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Global estimates of sepsis mortality are based on multiple causes of death (MCOD, any mention of the condition on death certificates); however, MCOD data are sparse and mainly referring to the pre-pandemic period. To investigate recent trends in sepsis-related mortality, associated sites of infection, and comorbidities in Veneto (Northeastern Italy). Mortality records from 2008 to 2022 were extracted, and sepsis-related mortality was assessed based both on the underlying cause of death (UCOD) and on MCOD. The average annual percent change in age-standardised rates was estimated by join point regression through the whole study period. MCOD records were investigated to retrieve infection sites and comorbidities. Sepsis was mentioned in 63,479 death certificates, growing from 4.9% out of all deaths in 2008 to 12.9% in 2022. Age-standardised mortality rates increased yearly by 8.2% (95%CI 2.1–14.7%) based on the UCOD and by 5.9% (95%CI 5.3–6.5%) based on MCOD. Sharp peaks in monthly mortality were observed in correspondence with flu epidemics, COVID-19 pandemic waves, and periods of extreme heat. The percentage of sepsis-related deaths associated to urinary tract infections, and with mention of neurodegenerative disorders and chronic kidney disease increased over time. Raised awareness of physicians, ageing of the population, spread of antimicrobial resistance further fuelled by the COVID-19 pandemic are among reasons of increasing sepsis-related mortality in Italy. Continuous monitoring of sepsis by means of MCOD data and other surveillance tools is warranted. [ABSTRACT FROM AUTHOR]

Abstract Context Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Using the multiple causes of death method could help understand the magnitude of these relationships and enable better targeting of investments in health. Objectives To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region. Methods Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the causes of death associated with IHD when IHD was defined as the underlying cause of death (UC) and the causes of death listed as the UC when IHD was recorded in any other lines of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these causes of death and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs. Results When IHD was listed as the UC of death, the most frequent associated causes of death were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent cause of death in women were DM as the UC and associated cause of death, AH as the UC, and CIHD and Alzheimer's disease as associated causes of death, while the most frequent causes of death in men were substance dependence as the UC and associated cause of death, and cancer as an associated cause of death. The most frequent causes of death were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South. Conclusions Several diseases – including AMI, AH, CIHD, HF, and DM – were the most frequent associated causes of death when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated cause of death. The degree of these associations varied between sexes and geographic regions.

Patients with hematologic malignancies are at increased risk of adverse COVID‐19 outcomes; nonetheless, only sparse population‐based data are available on mortality related to hematologic cancers during the pandemic. Number of deaths and age‐standardized mortality rates for specific hematologic malignancies selected either as the underlying cause of death (UCOD), or mentioned in death certificates (multiple causes of death‐MCOD) were extracted from the US National Center for Health Statistics, CDC WONDER Online Database. Joinpoint analysis was applied to identify changes in mortality trends from 1999 to 2021, and to estimate the annual percent change with 95% Confidence Intervals (CI) across time segments. Among the most common malignancies, chronic lymphocytic leukemia showed marked peaks in the monthly number of deaths attributed to COVID‐19 during epidemic waves; acute myeloid leukemia showed the least variation, and non‐Hodgkin lymphoma and multiple myeloma were characterized by an intermediate pattern. Age‐standardized death rates relying solely on the UCOD did not show significant variations during pandemic years. By contrast, rates based on MCOD increased by 14.0% (CI, 10.2–17.9%) per year for chronic lymphocytic leukemia, by 5.1% (CI, 3.1–7.2%) for non‐Hodgkin lymphoma and by 3.2% (CI, 0.3–6.1%) per year for multiple myeloma. Surveillance of mortality based on MCOD is warranted to accurately measure the impact of the COVID‐19 pandemic and of other epidemics, including seasonal flu, on patients with hematologic malignancies, and to assess the effects of vaccination campaigns and other preventive measures. [ABSTRACT FROM AUTHOR]

Context: Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Using the multiple causes of death method could help understand the magnitude of these relationships and enable better targeting of investments in health. Objectives: To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region. Methods: Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the causes of death associated with IHD when IHD was defined as the underlying cause of death (UC) and the causes of death listed as the UC when IHD was recorded in any other lines of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these causes of death and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs. Results: When IHD was listed as the UC of death, the most frequent associated causes of death were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent cause of death in women were DM as the UC and associated cause of death, AH as the UC, and CIHD and Alzheimer's disease as associated causes of death, while the most frequent causes of death in men were substance dependence as the UC and associated cause of death, and cancer as an associated cause of death. The most frequent causes of death were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South. Conclusions: Several diseases – including AMI, AH, CIHD, HF, and DM – were the most frequent associated causes of death when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated cause of death. The degree of these associations varied between sexes and geographic regions. [ABSTRACT FROM AUTHOR]

We investigate jointly modelling age–year-specific rates of various causes of death in a multinational setting. We apply multi-output Gaussian processes (MOGPs), a spatial machine learning method, to smooth and extrapolate multiple cause-of-death mortality rates across several countries and both genders. To maintain flexibility and scalability, we investigate MOGPs with Kronecker-structured kernels and latent factors. In particular, we develop a custom multi-level MOGP that leverages the gridded structure of mortality tables to efficiently capture heterogeneity and dependence across different factor inputs. Results are illustrated with datasets from the Human Cause-of-Death Database (HCD). We discuss a case study involving cancer variations in three European nations and a US-based study that considers eight top-level causes and includes comparison to all-cause analysis. Our models provide insights into the commonality of cause-specific mortality trends and demonstrate the opportunities for respective data fusion. [ABSTRACT FROM AUTHOR]

This article highlights the need to consider multiple causes of death during the COVID-19 pandemic. While the focus has been on COVID-19, other causes of death, such as cardiovascular diseases, have received less attention. The pandemic has had both direct and indirect effects on non-COVID-19 mortality, including long-term complications, strain on hospital resources, and reduced disease screening. The World Health Organization has provided guidelines for coding COVID-19 deaths on death certificates, prioritizing it as the underlying cause of death. However, this approach may alter mortality trends for other causes and lead to a misleading perception of their severity. Ongoing research is being conducted to evaluate the impact of the pandemic on other causes of death, and the use of multiple causes of death analysis is recommended for a more comprehensive understanding. [Extracted from the article]

Background and Aims: The objective of this study was to assess the impact of the COVID-19 pandemic and direct-acting antiviral (DAA) agents on mortality related to chronic liver diseases (CLD). Methods: Age-standardized mortality rates were computed based on CLD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple causes of death-MCOD). Time trends in age-standardized mortality rates were investigated using generalized estimation equation models. Additionally, we conducted age, period, and birth cohort (APC) analyses on CLD-related mortality associated with alcohol and hepatitis C virus (HCV). Results: Between 2008 and 2021, among residents in the Veneto region (Northeastern Italy) aged ≥35 years, there were 20 409 deaths based on the UCOD and 30 069 deaths based on MCOD from all CLD. We observed a 4% annual decline in age-standardized MCOD-based mortality throughout 2008--2021, with minor peaks corresponding to COVID-19 epidemic waves. Starting in 2016, the decline in HCV-related mortality accelerated further (p < .001). A peak in HCV-related mortality in the 1963--1967 birth cohort was observed, which levelled off by the end of the study period. Mortality related to alcoholic liver disease declined at a slower pace, becoming the most common aetiology mentioned in death certificates. Conclusions: The study demonstrates a significant decrease in HCV-related mortality at the population level in Italy with the introduction of DAAs. Continuous monitoring of MCOD data is warranted to determine if this favourable trend will continue. Further studies utilizing additional health records are needed to clarify the role of other CLD etiologies. [ABSTRACT FROM AUTHOR]

This study focuses on the factors that are associated with recording multiple causes as the cause of death in Czechia. An XGBoost multiple regression is used in the analysis and its results are interpreted with SHAP values. The most significant factors associated with the number of causes of death, ranked in order of importance, are the place of death, the region, and the underlying cause of death. Age and autopsy also contribute, albeit to a lesser extent. Several important interactions were identified as well. [ABSTRACT FROM AUTHOR]

Abstract Background National mortality statistics are based on a single underlying cause of death. This practice does not adequately represent the impact of the range of conditions experienced in an ageing population in which multimorbidity is common. Methods We propose a new method for weighting the percentages of deaths attributed to different causes that takes account of the patterns of associations among underlying and contributing causes of death. It is driven by the data and unlike previously proposed methods does not rely on arbitrary choices of weights which can over-emphasise the contribution of some causes of death. The method is illustrated using Australian mortality data for people aged 60 years or more. Results Compared to the usual method based only on the underlying cause of death the new method attributes higher percentages of deaths to conditions like diabetes and dementia that are frequently mentioned as contributing causes of death, rather than underlying causes, and lower percentages to conditions to which they are closely related such as ischaemic heart disease and cerebrovascular disease. For some causes, notably cancers, which are usually recorded as underlying causes with few if any contributing causes the new method produces similar percentages to the usual method. These different patterns among groups of related conditions are not apparent if arbitrary weights are used. Conclusion The new method could be used by national statistical agencies to produce additional mortality tables to complement the current tables based only on underlying causes of death.

Abstract Background People with dermatomyositis (DM) or polymyositis (PM) often die from cancer, pulmonary, cardiac complications, or infections. In such cases, DM or PM might not be designated as the underlying cause of death (UCD) for mortality tabulation. In this study, we investigated DM/PM mortality trends in the USA from 1981 to 2020 with respect to UCD and multiple causes of death (MCD) data. Methods We used the MCD data to identify all deaths with DM or PM mentioned anywhere on the death certificate and as the UCD in the USA from 1981–1982 to 2019–2020. We calculated age-adjusted mortality rates (AAMRs) and annual percentage changes (APCs) based on joinpoint regression analysis. Results We identified 12,249 (3985 with DM and 7097 with PM) and 23,608 (8264 with DM and 15,344 with PM) people who died between 1981 and 2020 according to the UCD and MCD data, respectively. For DM, the APC was − 6.7% (from 1981–1982 to 1985–1986), − 0.1% (from 1985–1986 to 2003–2004), and − 1.9% (from 2003–2004 to 2019–2020) according UCD and was − 1.2% (from 1981–1982 to 2003–2004), − 2.5% (from 2003–2004 to 2015–2016), and 2.8% (from 2015–2016 to 2019–2020) according MCD. For PM, the APC was 1.9% (from 1981–1982 to 1989–1990), − 2.3% (from 1989–1990 to 2005–2006), and − 5.2% (from 2005–2006 to 2019–2020) according UCD and was 1.3% (from 1981–1982 to 1991–1992) and − 4.1% (from 1991–1992 to 2019–2020) according MCD. Conclusion We identified two times as many DM/PM deaths using the MCD as those identified using the UCD. Similar downward DM/PM mortality trends were noted according to UCD and MCD. However, the year of significant decline in PM mortality was about 10 years earlier according to MCD than those according to UCD.

Introduction: The impact of conditions that partly or indirectly contribute to drinking‐related mortality is usually underestimated. We investigate all alcohol‐related multiple (underlying and contributory) causes of death and compare mortality distributions in countries with different levels and patterns of drinking. Method: Analysis of population‐level mortality data for persons aged 20 and over in Austria, Czechia, Poland and Spain. Age‐standardised death rates and standardised ratios of multiple to underlying cause were calculated for alcohol‐related causes of death. Results: Multiple‐cause mortality ranged from 20 to 58 deaths per 100,000 for men and from 5 to 16 per 100,000 for women. Liver diseases were the most common underlying and multiple causes, but mental and behavioural disorders were the second or third, depending on country and sex, most prevalent multiple mentions. Two distinct age patterns of alcohol‐related mortality were observed: in Czechia and Poland an inverted‐U distribution with a peak at the age of 60–64, in Austria and Spain a distribution increasing with age and then levelling off for older age groups. Discussion and Conclusion: The importance of alcohol‐related conditions that indirectly impact mortality can be re‐assessed with the use of contributory mentions. The multiple‐cause‐of‐death approach provides convergent results for countries characterised by similar patterns of alcohol consumption. Multiple‐cause mortality was almost double the level of mortality with alcohol as the underlying cause, except in Poland. Mental and behavioural disorders were mostly certified as contributory to other, non‐alcohol‐related underlying causes of death. [ABSTRACT FROM AUTHOR]

Background: Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics—reflecting increasing multimorbidity and complex causation patterns—is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes. Methods: We searched Medline, PubMed, Scopus, and Web of Science from their incept ion to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles. Results: Most articles we reviewed (76%, n = 332) were published since 2001. The majority of articles examined mortality by "any– mention" of the cause of death (87%, n = 377) and assessed pairwise combinations of causes (57%, n = 245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n = 9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n = 5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently. Conclusion: This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings. [ABSTRACT FROM AUTHOR]

Background: National mortality statistics are based on a single underlying cause of death. This practice does not adequately represent the impact of the range of conditions experienced in an ageing population in which multimorbidity is common. Methods: We propose a new method for weighting the percentages of deaths attributed to different causes that takes account of the patterns of associations among underlying and contributing causes of death. It is driven by the data and unlike previously proposed methods does not rely on arbitrary choices of weights which can over-emphasise the contribution of some causes of death. The method is illustrated using Australian mortality data for people aged 60 years or more. Results: Compared to the usual method based only on the underlying cause of death the new method attributes higher percentages of deaths to conditions like diabetes and dementia that are frequently mentioned as contributing causes of death, rather than underlying causes, and lower percentages to conditions to which they are closely related such as ischaemic heart disease and cerebrovascular disease. For some causes, notably cancers, which are usually recorded as underlying causes with few if any contributing causes the new method produces similar percentages to the usual method. These different patterns among groups of related conditions are not apparent if arbitrary weights are used. Conclusion: The new method could be used by national statistical agencies to produce additional mortality tables to complement the current tables based only on underlying causes of death. [ABSTRACT FROM AUTHOR]

Background Mortality statistics using a single underlying cause of death (UC) are key health indicators. Rising multimorbidity and chronic disease mean that deaths increasingly involve multiple conditions. However, additional causes reported on death certificates are rarely integrated into mortality indicators, partly due to complexities in data and methods. This study aimed to assess trends and patterns in cause-related mortality in Australia, integrating multiple causes (MC) of death. Methods Deaths (n  = 1 773 399) in Australia (2006–17) were mapped to 136 ICD-10-based groups and MC indicators applied. Age-standardized cause-related rates (deaths/100 000) based on the UC (ASRUC) were compared with rates based on any mention of the cause (ASRAM) using rate ratios (RR = ASRAM/ASRUC) and to rates based on weighting multiple contributing causes (ASRW). Results Deaths involved on average 3.4 causes in 2017; the percentage with >4 causes increased from 20.9 (2006) to 24.4 (2017). Ischaemic heart disease (ASRUC = 73.3, ASRAM = 135.8, ASRW = 63.5), dementia (ASRUC = 51.1, ASRAM = 98.1, ASRW = 52.1) and cerebrovascular diseases (ASRUC = 39.9, ASRAM = 76.7, ASRW = 33.5) ranked as leading causes by all methods. Causes with high RR included hypertension (ASRUC = 2.2, RR = 35.5), atrial fibrillation (ASRUC = 8.0, RR = 6.5) and diabetes (ASRUC = 18.5, RR = 3.5); the corresponding ASRW were 12.5, 12.6 and 24.0, respectively. Renal failure, atrial fibrillation and hypertension ranked among the 10 leading causes by ASRAM and ASRW but not by ASRUC. Practical considerations in working with MC data are discussed. Conclusions Despite the similarities in leading causes under the three methods, with integration of MC several preventable diseases emerged as leading causes. MC analyses offer a richer additional perspective for population health monitoring and policy development. [ABSTRACT FROM AUTHOR]

Cause-of-death diversity captures the variability of deaths across causes and is an important marker of heterogeneity in a population's health. We contribute to the debate of cause-of-death diversity dynamics by following a novel multiple causes of death (MCOD) approach and applying it to the U.S. context between 2003 and 2018 and across education groups. Results show that cause-of-death diversity increased over this period, especially up to 2012. These trends were mainly driven by increases in the groups aged 65 years or more. The inclusion of MCOD resulted in higher increases in cause-of-death diversity over time compared with merely using underlying causes of death, except for the 85 or more age group, where no difference was observed for males and a reverted gradient was observed for females. Results by educational attainment reveal lower diversity among the highest educated groups and widening differences across groups from around 2012 onward. The clear educational gradient observed at ages 30–64 diminished at older ages. The observed increases in cause-of-death diversity should be monitored to better understand mortality dynamics in aging populations. Our new MCOD diversity measures suggest that traditional approaches relying on single causes of death might be underestimating cause-of-death diversity dynamics, particularly for males. [ABSTRACT FROM AUTHOR]

BackgroundOpioids and stimulants (e.g., cocaine or methamphetamine/amphetamine [MAMP]) are major contributors to acute substance toxicity deaths. Causes of stimulant death have received little attention. We sought to characterize and compare causes of death and significant contributing conditions among persons who died from acute opioid, cocaine, or MAMP toxicity.MethodsWe identified all opioid, cocaine, or MAMP deaths in San Francisco from 2005 to 2015 through the California Electronic Death Reporting System. Multivariable logistic regression analyses were used to estimate associations between acute substance toxicity deaths (opioid versus stimulant; cocaine versus MAMP), additional reported causes of death, and significant contributing conditions most often linked to opioid and stimulant use.ResultsFrom 2005-2015, there were 1252 opioid deaths and 749 stimulant deaths. Cocaine accounted for most stimulant deaths. Decedents with cardiac or cerebral hemorrhage deaths had higher adjusted odds of death due to acute stimulant toxicity versus acute opioid toxicity (aOR = 4.79, 95%CI = 2.88-7.96, p

Background: The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. Objective: To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0Š) followed by France (24.1Š) and Spain (17.3Š), and lowest in the United States (14.0Š). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. Conclusions: Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. Contribution: Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population.

Abstract Background The expanded definition of liver-related deaths includes a wide range of etiologies and sequelae. We compared the changes in liver-related mortality by etiology and sequelae for different age groups between 2008 and 2018 in the USA using both underlying and multiple cause of death (UCOD and MCOD) data. Methods We extracted mortality data from the CDC WONDER. Both the absolute (rate difference) and relative (rate ratio and 95% confidence intervals) changes were calculated to quantify the magnitude of change using the expanded definition of liver-related mortality. Result Using the expanded definition including secondary liver cancer and according to UCOD data, we identified 68,037 liver-related deaths among people aged 20 years and above in 2008 (29 per 100,000) and this increased to 90,635 in 2018 (33 per 100,000), a 13% increase from 2008 to 2018. However, according to MCOD data, the number of deaths was 113,219 (48 per 100,000) in 2008 and increased to 161,312 (58 per 100,000) in 2018, indicating a 20% increase. The increase according to MCOD was mainly due to increase in alcoholic liver disease and secondary liver cancer (liver metastasis) for each age group and hepatitis C virus (HCV) and primary liver cancer among decedents aged 65–74 years. Conclusion The direction of mortality change (increasing or decreasing) was similar in UCOD and MCOD data in most etiologies and sequelae, except secondary liver cancer. However, the extent of change differed between UCOD and MCOD data.

The COVID-19 pandemic has significantly impacted many aspects of life, including death care. International and national protocols have been implemented for the management of the dead. This study aims to determine the characteristics of decedents managed according to COVID-19 protocols in Indonesia and the quality of their death certificates. This study uses a descriptive, cross-sectional design. Secondary data of deaths with COVID-19 were taken from hospital death registries, medical records, and death certificates. Data were collected from nine referral hospitals and one funeral home in 6 cities in Indonesia. The majority of the decedents were male, Muslim, with a median age of 57. Most were treated in non-intensive isolation wards, and almost half had known comorbidities. Many were still awaiting the result of their confirmative PCR at the time of death. Almost all were managed compliant with the standard protocol, and most were buried in COVID-only cemeteries. There were still deficiencies in the completeness and accuracy of the death certificates. "COVID-19" was mentioned as a cause of death in only about half of the cases, with a wide variety of terms and spelling. Management of the dead protocols for bodies with COVID-19 can generally be implemented in Indonesia. The quality of the death certificates should, however, be continuously improved. [ABSTRACT FROM AUTHOR]

Purpose: to assess the burden of epilepsy as the underlying or contributory cause of death, to investigate time trends in mortality with epilepsy, and to examine the main associated comorbidities.Methods: All deaths from January 1, 2008 to December 31, 2019 with any mention of epilepsy were retrieved from the mortality register of the Veneto Region (Italy). The average annual percent change (AAPC) in age-standardized mortality rates was estimated by log-linear models. The association between mention of epilepsy and of selected disease categories in death certificates was assessed by conditional logistic regression.Results: Any mention of epilepsy was reported in 5,907 death certificates; of these, epilepsy was selected as the underlying cause in 1,020 decedents. Deaths with epilepsy represented 0.8% of total mortality in 2008-2011, increasing to 1.3% in 2016-2019. The AAPC was 4.7% for males (95% CI 3.0-6.4, p<0.001) and 6.2% for females (95% CI 4.5-7.9, p<0.001). A strong association was found between mention of epilepsy and meningitis/encephalitis, congenital anomalies/cerebral palsy and other paralytic syndromes, central nervous system tumours, cerebrovascular diseases, and dementia/Alzheimer.Conclusions: The present analysis from Southern Europe confirms recent reports limited to the UK and the US on increasing epilepsy-related mortality rates. aging of the population and the growing prevalence of neurological disorders are among long-term causes of this unfavorable trend; further studies on mortality data and other health archives are warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS: The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS: Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS: This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies. [ABSTRACT FROM AUTHOR]

Background: The expanded definition of liver-related deaths includes a wide range of etiologies and sequelae. We compared the changes in liver-related mortality by etiology and sequelae for different age groups between 2008 and 2018 in the USA using both underlying and multiple cause of death (UCOD and MCOD) data. Methods: We extracted mortality data from the CDC WONDER. Both the absolute (rate difference) and relative (rate ratio and 95% confidence intervals) changes were calculated to quantify the magnitude of change using the expanded definition of liver-related mortality. Result: Using the expanded definition including secondary liver cancer and according to UCOD data, we identified 68,037 liver-related deaths among people aged 20 years and above in 2008 (29 per 100,000) and this increased to 90,635 in 2018 (33 per 100,000), a 13% increase from 2008 to 2018. However, according to MCOD data, the number of deaths was 113,219 (48 per 100,000) in 2008 and increased to 161,312 (58 per 100,000) in 2018, indicating a 20% increase. The increase according to MCOD was mainly due to increase in alcoholic liver disease and secondary liver cancer (liver metastasis) for each age group and hepatitis C virus (HCV) and primary liver cancer among decedents aged 65–74 years. Conclusion: The direction of mortality change (increasing or decreasing) was similar in UCOD and MCOD data in most etiologies and sequelae, except secondary liver cancer. However, the extent of change differed between UCOD and MCOD data. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA). Methods A nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15−74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA. Results Among 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8–14.4) and DM (95% CI: 9.5–17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0–9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4–8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8–16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7–18.2). The SMRs were particularly elevated among PWA aged

Musculoskeletal diseases (MSDs) are a topical medical, social, and economic problem. According to the 2015 data, MSDs in the structure of primary morbidity were 3.9% and those in the structure of mortality were 0.2% in the Russian Federation. Official mortality statistics is formed only by one (underlying) cause of death. The study of multiple causes of death will enable the understanding of its mechanisms, the necessity of making changes in the management tactics for patients and in the standards of medical care, as well as the possibility of correcting the mortality reduction plans. Objective: to investigate the reliability of statistics on MSD mortality and the ways of its reduction, by analyzing the underlying and multiple causes of death. Materials and methods. This investigation used a database on medical death certificates of the residents of the Tula Region in 2015. Mortality rates were calculated by conventional statistical methods. Death rates for the Russian Federation and the Tula Region were taken from the book «Medico-demographic indicators of the Russian Federation in 2015» by the Ministry of Health of Russia and C52 tables by the Federal State Statistics Service. The 2012–2014 European mortality databases were used for international comparisons. Results and discussion. The mortality rates were analyzed using the underlying and multiple causes of death. Expert evaluation showed that the 2015 mortality rates from MSDs were underestimated by approximately 11%. The MSD mortality rates in the Tula Region were 2.4 and 2.7 times higher than those in the entire Russian Federation and in Europe, respectively. Defects were found in drawing up medical death certificates. The reliability of mortality statistics was shown to be related to monitoring, physician training, and introduction of an automated system. Emphasis is laid on the correction of treatment tactics for patients with MSD.

Mortality statistics based on underlying cause of death are challenged by increased life expectancy and the growing share of population reaching ages associated with frequent multi-morbidity (with death likely resulting from interactions between multiple diseases). We provide a novel way of analysing causes of death: accounting for all causes mentioned on death certificates and summarizing this information along two dimensions emblematic of ageing populations—multi-morbidity and frailty. We implement this classification for all deaths at ages 50+ in Italy in 2014. Multi-morbid processes represent the majority of deaths, rising from 43 per cent at ages 50–54 to 63 per cent at ages 85–89. Multi-morbidity at death is more frequent among males, although age patterns are identical for both sexes. About one in four deaths involves frailty symptoms, rising to 45 per cent at ages 95+. Mortality rates involving frailty are very similar for both sexes. Supplementary material is available for this article at: [ABSTRACT FROM AUTHOR]

Background: In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35-74 years) in the USA and Australia. Following long-term declines, rates in the USA are now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data-direct individual-level evidence from death certificates-and linking the findings to cohort lifetime obesity prevalence.Methods: We identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006-2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence.Results: Each country's DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts.Conclusions: The increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends. [ABSTRACT FROM AUTHOR]

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Most studies on the mental health effect of greenspace assumed a constant effect of greenspace exposure over the entire study region. We expanded upon literature by hypothesizing spatial disparities in the effect of greenspace exposure on mental illness mortality across census tracts in Oregon (OR) and Washington (WA). Mental illness mortality was calculated using death register data with coordinates of residence over 13 years (2006-2018). Neighborhood park exposure was evaluated as the total area of parks in each census tract. Results indicated that the impact of park areas on mental illness mortality varied across census tracts in OR (Relative Risk=0.985, 95% credible interval=[0.950, 1.020] ‒ 1.030 [0.990, 1.072]) and WA (0.992 [0.952, 1.034] ‒ 1.013 [0.980, 1.048]). These estimates shifted overall fixed effect RRs (OR: 0.976 [0.958, 0.994]; WA: 0.976 [0.956, 0.996]). Protective effects were more likely in areas between Olympia, WA and Portland, OR. The urban-rural contrasts were explained by patients' preference, differential greenspace accessibility, and limited park supply in national and state forests. This research highlights the disparity in greenspace effect on mental illness mortality and calls for integrating local effect variability into mental health outcomes-greenspace studies. • Thirteen years (2006–2018) of mental illness mortality data in Oregon and Washington were analyzed. • Local variations were observed in the association between mental illness mortality and neighborhood park exposure. • Protective impacts were observed in southwestern and northeastern Washington and northwestern Oregon. • The physical features of parks might help explain the locally varying impacts of park exposures on mental illness mortality. [ABSTRACT FROM AUTHOR]

Abstract Background Multiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death. Using MCOD data, this study aimed to fully describe the cause-specific mortality of people with AIDS (PWA) compared to people without AIDS. Methods We conducted a nationwide investigation based on death certificates of 2,515 Italian PWA and 123,224 people without AIDS who had died between 2006 and 2010. The conditions most frequently associated with PWA mortality, compared to people without AIDS, were identified using an age-standardized proportion ratio (ASPR) calculated as the ratio between the age-standardized proportion of a specific cause among PWA and the same proportion among people without AIDS. Results The most frequently reported conditions at death among PWA were infectious/parasitic diseases (52%), digestive (36%), respiratory (33%), and circulatory (32%) system diseases, and neoplasms (29%). All AIDS-defining conditions resulted highly associated (ASPR significantly greater than unity) with PWA deaths. Significant associations also emerged for leishmaniasis (ASPR = 188.0), encephalitis/myelitis/encephalomyelitis (ASPR = 14.3), dementia (ASPR = 13.1), chronic viral hepatitis (ASPR = 13.1), liver fibrosis/cirrhosis (ASPR = 4.4), pneumonia (ASPR = 4.4), anal (ASPR = 12.1) and liver (ASPR = 1.9) cancers, and Hodgkin’s disease (ASPR = 3.1). Conclusions Study findings identified the contribution of several non-AIDS-defining conditions on PWA mortality, emphasizing the need of preventive public health interventions targeting this population.

The true burden of sepsis is largely unknown. Conventional underlying cause of death (UCoD) statistics largely underestimates sepsis-related mortality. This study aims to analyze all the conditions mentioned in the death certificates (multiple causes of death—MCoD) to estimate the nationwide burden of sepsis-related mortality in Italy, to investigate time trends and main comorbidities in sepsis-related deaths. All death certificates mentioning sepsis from 2003 to 2015 were analyzed. Age-standardized mortality rates were calculated for sepsis as both UCoD and MCoD, by gender and broad age groups. The ratio of the age-standardized proportions of any mention of sepsis in the presence/absence of associated chronic diseases (ASPR) was computed. The number of certificates reporting sepsis increased from 18,939 in 2003 to 49,010 in 2015 (from 3 to 8% of all deaths). The increase in sepsis mortality rates was larger for UCoD (males, + 200%; females, + 175%) than for MCoD-based figures (+ 100%; + 90%); MCoD rates remained noticeably higher than UCoD rates (2015, 87.3 per 100,000 vs. 16.3 for males; 54.9 vs. 11.8 for females). The largest increase was observed among the very elderly. The association between sepsis and chronic diseases was stronger for subjects aged less than 75 years. The increased awareness within the medical community in addition to the growing susceptible elderly population and the spread of antimicrobial resistance could have contributed to the sepsis-related mortality increase. MCoD statistics could help in recognizing sepsis not only as a clinical challenge, but also as a major public health issue. [ABSTRACT FROM AUTHOR]

Background: Little is known about the changes in the ranking of leading cause of death (COD) among people died with schizophrenia across years in the United States (U.S.). This study aims to determine the ranking of leading COD among U.S. decedents with mention of schizophrenia by age from 2000 to 2015.Methods: The mortality multiple COD files maintained by the National Center for Health Statistics were used to identify decedents aged 15 years old and above with mention of schizophrenia anywhere on the death certificates to determine the number and proportion of deaths attributed to various underlying CODs.Results: Of 13,289, 13,655, 14,135, and 15,033 people who died in 2000-2003, 2004-2007, 2008-2011and 2012-2015 with mention of schizophrenia, similar to all decedents, heart disease and cancer was the first and the second leading COD throughout the study years. Schizophrenia ranked the third in most years except in 2004-2007. The first leading COD for decedents with mention of schizophrenia aged 15-24, 25-44, 45-64, 65-74, and 75+ years old in 2012-2015 was suicide, accidents, heart disease, heart disease, and Alzheimer's disease and related dementia, respectively. Nevertheless, it was accidents, accidents, cancer, cancer, and heart disease, respectively for all decedents.Conclusion: The ranking of leading CODs among U.S. decedents with mention of schizophrenia changed across years and differed from all decedents by age, which suggest that different interventions should be designed accordingly. [ABSTRACT FROM AUTHOR]

Diseases of the musculoskeletal system (DMSS) are a topical social, medical, and economic problem. They are widespread and account for about 10% of the overall morbidity and primary disability of population, about 5% of primary morbidity, and about 0.1% of mortality. The reliable statistics are important to analyze the situation and make necessary adjustments to the organization of medical care.Objective. To examine the accuracy of the data on morbidity and mortality from DMSS in the Tula region.Materials and Methods. Data from statistical reports, reference documents, and databases of Tula region residents (including those who died in 2000–2011) were used.Results. The inequality in growth rates of general and primary morbidity were revealed, which is indicative of incorrect coding and underestimation of DMSS in medical organizations of the Tula region.A comprehensive phased statistical study was carried out to assess validity of the mortality data, including the following: verification of databases for errors using an automated system; control of postmortal diagnosis quality using the four-digit subcategory code in accordance with the WHO recommendations; analysis according to the initial and multiple causes of death. Underestimation of mortality from rheumatoid arthritis by about 25% was revealed. Attention was paid to the implementation and use of automated systems.

Background: Multiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death. Using MCOD data, this study aimed to fully describe the cause-specific mortality of people with AIDS (PWA) compared to people without AIDS. Methods: We conducted a nationwide investigation based on death certificates of 2,515 Italian PWA and 123,224 people without AIDS who had died between 2006 and 2010. The conditions most frequently associated with PWA mortality, compared to people without AIDS, were identified using an age-standardized proportion ratio (ASPR) calculated as the ratio between the age-standardized proportion of a specific cause among PWA and the same proportion among people without AIDS. Results: The most frequently reported conditions at death among PWA were infectious/parasitic diseases (52%), digestive (36%), respiratory (33%), and circulatory (32%) system diseases, and neoplasms (29%). All AIDS-defining conditions resulted highly associated (ASPR significantly greater than unity) with PWA deaths. Significant associations also emerged for leishmaniasis (ASPR = 188.0), encephalitis/myelitis/encephalomyelitis (ASPR = 14.3), dementia (ASPR = 13.1), chronic viral hepatitis (ASPR = 13.1), liver fibrosis/cirrhosis (ASPR = 4.4), pneumonia (ASPR = 4.4), anal (ASPR = 12.1) and liver (ASPR = 1.9) cancers, and Hodgkin's disease (ASPR = 3.1). Conclusions: Study findings identified the contribution of several non-AIDS-defining conditions on PWA mortality, emphasizing the need of preventive public health interventions targeting this population. [ABSTRACT FROM AUTHOR]

Prepandemic time trends in mortality from chronic liver disease (CLD) differed according to specific cause of death (decreasing for liver cirrhosis, stable or increasing for liver cancer), etiology (increasing for nonalcoholic fatty liver disease, generally decreasing for other etiologies), and world region (decreasing in areas with the highest burden of hepatitis B virus, increasing in Eastern Europe and other countries). The coronavirus disease 2019 (COVID-19) pandemic affected mortality of patients with CLD both directly, with a higher risk for severe illness and death depending on age, stage and etiology of the disease, and indirectly, through social isolation and loss of support, harmful drinking, and difficulties in access to care. Nevertheless, only sparse data are available on variations in CLD as a cause of death during the pandemic. In the USA, in 2020-2021 a growth in mortality was registered for all liver diseases, more marked for alcoholic liver disease, especially among young people aged 25-44 years and in selected ethnic groups. COVID-19 related deaths accounted only for a minor part of the excess. Further data from mortality registers of other countries are warranted, preferably adopting the so-called multiple cause-of-death approach, and extended to deaths attributed to viral hepatitis and liver cancer., Competing Interests: Conflict-of-interest statement: The authors declare they have no conflict of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The increasing prevalence of frailty in aging populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process., Objective: To examine frailty-related mortality as reported on the death certificate in France, Italy, Spain and the United States in 2017., Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain and the United States. We estimate the proportions of deaths by sex, age group and country with specific frailty-related ICD-codes on the death certificate 1) as the underlying cause of death (UC), 2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and 3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death)., Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%), then in France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code., Conclusions: Notable cross-country differences were found in the prevalence and the type of frailty-related symptoms at death even after adjusting for differential age distributions., Competing Interests: Declaration of conflicting interests: The Authors declare that there is no conflict of interest.

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.El estudio de las causas múltiples de óbitos permite conocer la extensión real de las estadísticas de mortalidad. El objetivo de esta investigación fue evaluar la tendencia de las tasas de mortalidad, relacionada con el asma, en el municipio de Río de Janeiro, Brasil, en el período de 2000-2009, con los datos obtenidos en el Sistema de Información de Mortalidad (SIM), de individuos con un año o más de edad, en quienes el asma fue mencionada en cualquier línea o parte del certificado médico de defunción. Para el análisis de datos fue utilizada la técnica de regresión lineal. La serie histórica mostró una tendencia al declive en las tasas de mortalidad estandarizadas, relacionada con el asma como causa básica y múltiple, con reducción entre los hombres y estabilidad entre las mujeres. Cuando el asma fue la causa básica, las razones asociadas más frecuentes fueron enfermedades del aparato respiratorio. La mortalidad relacionada con el asma fue subestimada cuando se consideraba solamente como causa básica, lo que podría ser evitado con la utilización de la metodología de causas múltiples en las estadísticas de mortalidad por asma.The study of multiple causes of death helps reveal the true extent of mortality statistics. The aim of this study was to assess trends in asthma mortality rates in the city of Rio de Janeiro, Brazil, from 2000 to 2009, based on data from the Mortality Information System among individuals one year or older, in which asthma was mentioned on any line or in any part of the death certificate. Linear regression was used for data analysis. The historical series showed a downward trend in the standardized mortality rate related to asthma as the underlying or associated cause of death, with a reduction in males and stability in females. When asthma was the underlying cause, the most common associated causes were diseases of the respiratory system. Asthma-related mortality was underestimated when considered only as the underlying cause, which could be avoided by the use of a multicausal methodology in asthma mortality statistics.

OBJETIVO: Avaliar a qualidade do Sistema de Informações sobre Mortalidade (SIM) em uma coorte especial de pacientes hospitalizados pelo Sistema Único de Saúde (SIH-SUS) que sofreram amputação de membros inferiores (AMI) devido ao diabetes mellitus (DM) em 2000, e comparar a mortalidade por causas da coorte com a da base populacional do Estado do Rio de Janeiro (ERJ) de 2000 a 2003. MÉTODOS: Os dados foram gerados a partir do relacionamento entre as bases de dados do SIH-SUS (2000) e do SIM (2000-2003). Foram excluídos os registros de indivíduos com menos de 30 anos e para análise de menção de DM, óbitos por causa básica (CB) não natural. A mortalidade foi analisada segundo causas da coorte especial e da base populacional. Os marcadores de qualidade do SIM na coorte foram a proporção de causas mencionadas de morte por DM e a proporção de CB mal definidas (MD) e, na base populacional, apenas o último. RESULTADOS: 38,0% dos indivíduos da coorte (n = 977) morreram nos quatro anos subsequentes à AMI devido ao DM, sendo que 49,1% desses no primeiro ano. As doenças endócrinas, nutricionais e metabólicas (41,5%), do aparelho circulatório (28,5%) e as causas MD (8,1%) foram as primeiras CB de morte. O DM foi mencionado 41,0% como CB, 1,6% como causa consequencial e 10,0% como contribuinte entre os óbitos pelas demais CB naturais nas declarações de óbito. Na base populacional, a mortalidade proporcional por causas MD foi 11,8% . CONCLUSÃO: O elevado risco de morte, o perfil de causas de morte e a sub-declaração do DM no atestado de óbito dos diabéticos tiveram resultados semelhantes aos de outros estudos de base populacional. A qualidade da certificação das causas de morte preenchidas nas declarações de óbito da coorte especial foi considerada ruim. É necessário um grande investimento para melhorar a qualidade da certificação das causas de mortes com o correto preenchimento do atestado de óbito pelos médicos e da codificação das causas de morte e seleção da CB pelos técnicos dos serviços de saúde. A metodologia desenvolvida neste estudo visando qualificar o SIM (relacionamento de base de dados e causas múltiplas de morte) mostrou-se efetiva e eficiente.OBJECTIVE: The aim of this study was to demonstrate the quality of the National Mortality Information System (SIM) in a special cohort of inpatients submitted to lower limb amputation (LLA) as a result of diabetes mellitus (DM), and compare the mortality pattern by causes for the cohort and for the population base of the State of Rio de Janeiro, from 2000 to 2003. METHODS: Data were generated from the linkage of the National Hospital Admittance Authorization - SIH-SUS (2000) and SIM (2000-2003) databases. Individuals under 30 years were excluded from the study, and deaths due to violent causes were also excluded in order to analyze the mention of DM as cause of death. Analyses of causes of death were conducted both in the cohort and the population base. Quality markers of SIM in the cohort were the frequency of mention of diabetes mellitus in the death certificate and the proportion of deaths classified as non-specific causes of death, and non-specific causes of death in the population base. RESULTS: 38.0% in the special cohort (n = 977) died during the four years following LLA as a result of diabetes mellitus (DM), and 49.1% of these deaths occurred during the first year. Endocrine, nutritional metabolic (41.5%), and cardiovascular diseases (28.5%), and non-specific causes of death (8.1%) were the main underlying causes of death (UC). DM was mentioned as UC for 41.0%, as a sequential cause for 1.6%, and as contributive cause for 10.0%, among the other natural underlying causes of death besides DM on death certificates. Non-specific underlying causes of death accounted for 11.8% of death certificates in the population base. CONCLUSIONS: The high risk of death, the causes of death and the underreporting of DM on death certificates of adults with diabetes were similar to other population-based mortality studies. In the special cohort, the quality of the causes of death on certificates was considered bad. The improvement in the reliability of cause-of-death depends on the ability of physicians to register, and of healthcare facilities to codify correctly the causes of death on death certificates. The method (linkage of data and multiple causes of death) applied in this study to qualify death information was efficient and effective.

OBJETIVO: Identificar as causas associadas de morte e o número de causas informadas nas declarações de óbito por doenças cerebrovasculares entre residentes no Estado do Paraná. MATERIAL E MÉTODOS: O banco de dados de mortalidade do ano de 2004 foi obtido do Sistema de Informação de Mortalidade disponível no endereço eletrônico do Datasus. A população escolhida foi separada pelo programa TabWin e as causas múltiplas foram processadas pelo programa Tabulador de Causas Múltiplas de Morte. RESULTADOS: O número médio de causas informadas foi de 2,92 para as mulheres e 2,97 para os homens. A maioria dos óbitos (74,8%) foi de pessoas com 65 anos ou mais de idade. Entre as causas associadas aos óbitos por doenças cerebrovasculares se destacaram as doenças do aparelho respiratório (37,9%), as doenças hipertensivas (37,5%) e os sintomas, sinais e achados anormais de exames clínicos e de laboratório (32,3%). CONSIDERAÇÕES FINAIS: Foi observada relativa melhora na qualidade dos dados de mortalidade em relação ao número de causas citadas. A hipertensão arterial como uma das principais causas associadas sugere a necessidade do seu controle no combate à mortalidade por doenças cerebrovasculares. Incentivos devem ser promovidos para estudos com causas múltiplas, para que se utilizem melhor informações tão importantes, que são desprezadas em estudos de mortalidade feitos somente com a causa básica de morte.OBJECTIVE: To identify associated causes and the number of causes on death certificates that reported cerebrovascular diseases as the underlying cause among residents of the State of Paraná, in Brazil. METHODS: Mortality data in 2004 were obtained on the Datasus website. The population was selected by the TabWin program and multiple causes were processed by the Multiple Causes of Death Tabulator program. RESULTS: The mean number of causes listed on death certificates was 2.92 for women and 2.97 for men. Most people who died (74.8%) were aged 65 or older. Among the major causes associated with cerebrovascular disease deaths were respiratory diseases (37.9%), hypertensive diseases (37.5%), and symptoms, signs and abnormal clinical and laboratory tests (32.3%). FINAL CONSIDERATIONS: There was a relative improvement in the quality of mortality data regarding the number of causes registered. Hypertension as a major associated cause suggests the need for its control in the fight against mortality caused by cerebrovascular disease. Studies with multiple causes should be encouraged, taking into account all causes listed on death certificates, many of which are overlooked in mortality studies that only use the underlying cause of death.