Le système d `information sur les causes médicales de décès

Mortality data production and use
« Methods and perspectives"
Eric Jougla - Grégoire Rey
Centre d’épidémiologie sur les causes médicales de décès
Inserm CépiDc - France
[email protected]
[email protected]
Données CépiDc : www.cepidc.inserm.fr
Certification électronique : www.certdc.inserm.fr
"BAPH Workshop on mortality data"
March, 1, 2013 - Brussels
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Background
Importance of mortality data
for public health monitoring
Example : suicide
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http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-30-08-357/EN/KS-30-08-357-EN.PDF
Quality, validity, comparability evaluation
Three levels
1. Medical certification
2. Diagnosis codification
3. Data base
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1. Medical certification
Certification process
- completion of the death certificate
- determination of the underlying cause of death
- transmission to the statistical office (centralized or not)
- specific procedures in case of "suspect or
unknown" cause of death
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1. Medical certification
Problems
Origin
Errors
* insufficient knowledge of the case
* misunderstanding of the certification
process
Ill defined
causes
* poor quality reporting
* insufficient knowledge of the case
* aging (multiple pathologies)
Unknown
causes
* lack of investigation
* pending after legal investigation
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1. Medical certification
Recommendations
- International death certificate (WHO)
- Module "manner of death"
- Certification training
- Feedback after legal investigation
- Queries to certifiers
- Electronic death certification
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1. Medical certification
Electronic death certification
- Contribution to alert systems
- Confidentiality reinforcement
- Quality of data improvement
(training module, online editing, online help…)
- Facility to send additional information
- Simplify the production of different documents
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2. Diagnosis codification
Codification process
- Coding of all diagnoses reported in the DC
- Selection of the underlying cause of death (ICD coding rules)
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2. Diagnosis codification
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Problems
Origin
Errors
Heterogeneity
* Manual coding
Complex
certificates
* Multiple chronic conditions (aging)
ICD changes
* ICD revisions and updates
2. Diagnosis codification
Recommendations
- Automated Coding System (international)
- Multiple cause coding
- Bridge coding
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2. Diagnosis codification
Automatic coding system (Iris)
Objective
- to improve quality and comparability of COD at international level
- to share experience and knowledge around a common tool
System
- language independant
- international knowledge base (decision tables…)
Organisation
- Core group (France, Germany, Hungary, Italy, Sweden)
- Iris Institute (German DIMDI) iris-institute.org
Implementation
Belgium (Flemish), Catalonia, Czech Republic, France, Germany, Israel,
Luxembourg, Norway, South Africa, Sweden
2013 : Canada, England-Wales, The Netherlands, Spain …
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2. Diagnoses codification
Bridge coding (ICD 9 manual - ICD 10 automated) - 1999 sample 1/10 - France
Cause
ICD 9
(a)
ICD 10
(b)
(b/a)
Infectious dis.
816
1 124
1.38
Nervous syst.
1 696
2 128
1.25
Endocrine dis.
1 715
1 932
1.13
Mental dis.
1 673
1 822
1.09
circulatory syst.
16 853
16 906
1.00
Cancer
14 974
15 078
1.01
Digestive syst.
2 612
2 430
0.93
Respiratory syst.
4 330
3 728
0.86
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3. Data base (checking - evaluation - correction)
Recommendations
- Editing (sex, age, rare diseases…)
- Monitoring (time trends…)
- Comparing with other data sources (medical files...)
- Evaluation (biases) - correction of the data
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3. Data base (checking - evaluation -correction)
Inquiry to the certifiers (representative sample - 2006 – France * )
Undetermined
intent
(64% suicide)
Unknown
causes
(16% suicide)
suicide underestimation : 9,4%
(number of suicides : 10 423 --> 11 405)
* Aouba A, Péquignot F, Camelin L, Jougla E.
Evaluation de la qualité et amélioration de la connaissance des données de mortalité par suicide.
Bul Epidémiol Hebd 2011;47-48:498-501
3. Data base (data analysis)
Recommendations
- Inequalities in mortality
- International comparaisons
- Multiple cause analysis
- Matching with other data base
- Specific grouping of COD (avoidable mortality…)
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3. Data base (data analysis)
Inequalities in mortality
- Male overmortality
- Social inequalities
- Socio-spatial disparities
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International comparisons
Standardized mortality rates (pour 100 000)
Males – All causes – Year 2010
Less than 65 yrs
> 65 yrs
Finlande
272,9
Danemark*
5 047,2
Portugal
268,2
Portugal
4 949,4
France
261,3
Finlande
4 653,6
Danemark*
243,8
Luxembourg
4 651,2
Autriche
237,3
Pays-Bas
4 538,3
Allemagne
232,9
Allemagne
4 450,7
Grèce
228,6
Autriche
4 442,5
Royaume-Uni
213,6
Irlande
4 400,1
Espagne
211,1
Norvège
4 390,2
Irlande
197,8
Suède
4 259,0
Luxembourg
187,6
Italie*
4 252,5
Italie*
184,7
Royaume-Uni
4 229,0
Norvège
183,8
Espagne
4 129,1
Pays-Bas
179,2
France
3 971,5
Suède
169,2
Suisse
3 924,3
Suisse
167,0
Grèce
3 253,5
Source : Eurostat 2010
3. Data base (data analysis)
Multiple causes analysis (number of deaths - 2010 - France)
Objectives
- to better apprehend the weight of a chronic pathology
- to improve between countries comparability
- to measure the association of causes of death at time of death
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3. Data base (data analysis)
Multiple causes analysis (number of deaths - 2010 - France)
Cause
Underlying
(a)
Multiple
(b)
(b/a)
Mental disorders
17 900
56 000
3,1
Diabetes
10 700
33 500
3,1
900
2 400
2,6
Digestive system
23 400
53 400
2,3
Nervous system
32 200
65 400
2,0
450
730
1,6
Circulatory system
142 500
248 500
1,7
Cancer
158 900
176 400
1,1
Asthma
HIV
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3. Data base (data analysis)
Matching with other data bases
- Census data files
(social analysis…)
- Hospital data files
(health care evaluation…)
- Health assurance data files
(pharmacoviligance, heath care evaluation…)
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3. Data base (data analysis)
Specific grouping of causes of deaths *
- amenable to health care
- preventable
- smoking related deaths
- alcohol related deaths
- ……..
* Eurostat TF on satellite lists - 2013
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Avoidable mortality *
Amenable to
Health care
Preventable
(2010 – males - Jougla)
(1998 – Nolte)
1. Sweden
2. Norway
3. France
4. Germany
5. Spain
6. Finland
7. Italy
8. Denmark
9. The Netherlands
10. Greece
11. Austria
12. Ireland
13. UK
14. Portugal
1. Sweden
2. Norway
3. The Netherlands
4. Italy
5. UK
6. Ireland
7. Greece
8. Spain
9. Germany
10. Denmark
11. Austria
12. Portugal
13. Finland
14. France
* Office for national statistics. Definitions of avoidable mortality. London, ONS, 2011.
http://www.networks.nhs.uk/nhs-networks/east-of-england-respiratoryprogramme/news/ons-consultation-on-avoidable-mortality-closes-12-april
Importance of International collaborations
Eurostat, WHO, CDC ICE...
* Certification -> death certificate form, E death certificate,
training module
* Codification -> ACS (MMDS, Iris), ICD updates (MRG)
training, discussion forum
* Data analysis -> Atlas, international comparability
International collaborations
Quality and comparability improvement of European causes
of death statistics (2001).
European Commission
DG Sanco Health Monitoring Program and Eurostat TF on causes of death
http://ec.europa.eu/health/ph_projects/1998/monitoring/fp_monitoring_1998_frep_04_en.pdf
39 Recommendations
- Coverage
- Confidentiality
- Organisation of statistics offices
- Infant COD certification
- General COD certification
- Query practices
- Training practices
- European collection of COD statistics
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