesidade no período analisado, mas a mortalidade por esta causa incrementa-se entre os jovens. The aim of this paper is to compare mortality attributable to overweight and obesity in Argentina between the years 2005 and 2009, in adults ages 20 and older, by sex and age group. Secondary data were used: The last National Risk Factors Survey (NRFS) of 2005 and 2009, and mortality statistics. Mortality attributable to overweight and obesity was estimated using the prevalence dependent method, based on the calculation of the population attributable fraction (PAF). To determine the impact on life expectancy, years of life expectancy lost (YLEL) were calculated. The main results indicate that in 2005, 5.2% of deaths among men and 6.1% of deaths among women were attributable to overweight and obesity; in 2009, it decreased to 4.9% and 5.5%, respectively. In 2009, for both sexes, there was a decline in deaths due to cardiovascular diseases and diabetes, while deaths from cancer have increased. YLEL attributable to weight excess were 0.33 years in 2005 and 0.30 years in 2009 for women; and 0.45 years in 2005 and 0.43 years in 2009 for men. By age group, an increase of YLEL attributable to overweight and obesity was found. In contrast to the initial hypothesis, it was not observed an increase in mortality attributable to overweight and obesity between 2005 and 2009 in Argentina, but an increase at among the youth was noted. Fil: Acosta, Laura Débora. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; Argentina Fil: Pelaez, Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; Argentina

There are two sets of annual mortality statistics released by the Central Statistics Office (CSO) in Ireland, one based on deaths registered in the particular year and the other based on the deaths that occurred in that year. We compared the registration and occurrence figures for suicide and for other deaths by an external cause for the years 1987-2003. The occurrence figures were, on average, 6% higher than the registration figures. There was evidence that the extent of the discrepancy increased over the study period, reaching almost 20% in recent years. The findings suggest that caution needs to be taken in the media reporting of registration figures for suicide and other external causes of death in Ireland and in the interpretation of these figures by health professionals.

Available maternal mortality statistics do not allow valid international comparisons. Our objective was to uniformly measure underreporting of mortality from pregnancy in official statistics from selected regions within the U.S. and Europe, and to provide comparable revised profiles of pregnancy-related mortality.We developed a standardized enhanced method to uniformly identify and classify pregnancy-associated deaths from 2 U.S. states, Massachusetts and North Carolina, and 2 European countries, Finland and France, for the years 1999-2000. Identification method included the use of all data available from the death certificate as well as computerized linkage of births and deaths registers. All cases were reviewed and classified by an international panel of experts.Four-hundred-and-four pregnancy-associated deaths were identified and reviewed. Underestimation of mortality causally related to pregnancy based on International Classification of Diseases cause-of-death codes alone varied from 22% in France to 93% in Massachusetts. Underreporting was greater in the regions with lower initial maternal mortality ratios. The distribution of causes of pregnancy-related mortality was specific to each region. The leading causes of death were cardiovascular conditions in Massachusetts; hemorrhage, pregnancy-induced hypertension, and peripartum cardiomyopathy in North Carolina; noncardiovascular medical conditions in Finland; and hemorrhage in France.This study shows the limitations of maternal mortality statistics based on International Classification of Diseases cause-of-death codes alone. Linkage of births and deaths registers should routinely be used in the ascertainment of pregnancy-related deaths. In addition, extension of the definition of a maternal death should be considered. Beyond pregnancy-related mortality ratios, considering the specific distribution of causes-of-death is important to define prevention strategies.

Acta Obstet Gynecol Scand 2002; 81: 323-327. © Acta Obstet Gynecol Scand 2002 Background. Under-reporting and misclassification of maternal deaths are common, even in countries with a high quality of death statistics. The aims of this study were to determine to what extent maternal deaths are under-reported in Austria and to determine factors that might explain under-reporting. Methods. Confidential enquiries on maternal deaths for the period 1980-98 were linked with the official mortality statistics from Statistics Austria. Maternal deaths were classified as direct and indirect obstetric deaths. Results. Between 1980 and 1998 a total of 119 maternal deaths (112 direct and seven indirect obstetric deaths) were registered at Statistics Austria. Confidential inquiries into maternal deaths accumulated 191 maternal deaths (an additional 43 direct obstetric deaths and 29 indirect obstetric deaths). Total under-reporting was 38% (95% CI 31-45). Significantly more indirect obstetrical deaths were under-reported ...

Agricultural workers have significant exposures to a myriad of occupational hazards on the farm. Morbidity and mortality statistics repeatedly illustrate the toll of these hazards on the thousands of farmers nationwide (NSC, 2000). Among the most common occupational diseases among farmers is noise–induced hearing loss (NIHL). Marvel (1992) estimates that approximately 328,000 farmers are exposed to potentially hazardous noise levels, especially tractor noise.

Objective ; Reliable mortality statistics are useful in determining national policies on preventive and interventional medicine. This study reviews, completed medical certificates of cause of death at the Cape Coast Teaching Hospital, in order to determine their accuracy and reliability. Methods : A one-year review of Medical Certificates of Cause of Death (MCCD) signed between 01-01-2013 and 31-12-2013 in the medical, pediatric, surgical and obstetrics/gynecology departments of Cape Coast Teaching Hospital were done, analyzing for errors using the WHO/ICD-10 guidelines as the standard. The errors were grouped into minor and major errors. Results : In all, 337 medical certificates of cause of death were audited. Majority, 212(62.9%) were issued in the internal medicine and therapeutics department. 30.86% (104) MCCDs were completed by specialists while 69.14% (233) were completed by non-specialist medical officers. Over half (56.68%) of the MCCDs had major errors while all (100%) had at least one minor error. Conclusion : Our study showed significant errors in MCCD records, with the errors more likely in certificates issued by non-specialist medical officers. All the certificates audited had at least one minor error. Training of doctors on proper completion of MCCDs is strongly advocated. Funding : None of the authors received any financial support for this study. Keywords : Errors, Medical Certificate of Cause of Death, Ghana

Background: Annually, about 400 cases of sudden unexpected death are attributed to cancer in Tokyo, Japan. These individuals may have been undiagnosed, or their medical conditions may not have been carefully evaluated before death. We examined medical consultations, cancer diagnoses, and economic status of all cancer deaths investigated by medical examiners in 2009. Methods: Among cases handled by the Tokyo Medical Examiner’ sO ffice in 2009 (N = 12493), records for all cases of cancer death (n = 400) were reviewed to determine the extent of medical care provided, diagnosis before death, and economic status of the decedent. Results: Most of the decedents (n = 232; 58%) had received a diagnosis of terminal/advanced cancer during a medical consultation. Most did not receive such medical consultations at home, despite their very weak physical condition. However, nearly one quarter of decedents (24%; 95/400) had not received a cancer diagnosis before death. The proportions of decedents who had been indigent, received no medical consulting, and had colon cancer were significantly higher among undiagnosed cases than among diagnosed cases. Indigent persons were the largest subgroup (n = 19; 43%) among those who had never received a medical consultation (n = 44). In addition, the proportion of those who had discontinued or received no medical consultation was higher among indigent persons than among non-indigent persons. Conclusions: The quality of medical services for cancer patients could be improved by educating general practitioners about terminal care, expanding efforts to monitor and diagnose cancer, especially among indigent patients, and increasing participation rates for colorectal cancer screening.

Objective: To determine whether the recording of diabetes on death certificates improved from 1986 to 1993. Method: Comparison of two National Mortality Follow-back Surveys that selected independent samples of death certificates with the purpose of obtaining information from informants about the decedents. Results: The recording of diabetes on death certificates did not improve from 1986 to 1993. Conclusion: Periodic monitoring of the accuracy of death certificates is essential for proper interpretation of mortality statistics which are routinely used to describe the burden of diabetes in our society.

Sudden cardiac death is assumed to be the most frequent cause of death in adults in industrialized countries. Definition of sudden cardiac death is not uniform. The differences in definition mainly rely on timing, i. e., duration of preceding symptoms, which only may be present for a few minutes up to several hours before arrest or may be simply known or unknown even to a bystander. Sometimes the term sudden cardiac death is also set equivalent to sudden arrhythmic death. In fact, a large number of problems related to the definition and also to causes and mechanisms which may lead to the clinical diagnosis of sudden cardiac death exist. In a considerable number of patients these uncertainties lead to misdiagnoses and misclassifications which in turm probably have an important impact on death certificates, mortality statistics or interpretation of the results of clinical studies. This review article discusses some of the specific questions and problems which have to be faced when diagnosing sudden cardiac death.

William Tomison, in charge of the Hudson's Bay Company's Cumberland House on the Saskatchewan River, described the devastating smallpox epidemic of 1781 and 1782. He understood contagion, practised isolation and disinfection, and provided mortality statistics during a 'virgin soil' epidemic. Above all, he showed remarkable compassion. He and his men took dying Indians into their already crowded quarters, and provided them with food, shelter and 24 h care. This article describes the epidemic and its aftermath.

We compared the diagnoses obtained from the routine mortality statistics with the standardized World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) classification in suspect coronary heart disease (CHD) deaths registered in the FINMONICA myocardial infarction (MI) register during 1983–1992. All CHD deaths from routine mortality statistics (International Classification of Diseases codes 410–414) were registered in the MI register. Of the CHD deaths in routine mortality statistics 1.7% in men and 4.8% in women did not fulfill the MONICA criteria for CHD death (P

STUDY OBJECTIVE: To validate the Belgian vital statistics for coronary heart disease (CHD) on the basis of an independent acute myocardial infarction (AMI) register, carried out as part of the WHO-MONICA project. DESIGN: Records of fatal cases of AMI in the WHO-MONICA register were individually linked to the corresponding death certificates. SETTING: Since 1983, the WHO-MONICA Collaborating Centre Ghent/Charleroi registers all fatal and non-fatal AMI in the age group 25-69 years in two geographical areas, Ghent in the northern Dutch speaking part and Charleroi in the southern French speaking part of Belgium. Registration is done according to the MONICA protocol. The official vital statistics in Belgium are published on a yearly basis. They are essentially a reflection of the "underlying" causes of death, coded according to the 9th revision of the International Classification of Diseases (ICD). The study was undertaken in the period 1983-1991. MAIN RESULTS: Out of a total of 741 (Ghent) and 934 (Charleroi) well documented MONICA fatal cases of AMI, 492 (66.4%) and 641 (68.6%), respectively, were officially labelled as CHD (ICD code 410-414); 438 (59.1%) and 385 (41.2%), respectively, were officially labelled as AMI (ICD code 410). A substantial fraction of the MONICA AMI cases--27.1% in Ghent and 38.2% in Charleroi--was coded as "other forms of CHD" (ICD 411-414) or as "other forms of heart disease" (ICD 420-429). The remaining MONICA AMI cases--13.8% in Ghent and 20.6% in Charleroi--were classified in either very aspecific (for example, atherosclerosis, ICD 440) or totally unrelated ICD codes (for example, neoplasm, ICD 140- 239). CONCLUSIONS: It is concluded from the results in this paper that a substantial part of all deaths caused by CHD in Belgium are labelled with incorrect ICD codes and are therefore misclassified in the official mortality statistics for Belgium. This is partly caused by a "drainage" of cases towards less specific CHD related ICD categories. A considerable fraction, however, seems to be absolutely misclassified.

Since 1901, the Swiss Federal Office of Statistics has published at least each decade detailed mortality statistics from tuberculosis. These cross-sectional data on deaths from respiratory tuberculosis from 1901 to 1991 were utilized to analyse retrospectively tuberculosis death experience within each birth cohort. The cross-sectional data indicate that tuberculosis mortality increases with age in each successive decade. Nevertheless, the cohort-contour approach indicates that this phenomenon is the result of a much higher mortality that each cohort experienced in their early adulthood, and that mortality form respiratory tuberculosis in Switzerland always preferentially affected the young. The data also indicate that tuberculosis mortality in Switzerland has been decreasing for at least 160 years, and perhaps peaked as early as in the eigh-teenth century.