Cause of Death Statistics
Cause of death statistics are an important component of a national health monitoring system. The death certificate is a source of information for local, regional and national mortality statistics. Overall, it provides a unique resource for assessing the burden of diseases in a population. Reliable mortality data in the national and regional statistics require precise and consistent cause of death coding. In turn, this coding depends on the correctness of cause of death diagnoses on the death certificate, and also on the correct completion of the certificate.
The difference in cardiovascular mortality between Russia and Norway is the largest in the world between two neighboring countries. However, it has been argued that a substantial number of deaths in Russia that have been ascribed to cardiovascular diseases may actually represent misclassified cases. As a result, the argument continues, this has led to overestimation of cardiovascular mortality in Russia. Moreover, the proportion of deaths in Russia that are subject to autopsy (and specifically forensic autopsy) is almost ten times greater than the relevant proportion in Norway, which provides unique research opportunities.
The goal of our part of the project is twofold. Firstly, we aim to determine whether practices of certifying death and coding causes of death differ between Russia and Norway. Secondly, if any differences are identified, we aim to find out whether they could provide a partial explanation for the gap in mortality between the two countries.
To answer these questions, four sub-studies have been planned. The first study compares coding practices in Russia with those of Norway, using a pre-defined set of excerpts from death certificates from Nordic and Baltic countries. The second study includes historical data from both Russia and Norway. This data provides the distributions of causes of death and proportions of “garbage codes” according to background variables such as the certifying authority, autopsy and the type of hospital.
The third study is a follow-up study that aims to find out the amount of information available to those people who certify deaths, and how they use this information. The fourth sub-study compares the procedures and results of forensic autopsies performed in Russia and Norway.
At present, the data has been collected for three of the four sub-studies, and this data is now being analysed.
Some of this work involves collaboration with other colleagues on the project making best use of existing data on mortality.