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The Integrated Population Information System (SINTREN) is a collection of actions to organize and distribute death certificate documents and population data electronically or via the internet using existing technology, communication, and information facilities. The SINTREN system is used with the aim of providing convenience in population administration services related to death certificates in Cirebon Regency. This research aims to review whether the management of the application or website is able to cut the distance and time of users to be more efficient. The research employs a qualitative approach through observation, documentation, and observations, with a particular focus on informants who were directly involved in the application of the SINTEREN application for issuing death certificates. Data analysis was conducted using Budiani's theory of effectiveness, which includes evaluating the accuracy of program goals, the effectiveness of program socialization, the achievement of program objectives, and the monitoring mechanisms in place. The study contributes by analyzing and interpreting data collected from various sources, providing insights into its implementation, functionality, and impact on improving population and civil registration services. This study could help identify areas for improvement, enhance system efficiency, and inform future policy decisions regarding population information management in the region. [ABSTRACT FROM AUTHOR]

Background: Death certification is an integral part of physician practice, yet common errors are being encountered from this vital source of health information. Most medical training programs lack formal curricula for this important skill. Accurate information from DC will help in improve our mortality data which can be use public health purposes Objectives: This study evaluated the effect of a multifaceted educational intervention on accuracy of completing death certification in a tertiary-based paediatric residency program Method: A pre-post intervention and control cohort study over 12- month period to assess the effect of our multifaceted intervention accuracy rate of completed DC was conducted. The intervention consisted of a 3-part program (distribution of educational material, presentation by a skilled instructor, skills workshop, and clinical mortality/auditing feedback sessions). Primary outcome was the difference in scores preand post-intervention and also the rate of accuracy on the MAHI death certificate scoring system. Results: The mean score before the intervention was 6.8±2.7 and 7.1±2.3 in both the intervention and control cohorts respectively. The mean score after the intervention was 16.3±2.5 and 7.3±2.8 in both the intervention and control cohorts respectively indicating an increase in scores. The mean difference in pre- and post-tutorial scores was significant (t=20.39, p=0.0001). Conclusions: We found that using a multifaceted educational intervention to train junior physicians on how to correctly complete a DC was effective in a residency-based pediatric program

The 11th Revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-11) will replace its predecessor as international standard for cause-of death-statistics. The digitization of healthcare is a main motivation for its introduction. In parallel, the replacement of the paper-based death certificate with an electronic format is under evaluation. At the moment, the death certificate is used in paper-based format with ICD-10 for coding in Germany. To be prepared for the switch to ICD-11, the compatibility between ICD-11 and the electronic certificate should be assured. Objectives were to check the appropriateness of diagnosis-related information found on death certificates for an ICD-11 coding and to describe enhancements to the certificate's structure needed to fully utilize the strengths of ICD-11. As part of an exploratory test of a respective application, information from 453 electronic death certificates were provided by one local health authority. From a sample of 200 certificates, 433 diagnosis texts were coded into the German version of ICD-11. The appropriateness of the results as well as the further requirements of ICD-11, particularly with regard to post-coordination, were checked. For 430 diagnosis texts, 649 ICD-11 codes were used. Three hundred and sixty two diagnosis texts were rated as appropriately represented through the coding result. Almost all certificates contained diagnosis texts that lacked details required by ICD-11 for a precise coding. The distribution of diseases was very similar between ICD-10 and ICD-11 coding. A few gaps in ICD-11 were identified. Information requested by ICD-11 for a mandatory post-coordination were almost entirely absent from the death certificates. The structure and content of the death certificate are currently not well prepared for an ICD-11 coding. Necessary information was frequently missing. The line-oriented structure of death certificates has to be supplemented with a more flexible approach. Then, the semantic knowledge base of ICD-11 should better guide the content related input fields of a future electronic death certificate. [ABSTRACT FROM AUTHOR]

Background: We conducted a systematic review to identify existing ICD-10 coding validation studies in progressive supranuclear palsy and corticobasal syndrome [PSP/CBS]) and, in a new study, evaluated the accuracy of ICD-10 diagnostic codes for PSP/CBS in Scottish hospital inpatient and death certificate data. Methods: Original studies that assessed the accuracy of specific ICD-10 diagnostic codes in PSP/CBS were sought. Separately, we estimated the positive predictive value (PPV) of specific codes for PSP/CBS in inpatient hospital data (SMR01, SMR04) compared to clinical diagnosis in four regions. Sensitivity was assessed in one region due to a concurrent prevalence study. For PSP, the consistency of the G23.1 code in inpatient and death certificate coding was evaluated across Scotland. Results: No previous ICD-10 validation studies were identified. 14,767 records (SMR01) and 1497 records (SMR04) were assigned the candidate ICD-10 diagnostic codes between February 2011 and July 2019. The best PPV was achieved with G23.1 (1.00, 95% CI 0.93–1.00) in PSP and G23.9 in CBS (0.20, 95% CI 0.04–0.62). The sensitivity of G23.1 for PSP was 0.52 (95% CI 0.33–0.70) and G31.8 for CBS was 0.17 (95% CI 0.05–0.45). Only 38.1% of deceased G23.1 hospital-coded cases also had this coding on their death certificate: the majority (49.0%) erroneously assigned the G12.2 code. Discussion: The high G23.1 PPV in inpatient data shows it is a useful tool for PSP case ascertainment, but death certificate coding is inaccurate. The PPV and sensitivity of existing ICD-10 codes for CBS are poor due to a lack of a specific code. [ABSTRACT FROM AUTHOR]

This study aims to determine the effectiveness of the Population Integrated Information System application program in Cirebon Regency conducted by the Population and Civil Registration Office of Cirebon Regency. This program is based on rules and regulations regulated by local and central governments, and involves various stakeholders and available resources. A qualitative approach was used in this study, with the purpose sampling method to provide an overview of the phenomena that occur. Program effectiveness based on Budiani's theory identifies four effectiveness indicators, namely target setting, program socialization, program objectives and program monitoring. The findings show that the program has been running well in the issuance of death certificates, although there are still some challenges faced, such as the lack of death certificate issuance services offered by the Population and Civil Registration Office of Cirebon Regency; second, the lack of public knowledge about the SINTREN application offered by the Population and Civil Registration Office of Cirebon Regency; and third, the Regional Apparatus Organization (OPD) is still insufficient in an effort to socialize the SINTREN application to the people of Cirebon Regency. Therefore, the study concluded that more enhanced efforts are maximizing human resources, repairing unstable networks and further socializing or educating the public to further improve the making of death certificates due to the benefits of the Death Certificate Document. [ABSTRACT FROM AUTHOR]

Background: Mortality is an important indicator for estimating the impact of the COVID-19 pandemic. However, different registrations provide different figures and the question is how to interpret the number of COVID-19 deaths reported. Objective: To study the role of COVID-19 in dying in order to explain the representation of COVID-19 in cause-of-death statistics. Methods: Analysis of all death certificates mentioning COVID-19 in the Dutch cause-of-death registry during the pandemic (n=51,181). The role of COVID-19 as cause of death was studied by the way it was reported on death certificates. A calculation of odds ratios was performed for studying associations between COVID-19 and other reported causes of death.Results: In 24% of the cases COVID-19 was the only cause of death mentioned on a death certificate. In 76% of the cases, one or more other diseases played a role in dying. Three patterns emerged: COVI9 associated with 1. neurodegenerative disorders, 2. chronic respiratory disorders, and 3. metabolic disorders. Of all death certificates mentioning the diseases, COVID-19 was the start of the causal chain leading to death in 45.2% of the cases, while COVID-19 was selected for cause-of-death statistics by special World Health Organization WHO instructions in 93.9% of the cases. Conclusions: Cause-of-death statistics overestimate the role of COVI9 as underlying cause of death. In a majority of the deceased cases, there is an association of COVID-19 with other diseases not captured by cause-of-death statistics reporting (only) one cause of death per deceased. ti-causal approach is needed to evaluate the pandemic and inform health policy.

The demographic and epidemiological transitions of the past 200 years are well documented at an aggregate level. Understanding differences in individual and group risks for mortality during these transitions requires linkage between demographic data and detailed individual cause of death information. This paper describes the digitization of almost 185,000 causes of death for Ohio to supplement demographic information in the Longitudinal, Intergenerational Family Electronic Micro-database (LIFE-M). To extract causes of death, our methodology combines handwriting recognition, extensive data cleaning algorithms, and the semi-automated classification of causes of death into International Classification of Diseases (ICD) codes. Our procedures are adaptable to other collections of handwritten data, which require both handwriting recognition and semi-automated coding of the information extracted.

ABSTRACT Objective To evaluate, characterize and search for trends in the underreporting of diabetes mellitus (DM) as the cause of death in Bauru, São Paulo, Brazil, over 40 years. Subjects and methods This was a documental study. Clinical and mortality data were collected from individuals known to have type 1 (DM1) and type 2 diabetes mellitus (DM2), residing in Bauru, State of São Paulo, followed at a local endocrinology clinic from 1982 to 2021, who deceased during this period. Results A significant underreporting of DM as the cause of death (64.41%) was found, mostly associated with male gender (OR = 1.59 [95% CI: 1.18; 2.15]; p < 0.01), DM2 (OR = 2.64 [95% CI: 1.32; 5.26]; p < 0.01), dying in the first decade of the study (OR = 4.07 [95% CI: 1.54; 10.71]; p < 0.001) and shorter DM duration (OR = 1.02 [95% CI: 1.01; 1.04]; p < 0.01). Age, type of treatment, body mass index, marital status and ethnicity, did not show a significant association with DM underreporting. There was a decreasing trend in DM1 underreporting (Decade Percentual Change = -7.10 [95% CI: -11.35; -3.40]), but a stationary trend for DM and DM2. The main primary cause of death was cardiovascular-related complications. Conclusion The underreporting of DM as the cause of death was very frequently found, and was associated with male gender, decade of death, shorter DM duration and DM2. If our data could be applied to the whole country, DM would possibly emerge as a more prominent cause of death in Brazil. Future studies in other cities and geographic regions are warranted to confirm our findings.

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]

Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55–69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by linkage with the GBA from 1991 until 2009. Of these, a medical autopsy was performed on 3736 deceased according to linkage with PALGA, resulting in an overall autopsy rate of 6.3%. Major variations in the autopsy rate were observed according to the cause of death. The autopsy rate increased according to the number of contributing causes of death. Lastly, a diagnosis of cancer affected the autopsy rate. The clinical cause of death and a history of cancer both influenced the medical autopsy rate in a large national cohort. The insight this study provides may help clinicians and pathologists counteracting the further downfall of the medical autopsy. [ABSTRACT FROM AUTHOR]

Medical technology has made tremendous strides in extending the lives of patients who have suffered organ failure. Machines can now replace the function of the kidneys, the heart, and other vital organs. Much has been written about a patient's right to refuse or direct the withdrawal of medical treatment, especially at the end of life, under the guise of "death with dignity." However, little attention has been paid to the situation where a patient elects to deactivate their life‐sustaining medical device without a physician's involvement. This raises the challenging question of whether the patient's manner of death should be classified as suicide or natural. Surprisingly, common law, statutes, medical ethics, and public health practice are not in alignment on the answer. This article will explore the ramifications and far‐reaching impact that such divergence has on the survivors and the medical community, as well as recommend corrective actions and practical approaches for the medical and legal practitioner. [ABSTRACT FROM AUTHOR]

In South Korea, the manner and cause of death are determined by physicians. The present study aimed to investigate the differences in decisions made by physicians when completing death certificates and the factors that lead to these differences in South Korea. Questionnaires were used to survey 210 physicians who routinely complete death certificates, and demographic data along with information on their decisions regarding the manner and cause of death as well as natural and unnatural contributory causes were ascertained for eight representative cases. The study sample comprised 149 (71.0%) and 61 (29.0%) male and female physicians, respectively, and the mean age in this sample was 36.93 ± 4.51 years. We found that 64.7%, 61.4%, 7.6%, 4.3%, 4.3%, 65.7%, 84.3% and 53.3% of the physicians considered cases 1, 2, 3, 4, 5, 6, 7 and 8 as unnatural deaths, respectively, while 27.6%, 32.0%, 91.9%, 95%, 8.5%, 26.6%, 6.7% and 38.1% considered them to be natural deaths, respectively. In Case 5, 81.7% considered death to be due to an indeterminate cause. We found that differences may exist in how physicians select the manner of death when completing a death certificate and that this decision is influenced by several factors. [ABSTRACT FROM AUTHOR]

The 11th Revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-11) will replace its predecessor as international standard for cause-of death-statistics. The digitization of healthcare is a main motivation for its introduction. In parallel, the replacement of the paper-based death certificate with an electronic format is under evaluation. At the moment, the death certificate is used in paper-based format with ICD-10 for coding in Germany. To be prepared for the switch to ICD-11, the compatibility between ICD-11 and the electronic certificate should be assured. Objectives were to check the appropriateness of diagnosis-related information found on death certificates for an ICD-11 coding and to describe enhancements to the certificate’s structure needed to fully utilize the strengths of ICD-11. As part of an exploratory test of a respective application, information from 453 electronic death certificates were provided by one local health authority. From a sample of 200 certificates, 433 diagnosis texts were coded into the German version of ICD-11. The appropriateness of the results as well as the further requirements of ICD-11, particularly with regard to post-coordination, were checked. For 430 diagnosis texts, 649 ICD-11 codes were used. Three hundred and sixty two diagnosis texts were rated as appropriately represented through the coding result. Almost all certificates contained diagnosis texts that lacked details required by ICD-11 for a precise coding. The distribution of diseases was very similar between ICD-10 and ICD-11 coding. A few gaps in ICD-11 were identified. Information requested by ICD-11 for a mandatory post-coordination were almost entirely absent from the death certificates. The structure and content of the death certificate are currently not well prepared for an ICD-11 coding. Necessary information was frequently missing. The line-oriented structure of death certificates has to be supplemented with a more flexible approach. Then, the semantic knowledge base of ICD-11 should better guide the content related input fields of a future electronic death certificate.

Background: Multiple long-term health conditions (MLTCs) are common and increasing among older people, yet there is limited understanding of their prevalence and association with social care expenditure. Aim: To estimate the prevalence of MTLCs and association with English social care expenditure. Methods: Our study population included those aged ≥ 65 who died in England in the year 2018 with any of the following long-term conditions recorded on their death certificate: diabetes; cardiovascular diseases (CVDs) including hypertension; dementia; stroke; respiratory; and chronic kidney diseases (CKDs). Prevalence was based on the proportion of death reported for older people with MTLCs (≥ 2) in each of the 152 English Local Authorities (LAs). Ordinary least square regression (OLS) was used to assess the relationship between prevalence of MTLCs and adult social care expenditure, adjusting for LA characteristics. Results: Of the 409551 deaths reported, 19.9% (n = 81395) had ≥ 2 MTLCs, of which the combination of CVDs-diabetes was the most prevalent. Hospitals were the leading place of death for those with MTLCs. Results from the OLS regression model showed that an increased prevalence of MLTCs is associated with higher LA social care expenditure. A percentage point increase in prevalence of MLTCs is associated with an increase of about £8.13 in per capita LA social care expenditure. Conclusion: Our findings suggest that the increased prevalence of MTLCs is associated with increased LA social care expenditure. It is important for future studies to further explore the mechanisms or link between LA social care expenditure and the prevalence of MTLCs. [ABSTRACT FROM AUTHOR]

Background: Given the increase in mortality from COVID-19 disease, understanding the causal chain leading to death in patients with this disease will be of particular importance. This study aimed to draw the death map of patients with COVID-19 in BESAT hospital (West of Iran), based on investigating the underlying, intermediate, and terminal causes of death in this group of patients. Materials and Methods: To draw the death map of patients with COVID-19 in this cross-sectional study, the death certificate and medical records of 183 COVID-19 patients who died at BESAT Hospital in Hamadan (West of Iran) in 2020 were reviewed. The cases in which the underlying cause of death was COVID-19 were reviewed. A checklist was used to collect the data. It was designed based on the international form of medical certificate of cause of death (issued by WHO). The collected data were analyzed by SPSS software version 23. Results: The most prevalent underlying causes of death were COVID-19 (60.7%), COVID-19-related pneumonia (19.1%), acute respiratory distress syndrome (10.9%), and severe sepsis (9.8%). Hypertension (8.2%), diabetes (6.0%), seizures (3.8%), and ischemic heart disease (2.2%) were the most influential conditions affecting death. The number of deaths due to the terminal cause of acute respiratory distress syndrome in women (22.5%) was much higher than in men (7.1%) (P-value=0.041). Findings indicated that most patients died from four main pathways originating from COVID-19, leading to causes such as sepsis, ARDS, myocarditis, MI, and PTE. Conclusion: The results indicate that health officials and healthcare providers should be able to identify and monitor patients with chronic diseases and implement effective plans to prevent COVID-19. Physicians should also take important steps in offices, clinics, and hospitals, such as conducting early echocardiography in children, providing respiratory support, and preventing deep vein thrombosis in adults during hospitalization. It is also essential to inform the public through audio and video media, including radio and television. [ABSTRACT FROM AUTHOR]

In recent years, health care providers and the general public in the United States have gained a greater awareness of Voluntary Stopping of Eating and Drinking (VSED) as a last resort option to escape from unbearable suffering, thanks to a growing number of publications, books, and documentaries. However, the challenges and issues that can arise in completing a death certificate after VSED are not well described in literature. In this article, we first present an example case of VSED in which the death certificate was issued listing suicide as the manner of death by the medical examiner. Then, we describe the challenges and issues related to death certificates in VSED cases. Because there is no consensus on whether VSED is natural death or suicide, the death certificate may need to be referred to a medical examiner in many jurisdictions, potentially resulting in suicide being designated as the manner of death. Such designations can cause reticence in providers and institutions that might otherwise support patients who choose VSED but are concerned about the legal or reputational implications of enabling a "suicide" at their facility. A suicide designation may also contribute to moral distress in health care staff and impose emotional and practical burdens on the patient's surviving loved ones. We suggest that there are 3 approaches to addressing challenges and issues associated with death certificates after VSED: (1) navigate the existing system with guidance developed by professional organizations, (2) make a legal exemption, and (3) change the death certification system. Debate involving a wide variety of experts is warranted. [ABSTRACT FROM AUTHOR]

Background: The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. Methods: Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. Results: The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%–52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. Conclusions: Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent. [ABSTRACT FROM AUTHOR]

Introduction: Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India. Methods: A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants. Results: The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24-3.83)) and malignancy (AOR = 3.05 (1.27-7.32)) to be significantly associated with mortality as individual determinants. Hypertension--diabetes mellitus [AOR = 1.68 (1.02-2.76), P = 0.043] and hypertension--CKD [AOR = 3.49 (1.01-12.01), P = 0.48] dyads were multimorbidities significantly associated with mortality. Conclusion: Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19. [ABSTRACT FROM AUTHOR]

OBJECTIVES OBJECTIVES: Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan. METHODS Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated. RESULTS The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality. CONCLUSIONS Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.

Objective: The purpose of this research is to identify problems that arise while producing death certificates in the tertiary care hospital setting and to propose ways to fix them in order to avoid any medicolegal complications later. Methods: This retrospective observational study aimed to sample and audit the mortality status & quality of death certification in the medical intensive-care unit (ICU) of a tertiary care, thirdlargest hospital in Karachi, the Abbasi Shaheed hospital, for the period January 2018 to December 2018. Using a predetermined standard form, we gathered information from death certificates including demographics, administration, comorbidities, and causes of death. Their medical records were used to confirm the accuracy of this data. The death certificates were graded on a scale from zero to five, with a zero being assigned if no mistakes were found to a five if the wrong cause of death was listed or listed in the wrong order. Results: Over the course of the study's 12-month duration, 283 death certificates were examined. Of the total 283, 140 were women and 143 were men. About a quarter of all certificates of death include no inaccuracy of any kind. Grade III errors (co-morbidities list was not stated) made up 64% of all the errors found in the audited certificates, while Grade IV errors (18%) stood second. At least one mistake was found in 138 certificates. Sixty-nine of the death certificates include at least two mistakes. Conclusion: Death certificates prepared at a tertiary care hospital were found to include an extremely high mistake rate. Such mistakes could lead to medicolegal complications. Appropriate intervention(s) are urgently required to address this critical problem. [ABSTRACT FROM AUTHOR]

Objective: To examine international variations in national diagnosis and certification habits prefer recording dementia (D) versus Alzhiemer disease (AD) as the underlying cause of death (UCOD) and their associations with mortality rates of dementia and AD. Methods: We calculated proportions of D/D+AD and AD/D+AD deaths as proxies of national diagnosis and certification habits. Pearson correlation coefficients (r) were estimated to assess the associations of proportions with the mortality rates of dementia or AD among adults aged 75 to 84 years across 38 countries. Results: The countries with a high preference for recording dementia as the UCOD were Taiwan and Latvia with proportion of D/D+AD deaths of 92% and 88%, respectively, and those with a high preference for recording AD as the UCOD were Slovenia, Turkey, and Poland with proportion of AD/D+AD deaths of 100%, 99%, and 89%, respectively. The r values for the proportions and mortality rate for dementia and AD were 0.67 (95% CI: 0.44-0.81) and 0.46 (95% CI: 0.16-0.68), respectively. Conclusion: We identified a small number of countries with obvious natonal diagnosis and certification habits preferring dementia or AD and had moderate effects on international variations in the mortality rates of dementia and AD. [ABSTRACT FROM AUTHOR]

Introduction: Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India. Methods: A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants. Results: The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24–3.83)) and malignancy (AOR = 3.05 (1.27–7.32)) to be significantly associated with mortality as individual determinants. Hypertension–diabetes mellitus [AOR = 1.68 (1.02–2.76), P = 0.043] and hypertension–CKD [AOR = 3.49 (1.01–12.01), P = 0.48] dyads were multimorbidities significantly associated with mortality. Conclusion: Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19.

Chronic obstructive pulmonary disease (COPD) remains a compelling cause of morbidity and mortality; however, it is underestimated and undertreated in Brazil. Using multiple causes of death data from the Information System on Mortality, we evaluated, from 2000 to 2019, national proportional mortality; trends in mortality rates stratified by age, sex, and macro-region; and causes of death and seasonal variation, considering COPD as an underlying and associated cause of death. COPD occurred in 1,132,968 deaths, corresponding to a proportional mortality of 5.0% (5.2% and 4.7% among men and women), 67.6% as the underlying, and 32.4% as an associated cause of death. The standardized mortality rate decreased by 25.8% from 2000 to 2019, and the underlying, associated, male and female, Southeast, South, and Center-West region deaths revealed decreasing standardized mortality trends. The mean age at death increased from 73.2 (±12.5) to 76.0 (±12.0) years of age. Respiratory diseases were the leading underlying causes, totaling 69.8%, with COPD itself reported for 67.6% of deaths, followed by circulatory diseases (15.8%) and neoplasms (6.24%). Respiratory failure, pneumonia, septicemia, and hypertensive diseases were the major associated causes of death. Significant seasonal variations, with the highest proportional COPD mortality during winter, occurred in the southeast, south, and center-west regions. This study discloses the need and value to accurately document epidemiologic trends related to COPD in Brazil, provided its burden on mortality in older age as a significant cause of death, aiming at effective planning of mortality prevention and control.

Serious adverse drug reactions (ADRs) to medicinal products can cause death. It is an immediate challenge for modern medicine to prevent the possibility of this outcome and to improve the safety of pharmacotherapy. The aim of this study was to identify and analyse the main methodological approaches to studying the prevalence, patterns, and risk factors of fatal ADRs. The authors identified three main methods for studying such reactions: analysis of death certificates, monitoring of spontaneous reports, and review of clinical trials with a particular focus on safety. Each of these methods has its advantages and limitations. Clinical trials provide the most accurate information on the prevalence of fatal ADRs. For inpatients, this value ranged from 0.05 to 0.95% of the total number of hospital admissions. Data from death certificates may be particularly useful for identifying the groups of medicinal products posing a high risk of death and for making longitudinal comparisons. Monitoring of spontaneous reports is very effective in rapidly identifying fatal adverse reactions to new medicinal products. According to the authors, not only the choice of a data collection method, but also its application can affect the results of an ADR study. It was noted that the data varied across clinical trials conducted in different countries. Such variations indicate the importance of studying the problem of fatal ADRs at the national level, as well as the need for initiating such studies in the Russian Federation.

Objective: To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category. Patients and Methods: Using data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate‐specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system. Results: Both no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low‐risk, 14% for intermediate‐risk, 8% for high‐risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low‐risk, 29% for intermediate‐risk, 29% for high‐risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5–19%) were estimated to have either no evidence or moderate evidence of PCa progression. Conclusions: Weak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low‐risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis. [ABSTRACT FROM AUTHOR]

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Abstract Objective: to evaluate the incompleteness of Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) data on deaths from external causes (ECs) in the state of Rio Grande do Sul, Brazil, 2000-2019. Methods: This was an ecological study, using SIM data on all deaths from external causes and, specifically, from transport accident, homicides, suicides and falls; the analysis of the trend of incompleteness was performed by means of Prais-Winsten regression, with a 5% significance level. Results: A total of 146,882 deaths were evaluated; sex (0.1%), place of death (0.1%) and age (0.4%) showed the lowest incompleteness in 2019; the proportion of incompleteness showed a decreasing trend for the place of death and schooling, an increasing trend for marital status and a stable trend for age and race/skin color, among all types of death evaluated. Conclusion: the variables analyzed reached a high degree of completion; with the exception of marital status and schooling, for which unsatisfactory scores persisted for deaths from ECs, both total and by subgroups.

Abstract Background Reliable statistics on the underlying cause of death are essential for monitoring the health in a population. When there is insufficient information to identify the true underlying cause of death, the death will be classified using less informative codes, garbage codes. If many deaths are assigned a garbage code, the information value of the cause-of-death statistics is reduced. The aim of this study was to analyse the use of garbage codes in the Norwegian Cause of Death Registry (NCoDR). Methods Data from NCoDR on all deaths among Norwegian residents in the years 1996–2019 were used to describe the occurrence of garbage codes. We used logistic regression analyses to identify determinants for the use of garbage codes. Possible explanatory factors were year of death, sex, age of death, place of death and whether an autopsy was performed. Results A total of 29.0% (290,469/1,000,128) of the deaths were coded with a garbage code; 14.1% (140,804/1,000,128) with a major and 15.0% (149,665/1,000,128) with a minor garbage code. The five most common major garbage codes overall were ICD-10 codes I50 (heart failure), R96 (sudden death), R54 (senility), X59 (exposure to unspecified factor), and A41 (other sepsis). The most prevalent minor garbage codes were I64 (unspecified stroke), J18 (unspecified pneumonia), C80 (malignant neoplasm with unknown primary site), E14 (unspecified diabetes mellitus), and I69 (sequelae of cerebrovascular disease). The most important determinants for the use of garbage codes were the age of the deceased (OR 17.4 for age ≥ 90 vs age

Background: Although many child death review (CDR) systems have been developed in Japan, the optimal system is still being identified. The aim of this study is to identify the etiologies of child deaths and to propose a screening method for initiating the CDR process in Japan. Methods: Clinical medical records (CMRs) in hospitals and autopsy records were surveyed for cases of deaths of children aged less than 15 years between 2014 and 2016 in Aichi Prefecture, Japan. The data were analyzed in three steps, and the findings were compared with the vital statistics. Results: Of the 695 children whose death certificates were submitted to Aichi Prefecture, 590 could be traced to pediatric care hospitals. The distribution of causes of death was slightly different from the vital statistics, with 11.5% dying of extrinsic causes and 19.7% dying of unknown causes. Maltreatment was suspected in 64 cases, which was much higher than that in government statistics. Overall, 158 (26.8%) deaths were considered preventable. The number of unnatural deaths, which might be screened in, was calculated as 172 (29.2%) in the vital statistics, whereas the survey of CMRs revealed that 241 (40.8%) to 282 (47.8%) should be screened in. Conclusions: Surveying CMRs in hospitals may be a suitable method to detect and screen deaths to start the CDR process in Japan. [ABSTRACT FROM AUTHOR]

Background: Suicide represents an important public health problem in the world. Considered a complex phenomenon it is associated with social, biological and demographic factors. The quality of the data registered in the Death Certificate is fundamental to know the magnitude of this problem and subsidizes the construction of epidemiological indicators that contribute to the efficiency of health management. Objective: To analyze the evolution of the completeness of suicide records in the mortality information system (SIM) of the state of Pernambuco, between 1996 and 2015. Method: The proportion of completeness of the death certificate variables was calculated. For the analysis of the completeness trend, the Joinpoint Regression model was used. Results: There was a tendency to increase the completeness of the variables analyzed, with an emphasis on "race/color", "marital status", and "education level", with an increase of more than 60%. Conclusion: Analysis of temporal trends showed an improvement in the filling of suicide data into the SIM. However, the challenge remains to reach less than 5% incompleteness across all variables. The assessment of the completeness of suicide records in the SIM is relevant for contributing to the suicide surveillance system and for the improvement of vital statistics related to external causes. [ABSTRACT FROM AUTHOR]

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Background: Adults with cerebral palsy (CP) represent a growing population whose healthcare needs are poorly understood. The purpose of this study was to examine trends in the underlying causes of death (UCOD) among adults with CP in the United States. Methods: A national cohort was created from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2019. The UCOD was determined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10 code G80x, Infantile CP) based on death certificate adjudication. Crude and age-adjusted mortality rates (AAMRs), as well as 95% confidence intervals (CIs) were calculated for adults with CP. Results: There were 25,138 deaths where CP was listed as the UCOD between 1999–2019. There was a steady increase in the UCOD attributable to CP in both crude mortality rates and AAMRs, with the highest rates occurring in 2019. The highest co-occurring secondary causes of death were other diseases of the nervous system (e.g., epilepsy), diseases of the respiratory system (e.g., pneumonia), symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (e.g., dysphagia), and diseases of the circulatory system (e.g., cardiovascular disease). Conclusions: Listing the UCOD as CP should be accompanied by other mechanisms leading to mortality in this population. [ABSTRACT FROM AUTHOR]

Background. Different types of death among people indicates both the extent to which people use different types of health care and the growth and development of a society. Premature mortality imposes a heavy burden on society in terms of health, economy, and mental issues. Given the preventability of these deaths, efforts are being made to reduce premature deaths by 25 percent ın hıgh level plans by 1404s. Methods. The purpose of this descriptive-analytical study, using death registration data, was to perform zoning of premature deaths in the cities supervised by Semnan University of Medical Sciences in Iran, it also investigated the factors affecting the premature deaths in order to reduce premature mortality especially among people at the age range of 30 to 69. Data were extracted based on the information of death certificates entered in the death registration system from 2013 to 2018. We, thus, studied 3619 registered deaths. The data were analyzed through SPSS software, using descriptive statistics (Relative Frequency, Mean, and Standard Deviation) and inferential tests (chi-square and independent t-test) according to the type of variables. The level of significance was set at 5 percent. Results. The mean and standard deviation of premature mortality was found to be 55.7 ± 10.6 and most of the deaths occurred in the seventh decade of their life. Premature mortality was more common among men, employed people, and urban residents. The major causes of premature mortality included cardiovascular diseases, cancer, and accidents. Conclusion. The results showed that accidents are the major cause of premature mortality at younger age, but they are gradually replaced by chronic and non-communicable diseases at the middle age. Therefore, in order to reduce the risk factors regarding premature mortality, collaboration of the related organizations is essential. Extended Abstract Background Different types of death among people indicates both the extent to which people use different types of health care and the growth and development of a society. Premature mortality also imposes a heavy burden on society in terms of health, economy, and mental issues. Given the preventability of premature mortality and the serious efforts to reduce premature mortality by 25 percent by 2025, we decided to conduct a study in this field under the title of ''Assessment of causes and Geographical distribution of early death in 30 to 69- year- old population covered by the Semnan University of Medical Science (SUMS) and its relation with Demographic characteristics: a 10 years cross-sectional study between 2009 to 2018''. Methods The population of this study included all cases of premature death in the population aged 30 to 69 years for whom a death certificate had been issued and registered in the death registration system under the supervision of the SUMS in Semnan Province. Semnan is one of the largest provinces of Iran including eight important cities. Six out of 8 cities including: 1-Garmsar, 2-Aradan, 3-Sorkhe, 4-Semnan, 5-Mahdishahr and 6-Damghan is supervised by the SUMS health network which was considered as population of this study from the year 2013 to 2018. Demographic information of the deceased was extracted and analyzed from the death registration system without using their personal information. This was a census study and the studied variables included causes of premature death (Cardiovascular diseases, malignant neoplasms, respiratory diseases, neurological diseases, accidents, traffic accidents, poisoning, kidney diseases, gastrointestinal diseases, infections, surgical complications and other causes) , age, gender(Male, Female), place of residence (urban and rural) and education. Descriptive statistics were used for the analysis and independent chi-square and t-tests were used to analyze the relationship between variables according to the type of variable at a significance level of 5percent with SPSS software. Results A total of 3619 premature deaths occurred between the ages of 30 and of 69 from 2009 to 2018. The mean ± standard deviation of premature mortality was 55.7 ± 10.6 years. The highest number of premature deaths in 2011 was 18percent and the lowest was related to 2010 with 15.3percent. Premature mortality was more common in men, employed people, medical centers, illiterate and urban residents and most of the deaths occurred in the seventh decade their life. 39.3 percent of premature deaths was recorded in Semnan district. The major causes of premature mortality include cardiovascular diseases, cancers, and accidents. The prime cause of premature death was found to be cardiovascular diseases, accounting for 31.1 percent of all deaths, often resulting from heart attacks and atherosclerosis of various arteries and high blood pressure. The rate of annual premature mortality between 2009 and 2018was not related to the year of collection (P = 0.086). Only the number of premature deaths due to car accidents and surgical complications is the same in different age groups (p> 0.05). Cardiovascular diseases seem to increase significantly with age. Conclusion The results show that accidents at a young age are the major cause of premature mortality, but they are gradually being replaced by chronic and non-communicable diseases in the middle age.This study recommends the cooperation of organizations involved in the control of premature mortality, such as the Ministry of Roads and Transportation, Ministry of Urban development, and the Ministry of Health. Practical Implications of Research In order to reduce premature deaths and increase life expectancy, we must try to prevent accidents and the underlying causes of internal diseases, in addition to creating a culture of changing the lifestyle of citizens to reduce risk factors as much as possible. Ethical Consideration This research has been supported by Semnan University of Medical Sciences and health Services grant IR.SEMUMS.REC.1398.114 and its information has been extracted from the health deputy system with the permission of the university. Conflict of InterestsThe Authors declare that there is no conflict of interest. Acknowledgement We would like to thank the Deputy Minister of Health at Semnan University of Medical Sciences for providing the necessary facilities for doing this research.

Mohammed Madadin Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Mohammed MadadinDepartment of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, 34211, Saudi ArabiaTel +966 13 3333766; +966504997673Fax +966 13 3330333Email Mmadadin@iau.edu.saBackground: The medical certificate of cause-of-death is an important document of medicolegal significance. Errors in the completion of the death certificate by doctors are not uncommon. Therefore, it is important for medical students, the future doctors, to be trained in completing the medical certificate of cause-of-death. This study aimed to investigate the understanding of final-year medical students of the cause-of-death certification and to assess their ability to complete the cause-of-death statement.Material and Methods: The final-year medical students of Imam Abdulrahman Bin Faisal University, of the academic year 2020– 21 formed the cohort of medical students that participated in the current descriptive, cross-sectional study wherein a self-administered online questionnaire was used.Results: A total of 174 students provided complete responses. The immediate cause of death in the given case scenario was answered correctly by 107 (61.5%) of the students. The underlying cause of death was answered correctly by only 20 (11.5%) students. It was apparent that the chain of events leading to death in the given case scenario was wrongly understood by the majority of the students. Nonetheless, the other significant condition contributing to death was answered correctly by 151 (86.8%) students. Other errors included the use of abbreviations, mention of the mechanism of death as a cause of death, mention of clinical features or irrelevant causes of death and mention of the incorrect time interval between the onset of a cause of death and death.Conclusion: The current study found that the overall performance of final-year medical students was reasonably good except for the fact that most misunderstood the underlying cause of death in the given case scenario. The majority of the students had attended a tutorial on medical certification of cause-of-death before participating in the current study, which suggests that continuous training might be required.Keywords: death certification, cause of death, medical student, future doctor, death certificate

Shu-Yu Tai,1– 3 Jingyi Wu,4 Lukas Jyuhn-Hsiarn Lee,5 Tsung-Hsueh Lu4 1Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; 2Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City, Taiwan; 3Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; 4Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5National Institute of Environmental Health Sciences, National Health Research Institutes, Zhuna, TaiwanCorrespondence: Tsung-Hsueh LuDepartment of Public Health, College of Medicine, National Cheng Kung University, No. 1, Dah Hsueh Road, East District, Tainan, 701, TaiwanTel +886-6-2353535 ext. 5567Fax +886-6-2359033Email robertlu@mail.ncku.edu.twPurpose: Malignant mesothelioma (MM) is associated with past exposure to asbestos and the latency period ranged from 20 to 40 years. Asbestos consumption reached a peak in the 1980s in Taiwan, and the MM mortality is expected to increase since 2000s. However, no specific code for MM was available before the International Classification of Disease, Tenth Revision (ICD-10), which was launched in 2008 in Taiwan. We examined how MM was coded in mortality data in Taiwan during the years when the ICD, Ninth Revision (ICD-9) was used.Patients and Methods: Double-coded mortality data (each death coded according to both ICD-10 and ICD-9 codes) for the period 2002– 2008 were obtained for analysis. Detection rates (similar to sensitivity) and confirmation rates (similar to positive predictive value) for various potential proxy ICD-9 codes for MM were calculated.Results: For 113 deaths, for which the underlying cause of death was ICD-10 code C45 (MM), 14 corresponding ICD-9 codes were used. Four ICD-9 codes constituted 77% (87/113) of all MM deaths. The detection rate for code 199 (malignant neoplasm [MN] without specification of site) was 37% (42/113), that for code 163 (MN of pleura) was 18% (20/113), that for code 162 (MN of trachea, bronchus, and lung) was 12% (14/113), and that for code 173 (other MN of skin) was 10% (11/113). The confirmation rates for codes 199, 163, 162, and 173 were 0.9% (42/4759), 14.3% (20/140), 0.03% (14/51,778), and 1.5% (11/717), respectively.Conclusion: ICD-9 codes 199, 163, 162, and 173 were most commonly used for MM deaths in Taiwan during the years before the ICD-10 introduction. However, when we used only ICD-9 code 163, which was most commonly used as a surrogate measure of MM in mortality studies during the ICD-9 era, we could detect only one-fifth of MM deaths in Taiwan.Keywords: International Classification of Diseases, Ninth and Tenth Revision, ICD-9, ICD-10, malignant mesothelioma, death certificate, bridge coding study, comparability study

Purpose: Epidemiological studies of primary subarachnoid hemorrhage (pSAH) frequently include population-based death registries for case finding. The positive predictive value of pSAH diagnoses in death registries is unknown.Methods: This cross-sectional study identified all people in Ontario, Canada with pSAH listed as a cause of death between 2013 and 2017. pSAH was classified as "very likely" if diagnosis of pSAH was confirmed by autopsy, there was a previous hospitalization where pSAH probability exceeded 85% or death was preceded within a week by an emergency room visit where pSAH probability exceeded 25%. pSAH was classified as "very unlikely" if previous cerebrovascular imaging had never been done. Remaining cases were classified as "pSAH status unknown".Results: 1,613 deaths attributed to pSAH were identified (mean 322/year). pSAH classification frequencies were as follows: very likely 528 (32.7%); very unlikely 433 (26.8%); and status unknown 652 (40.4%).Conclusion: We found that a quarter of pSAH cases in our province's death registry were very unlikely to be true pSAH while 40% had unknown veracity. These data should be considered when using death registries for pSAH case finding. [ABSTRACT FROM AUTHOR]

Le constat de décès est une responsabilité incombant à tout médecin. En cas de décès suspect, inattendu ou violent, l'obstacle médico-légal (OML) doit être coché sur le certificat de décès. Les études françaises publiées sur l'OML concernent exclusivement les médecins pré-hospitaliers. L'objectif principal de notre étude était d'évaluer les connaissances et les pratiques actuelles des médecins intra-hospitaliers concernant l'OML. Nous avons réalisé une étude descriptive, quantitative, multicentrique comprenant d'abord un recueil rétrospectif du nombre de certificats avec OML reçus à la chambre mortuaire du CHU d'Angers provenant de quatre hôpitaux du Maine-et-Loire (CHU d'Angers, CH de Cholet, CH de Saumur, CESAME) entre 2017 et 2020 puis un questionnaire anonyme adressé aux médecins thésés et internes de ces mêmes hôpitaux, les interrogeant sur leurs connaissances et expériences sur le sujet et comportant huit cas cliniques fictifs sur les situations les plus fréquemment rencontrées en pratique. Les réponses libres aux cas cliniques ont été classées en quatre catégories avec aussi la possibilité de répondre « ne sait pas ». De 2017 à 2020, 1,7 % (131/7484) des décès survenus au CHU d'Angers ont été concernés par un OML. Le questionnaire a permis de recueillir, au total, 386 réponses sur 1596 personnes contactées (24,2 %). Le frein principal à la pose d'un OML était une « méconnaissance globale sur l'OML » (80,1 % des participants). Avoir une formation antérieure en médecine légale était à l'origine d'une influence significative sur la pose d'OML. Presque 50 % des participants ne poseraient pas d'OML en cas de suspicion de faute durant la prise en charge. Tous cas cliniques confondus, la réponse majoritaire était la catégorie 1 (37 % des réponses). Notre étude apporte des résultats similaires aux publications actuelles de la littérature française concernant les médecins pré-hospitaliers. Un renforcement des connaissances des cliniciens sur l'OML et l'incitation à une prise d'avis auprès du légiste d'astreinte du CHU d'Angers sont à promouvoir. Notre étude a également permis d'aborder la problématique des situations de suspicions de faute médicale qui représentent une difficulté supplémentaire pour les médecins du fait du conflit d'intérêt généré et pour lesquelles le procédé d'OML semble peu adapté. The declaration of death is the responsibility of every clinician. In the case of a suspicious, unexpected or violent death, the "obstacle médico-légal" (OML) must be ticked off on the death certificate. Published French studies on the OML concern exclusively pre-hospital doctors. The main objective of our study was to evaluate the knowledge and current practices of in-hospital physicians regarding the OML. We carried out a descriptive, quantitative, multicentre study comprising firstly a retrospective collection of the number of certificates with OML issued in four hospitals in Maine-et-Loire (Angers University Hospital, Cholet Hospital, Saumur Hospital, CESAME) between 2017 and 2020, and then an anonymous questionnaire addressed to the post-graduate doctors and interns of these same hospitals, asking them about their knowledge and experience on the subject and including eight fictitious clinical cases on the situations most frequently encountered in practice. The free answers to the clinical cases were classified into four categories with the possibility of answering " I don't know ". From 2017 to 2020, 1.7% (131/7484) of deaths at Angers University Hospital were concerned by an OML. The questionnaire collected a total of 386 responses out of 1596 people contacted (24.2%). The main obstacle to the installation of an OML was a " general lack of knowledge about the OML " (80.1% of participants). Having previous training in forensic medicine had a significant influence on the placement of an OML. Almost 50% of the participants would not apply an OML if there was a suspicion of misconduct during care. In all clinical cases, the majority response was category 1 (37% of responses). The results of our study are similar to the current publications in the French literature concerning only pre-hospital doctors. The knowledge of clinicians about OML should be reinforced and they should be encouraged to seek advice from the on-call coroner at Angers University Hospital. Our study also addressed the problem of suspected medical malpractice situations, which represent an additional difficulty for doctors because of the conflict of interest generated and for which the OML procedure does not seem to be very suitable. [ABSTRACT FROM AUTHOR]

Copyright of Rechtsmedizin 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.)

Background: Reliable statistics on the underlying cause of death are essential for monitoring the health in a population. When there is insufficient information to identify the true underlying cause of death, the death will be classified using less informative codes, garbage codes. If many deaths are assigned a garbage code, the information value of the cause-of-death statistics is reduced. The aim of this study was to analyse the use of garbage codes in the Norwegian Cause of Death Registry (NCoDR).Methods: Data from NCoDR on all deaths among Norwegian residents in the years 1996-2019 were used to describe the occurrence of garbage codes. We used logistic regression analyses to identify determinants for the use of garbage codes. Possible explanatory factors were year of death, sex, age of death, place of death and whether an autopsy was performed.Results: A total of 29.0% (290,469/1,000,128) of the deaths were coded with a garbage code; 14.1% (140,804/1,000,128) with a major and 15.0% (149,665/1,000,128) with a minor garbage code. The five most common major garbage codes overall were ICD-10 codes I50 (heart failure), R96 (sudden death), R54 (senility), X59 (exposure to unspecified factor), and A41 (other sepsis). The most prevalent minor garbage codes were I64 (unspecified stroke), J18 (unspecified pneumonia), C80 (malignant neoplasm with unknown primary site), E14 (unspecified diabetes mellitus), and I69 (sequelae of cerebrovascular disease). The most important determinants for the use of garbage codes were the age of the deceased (OR 17.4 for age ≥ 90 vs age < 1) and death outside hospital (OR 2.08 for unknown place of death vs hospital).Conclusion: Over a 24-year period, garbage codes were used in 29.0% of all deaths. The most important determinants of a death to be assigned a garbage code were advanced age and place of death outside hospital. Knowledge of the national epidemiological situation, as well as the rules and guidelines for mortality coding, is essential for understanding the prevalence and distribution of garbage codes, in order to rely on vital statistics. [ABSTRACT FROM AUTHOR]

Objective: To evaluate mortality for Parkinson's disease (PD) in Italy during a long time period (1980-2015) and to discuss the role of possible general and specific influencing factors.Methods: Based on mortality data provided by the Italian National Institute of Statistics, sex- and age-specific crude mortality rates were computed, for the whole country and for its main geographical sub-areas. Rates were standardized using both direct (annual mortality rates AMRs) and indirect (standardized mortality rates SMRs) methods. SMRs were used to evaluate geographical differences, whereas AMRs and joinpoint linear regression analysis to study mortality trends.Results: Considering the entire period, highest mortality rates were observed in males (AMR/100,000: 9.0 in males, 5.25 in females), in North-West and Central Italy (SMR > 100). Overall PD mortality decreased from mid-eighties onwards and then rapidly reversed the trend in the period 1998-2002, rising up to a maximum in 2015, with some differences according to sex and geographical areas.Conclusions: Several factors may have contributed to the rapid inversion of decreasing trend in mortality observed in the last part of XX century. Possible explanations of this rising trend are related to the increasing burden of PD (especially in males and in certain Italian regions), caused by different factors as population aging, physiological prevalence rise due to incidence exceeding mortality, and growing exposure to environmental or occupational risk factors. In addition, the accuracy of death certificate compilation could account for geographical differences and for the temporal trend. The role of levodopa and recently introduced dopaminergic drugs is also discussed. [ABSTRACT FROM AUTHOR]

ObjectivesThe provide a descriptive analysis of the available population-level aggregated data on committed suicides in the Republic of Croatia, in the 2004–2018 period, showing emerging trends in suicide incidence focusing on sex/age/geographical distribution of suicides and the primary and secondary causes of suicide mortality, as well as making comparisons with similar neighboring neighboring countries.MethodsThe aggregated suicide data were obtained from the Croatian Committed Suicides Registry, a national registry maintained by the public health authority. The raw data extract was organized into tables according to several variables (age, sex, place of birth, place of residence, and cause of death). Simple descriptive statistics were performed on the structured data.ResultsDespite being among the highest in the world and EU, the number of committed suicides in Croatia is in decline since 2004. A higher number of suicides by males was observed when compared to females. Most of the suicides occur during spring and summer. The wealthier, northern continental region of the country had the highest average rate of committed suicides per 1,00,000 population, contrary to some of the findings in the published literature associating economic instability with suicide. The most common way to commit suicide for both sexes in all age groups is self-harm by hanging, strangulation and suffocation. Suicide by firearm and explosive devices discharge remains higher than the global average.ConclusionsDespite its steadily declining incidence rates in the past 20 years, suicides remain a major public health challenge in Croatia. Results may bolster the Ugro-Finnish suicide hypothesis, linking higher suicide rates to regions with populations of Hungarian descent.

Introduction Smoking-attributed mortality is increasing steadily in most developing countries. The aim of the study is to assess the reduction in smoking-associated mortality following cessation. Methods Death data were collected from 2016 to 2017. Cases were deaths from pre-defined diseases of interest (65298); controls were deaths from pre-defined non-smoking-related diseases (13527). Case versus control odds ratios for exsmokers versus smokers were calculated by age, sex, marital status and education with standardized logistic regression. These are described as mortality rate ratios (RRs, calculated as odds ratios), with a group-specific confidence interval (CI). The statistical analysis of the data was conducted from June to August 2019. Results For deaths from pre-defined non-smoking-related diseases at age 35–59 years, the RRs for quitting smoking 0–4, 5–9 or ≥10 years ago and never smoking were 0.66 (95% CI: 0.55–0.78), 0.58 (95% CI: 0.38–0.88), 0.61 (95% CI: 0.45– 0.82), and 0.43 (95% CI: 0.39–0.46), respectively. The same trend was found at ages 60–69 years and 70–79 years. Younger age of quitting (25–44 or 45–64 years) appeared to be associated with greater protection among the age groups: RR was 0.55 (95% CI: 0.42–0.74) and 0.67 (95% CI: 0.56–0.79), respectively, at age 35–59 years. Among the patients who died of lung cancer, the strong protective effect can only be observed when the duration of quitting is ≥10 years. The effect of smoking cessation on the risk of death from cardiovascular disease can be observed when the duration of quitting is 1–5 years. Conclusions Longer durations of smoking cessation are associated with progressively lower mortality rates from the diseases of interest, such as lung cancer and other smoking related cancers. For sustainable monitoring of tobacco-attributed mortality, smoking information over decades, such as smoking duration and quit smoking years, should be recorded during registration of death.

Background. Different types of death among people indicates both the extent to which people use different types of health care and the growth and development of a society. Premature mortality imposes a heavy burden on society in terms of health, economy, and mental issues. Given the preventability of these deaths, efforts are being made to reduce premature deaths by 25 percent m high level plans by 1404s. Methods. The purpose of this descriptive-analytical study, using death registration data, was to perform zoning of premature deaths in the cities supervised by Semnan University of Medical Sciences in Iran, it also investigated the factors affecting the premature deaths in order to reduce premature mortality especially among people at the age range of 30 to 69. Data were extracted based on the information of death certificates entered in the death registration system from 2013 to 2018. We, thus, studied 3619 registered deaths. The data were analyzed through SPSS software, using descriptive statistics (Relative Frequency, Mean, and Standard Deviation) and inferential tests (chi-square and independent t-test) according to the type of variables. The level of significance was set at 5 percent. Results. The mean and standard deviation of premature mortality was found to be 55.7 ± 10.6 and most of the deaths occurred in the seventh decade of their life. Premature mortality was more common among men, employed people, and urban residents. The major causes of premature mortality included cardiovascular diseases, cancer, and accidents. Conclusion. The results showed that accidents are the major cause of premature mortality at younger age, but they are gradually replaced by chronic and non-communicable diseases at the middle age. Therefore, in order to reduce the risk factors regarding premature mortality, collaboration of the related organizations is essential. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate errors on death certificates and factors associated with the occurrence of major errors. A retrospective analysis was conducted for six months in 2020 at a university training hospital. Errors were judged as major and minor errors according to the contribution to the process of determining the cause of death. Death certificates were classified into two groups with major errors (ME group) and without major errors (non-ME group). General characteristics of the death certificates, the main cause of death (cancer, cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, genitourinary disease, intentional self-harm, external causes, and other causes), the number of causes of deaths written on the death certificate, and major and minor errors were investigated. The ME group had 127 cases out of 548 death certificates. The number of causes of deaths written on the death certificates and the total number of errors were higher in the ME group than in the non-ME group. Cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, external causes, and other diseases as causes of deaths had higher risks of major errors on death certificates than cancer as a cause of death. The group with cancer as a cause of death had the lowest incidence of major errors and fewer causes of deaths. To reduce major errors, continuous education and feedback are needed for those who are qualified to issue a death certificate. [ABSTRACT FROM AUTHOR]