International Comparisons of Proportion of Unspecified External Causes of Death

1. International Comparisons of Proportion of Unspecified External Causes of Death Tsung-Hsueh (Robert) Lu, MD, MPH Institute of Public Health, College of Medicine National Cheng Kung University, Tainan, Taiwan robertlu@mail.ncku.edu.tw

2. April 2003 Sep 1999 Nov 1996

3. 台灣多重死因中文診斷自動化輸入系統 MADE in Taiwan Multiple-cause-of-death Automated Data Entry System , 2004 version

8. Introduction • IDEALLY, external causes of death (ECD) provide information of circumstances related to the occurrence of injury events, which provide important information for injury prevention. (Users) • REALISTICALLY, certifiers (medical examiners and coroners) did not provide sufficient information for ideal external causes coding. (Producers)

9. Transport accidents V243 Circumstances of the event and the role of the victim Transport accidents Mode of transport of the victim Mode of transport of counterpart

10. Example One Accidental head injury ECD: X59 exposure to unspecified factor

11. Example Two Head injury Transport accident ECD: V99 unspecified transport accident

12. Example Three Head injury Motorcyclist in collision with bus ECD: V244 motorcycle rider injured in collision with heavy transport vehicle or bus

13. Research Questions • What’s the proportion of injury deaths of which the information reported could only be coded as “unspecified”? ---- an indicator of insufficiency of specific information the certifiers reported on the death certificates • Did this proportion differ by country? • Did this proportion differ by ECD?

14. Materials & Methods • The number of deaths registered in the year 2001 for each three-character code in Chapter XX (External causes of morbidity and mortality) of the ICD-10 were provided by four countries participating in the ICE (International Collaborate Efforts on Automating Mortality Statistics), i.e., Australia, Sweden, Taiwan and the United States.

15. Materials & Methods (cont.)

16. Results • Sweden (32.5%) had the highest proportion of unspecified code (ICD-10 code X59), followed by Australia (16.6%), Taiwan (13.2%) and the USA (7.2%). • The percentage of unspecified code was relatively high in falls and unintentional drowning and was relatively low in accidental poisoning, intentional self-harm and event of undetermined intent.

17. Results (cont.) • Sweden had highest unspecified percentage (63.7%) of deaths from falls, followed by Australia with 55.5%, the USA (50.9%) and Taiwan (49.1%). The proportion increased with age in each country (Table 2). • Taiwan had an extremely high percentage of unspecified codes in transport accidents (86.5%), accidental drowning (98.7%) and fire and flame (98.7%).

18. Persons? Why the % in Aus & Swe are relatively high compared with US? Why the % in Aus & Swe are relatively low compared with US? Why all countries had relatively high % in falls?

19. Explaining the variations • Differences in the system of medical examiners and coroners? • Differences in the training of medical examiners and coroners? • Differences in the format of death certificate? • Differences in the query system?

24. Taiwan’s attempts to improve • Communicating with the medical examiners, coroners, and prosecutors. • Querying the certifiers for more specific information for coding. • Revising the format of death certificate. • Interviewing the families of the deceased to collect detail information. • Building the National Coroners Information System like those in Australia

25. Conclusions • According to our findings, there were certain gaps between the ‘ideal’ and the ‘reality’ in classifying injury deaths among the four ICE participating countries. • Should the ‘users’ slow down the pace a little bit and spend more time with the ‘producers’ to improve the quality of data entry?

26. Comments are needed! Persons? Why the % in Aus & Swe are relatively high compared with US? Why the % in Aus & Swe are relatively low compared with US? Why all countries had relatively high % in falls?