Health Statistics and Informatics An introduction to cause-of-death statistics Department of Health Statistics and Information Systems Presented by Doris

Health Statistics and Informatics

An introduction to cause-of-death statistics

Department of Health Statistics and Information Systems

Presented by Doris Ma Fat

([email protected])

Health Statistics and Information Systems

Tools and

way forward

Tools and

way forwardChallenges in collecting

and compiling good data

Challenges in collecting


Overview of cause of death


Outline of this presentation


Importance of cause-of-death statistics

Measure the health of a nation:• Provide levels and trends in mortality• Identify changes in mortality patterns

Guide public health programs• Set priorities for intervention programs

Research• Contribute to research e.g. smoking and

deaths from lung cancer.


Global interest in causes of death

United Nations Commission on Information and Accountability for Women’s and Children’s Health:

Recommendation 1:

" By 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes of death, and have well-functioning health information systems that combine data from facilities, administrative sources and surveys."


Globally only about 1/3 of all the deaths are reported to WHO


Africa and Asia: low number of reported deaths

Reported deaths v/s estimated deaths, 2007

0

7,000,000

14,000,000

21,000,000

28,000,000

35,000,000

Oceania NorthAmerica

LatinAmerica &Caribbean

Europe Africa Asia

Nu

mb

er o

f d

eath

s

ESTIMATED

REPORTED


Data on deaths by age, sex and cause not widely available


Sources of cause-of-death information

Civil registries Hospital recordsDemographic surveillance sitesSurveysCensus


Some examples of efforts towards compiling and analysing cause of death statistics in local

areas

•Demographic Surveillance Sites (DSS) collect cause of death – verbal autopsy


Health Facility based data collection

Data should be used with caution Data should be used with caution

• selection bias and coverageselection bias and coverage

• type of hospitals / wards includedtype of hospitals / wards included

• admission diagnoses and not admission diagnoses and not underlying underlying cause of deathcause of death


Civil registries based data collection

Existence of a legal framework: laws and regulations make it obligatory to register death -> the right to obtain a death certificate

Standards are followed: UN or WHO definitions and recommendations

Data collection is done as part of established government routine and continuous functions


Estimated coverage of civil registration and gross national income per head (int.

USD)

Source: WHO Counts?1 Lancet, 29 Oct 2007


Recording the cause of death at country level consists of several steps

DEATH

Physician certifies the cause of death

Death Certificate

Administrative and Demographic part

+ Medical Part

SUSPECT DEATH

AUTOPSY REQUEST

Forensic or medico-legal institutecertifies cause of death

Civil RegistrationCivil Status Office of

Municipality


Standards enhance the comparability of mortality data

The International Statistical Classification of Causes of Death and Related Health Problems (ICD) – to code and compare causes. Latest revision-> ICD-10

The International Form of Medical Certification of Cause of Death – to record all the conditions relating to the death

ICD rules – to select the underlying cause of death


Definition of the underlying cause of death

"the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury"


WHO recommends the use of the International Form of Medical Certification of

Cause of Death

Traumatic shock

AIDS

Internal injuries

Pedestrian hit by car


Tools and

way forward

Tools and




and compiling good dataOverview of

cause of death




Egypt: under-5 mortality data and estimated trend

Estimates line

VR data with good coverage

Vital registration data available since 1954


Egypt causes of death: Around half of all deaths are ill-defined -> problematic to

use

Proportion of defined causes v/s ill-defined causes

defined

infec

can

blood

endo

heart

resp

diges

genit

perin

symp

exter

Defined causes ill-defined

causes

Examples of ill-defined causes: cardiac arrest, heart failure, respiratory failure, unknown cause


Some potential sources of biases

Type of certifiers – authorised doctors/any medically qualified practitioner/nurses

Certification practice – variations in medical culture and cause of death attribution

Coding practices

Social stigma or pressures

Changes in ICD revision, e.g. from ICD-9 to ICD-10


Mauritius – Trends in mortality from diabetes

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

2006

2009

cru

de

dea

th r

ate

per

10

000

po

p

ICD-7 ICD-8 ICD-10

ICD-9


South Africa – issues with HIV deaths

0

1000

2000

3000

4000

5000

6000

0 5 15 25 35 45 55 65 75 85

age

No

of

dea

ths

1993

1996

2008

0

500

1000

1500

2000

2500

3000

3500

4000

0 5 15 25 35 45 55 65 75 85

age

No

of

dea

ths

1993

1996

2008

Diarrhoea - maleAcute respiratory infections - female


Tools and

way forward

Tools and









Tools available

• Assessment tool: "Improving the quality and use of birth, death and cause-of-death information"

• http://whqlibdoc.who.int/publications/2010/9789241547970_eng.pdf

• ICD-10 electronic training tool :Facilitates the implementation of the

International Classification of Diseases http://apps.who.int/classifications/apps/icd/icd10training/

• ANACOD – Analysing mortality levels and causes-of- death

builds analytical capacity to assess the quality of mortality statistics

Request for the tool, email: [email protected]



WHO Collaborating Centres for the Family of International Classifications

(WHO-FIC)

Established to assist WHO and users with the development and implementation of WHO-FIC classifications including ICD-10


ANACoD builds analytical capacity to assess the quality of mortality

statistics

Tool is an Excel-based application

Only knowledge of basic Excel commands required.

Basic understanding of ICD-10 is needed

All analyses are automated


Innovation to overcome infrastuctural barriers

mHealth or mobile health: the use of mobile devices to support practice of medical and public health

• Rapid rise of mobile phones in developing countries -> emergence of mHealth from preventing famine to delivery of health care services

• mHealth now gradually being used for alerting and considered for registering births and deaths


Mobile technology - components

Central data base

Data manager

External system user

Formatted sms or forms

Acc

ess

inte

rfac

e

Data management


Verbal autopsy to obtain cause of death

Interview conducted with the family members of the deceased using a standard questionnaire

Review of the responses to the questonnaire by a physician or computer-assisted algorithms to obtain the most probable underlying cause of death

WHO is currently developing a short version of

the questionnaire to use on mobile phones


In summary

Cause of death statistics are useful to understand which diseases kill and how many people die

Collection of cause-of-death data requires strong collaboration between Ministry of Health, Department of Civil Registration, National Bureau of Statistics

Cause of death collection done within a legal framework is more likely to be continuous

Innovation in information technology helps to overcome infrastructural barriers


Thank you

Documents

Health Statistics and Informatics An introduction to cause-of-death statistics Department of Health Statistics and Information Systems Presented by Doris