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European study on causes of death quality and comparability

European study on causes of death quality and comparability. E Jougla, G Pavillon INSERM – CépiDc - France Epidemiological Center on Medical Causes of Death. Automating coding systems for mortality data June 3-5, 2004 – Prague, Czech Republic. Summary.

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European study on causes of death quality and comparability

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  1. European study on causes of death quality and comparability E Jougla, G Pavillon INSERM – CépiDc - France Epidemiological Center on Medical Causes of Death Automating coding systems for mortality data June 3-5, 2004 – Prague, Czech Republic

  2. Summary 1. European Union data on causes of death statistics 2. Investigations on data quality and comparability 3. Differences due to the coding process

  3. Summary 1. European Union data on causes of death statistics

  4. Causes of death data Dissemination at national and regional level (Eurostat – New Cronos) * numbers by 5 years age group * raw death rate and standardised death rate (total & 0-64 yrs)

  5. ”AVOIDABLE MORTALITY“ (Males <65 yrs 1994-1996)

  6. FOR FRANCE, PRIMARY PREVENTION AS A PRIORITY IN HEALTH PROGRAMS

  7. BUT NECESSITY TO ASSESS THE INTERNATIONAL COMPARABILITY AND QUALITY OF THE DATA

  8. Summary 2. Investigations on data quality and comparability

  9. Overall goal To improve the collection, analysis and dissemination of comparable COD statistics within European Union Three domains • Certification of Causes of death • Coding of Causes of death • Causes of death statistics Eurostat Task Force on Causes of Death Statistics (TF/COD) since 1997

  10. Report “Comparability and quality improvement of European causes of death statistics” (Eurostat, DG SANCO) Jougla et al. 2001 39 recommandations Litterature review on problems of comparability Exemple of methodologies to access the biases (suicide, cardio-vascular, cancer, respiratory diseases)

  11. Recommendations - Coverage - Confidentiality - General causes of death certification - Query practices - Training practices

  12. Recommendations projects 2003 "Training practices" Recommendation 33 : "Creation of a basic training course package should be developed as an international reference on certification" Call for tender ”EU training package on certification of causes of death“ manual and electronic (interactive on web) 2003 Other prority recommendations - Confidentiality practices - Coverage of causes of death

  13. 3. Differences due to the coding process Specific international coding studies Bridge coding ICD9/ICD10 Summary

  14. Specific international coding studies * Set of death certificates from different countries * Certificates coded by national offices and by a WHO reference centre

  15. Specific international coding studies Investigation rare - First study (1965 – 6 countries - 1000 certificates) - cancer (1978, 1986) - diabetes (1989)

  16. International coding studies - Cancer (1978,1986) * Random set of 1243 US death certificates mentioning cancer * Nine countries coded the 1243 death certificates Percy et al. Am J Epidemiol 1989, 129 : 934-946.

  17. International coding studies - Cancer (1986) Differences in the underlying cause of death with US coders at the 3-digit level Differences % 16 W Germany 15 France USSR 15 12 Netherlands 10 England 9 Brazil New Zealand 8 6 Canada Percy

  18. International coding studies - Cancer (1986) Underlying cause coded (certificates mentioning cancer) Other diseases (%) Cancer (%) Circulatory diseases (%) Country France 96 3 1 England 92 6 3 W Germany 92 6 3 New Zealand 91 8 8 Brazil 91 6 2 Netherlands 91 6 3 USSR 90 8 2 Canada 89 7 4 United States 88 7 5

  19. International coding studies - Cancer (1986) Comparison of published death rates with “corrected” rates Variation Published rates Corrected rates Country England 151 145 -4% Netherlands 146 142 -3% France 140 128 -9% New Zealand 140 137 -2% W Germany 137 131 -4% Canada 134 133 -1% Percy

  20. International coding studies - Diabetes (1989) * Random set of 200 death certificates mentioning diabetes from 9 EC countries * The 1800 certificates recoded by a WHO reference centre Jougla et al. Int J Epidem 1992, 21:343-351.

  21. International coding studies - Diabetes (1989) > 4 conditions reported (%) Possibility to apply the ICD General Rule (%) Country N Ireland 14 96 Scotland 10 92 Netherlands 28 86 Rep Ireland 18 84 France 32 64 W Germany 54 60 Switzerland 36 52 Belgium 8 36

  22. International coding studies - Diabetes (1989) Proportion of certificates with diabetes coded as the underlying cause Ratio (b/a) National Coding (a) (%) Reference coding (b) (%) Country Belgium 68 72 0.9 France 43 37 0.9 Rep. Ireland 41 34 0.8 Netherlands 35 22 0.6 Switzerland 28 30 1.1 Scotland 24 22 0.9 W Germany 24 30 1.2 N Ireland 7 18 2.5 Jougla

  23. Diabetes mortality rates per100 000 (1989) Country Male Female Netherlands 26 31 Switzerland 21 21 Rep Ireland 20 17 Belgium 17 24 W Germany 16 17 France 12 12 Scotland 11 9 N Ireland 5 3 Jougla

  24. * Impact of use of different ICD revisions Bridge coding “ICD9 / ICD 10”

  25. 1994 Denmark 1995 Switzerland 1996 Finland, Norway, Iceland 1997 Netherlands, Sweden 1998 Germany, Luxembourg 1999 Belgium, Spain 2000 France 2002 Greece, Italy 2002 Portugal, Austria 2000 United Kingdom 2003 Ireland ICD 9 - ICD 10 ICD 10 Date

  26. Example ”Bridge Coding - France“ Objective To document the changes Methods * Sample of 53 000 deaths in 1999 (1 out 10) - ICD9 + Manual coding - ICD 10 + Automatic coding (Styx) * Comparison based on the short 65 Eurostat list (compatible ICD9 - ICD10)

  27. Bridge coding - ICD9 / ICD10 by chapters Sample 1/10 – 1999 - France

  28. Bridge coding - ICD9 / ICD10 by chapters Sample 1/10 – 1999 - France

  29. Cancer – Death rates - France 1990-1999 (ICD9) - 2000 (ICD10)

  30. Pneumonia - Death rates - France 1990-1999 (ICD9) - 2000 (ICD10)

  31. Automating Coding Systems * To improve between-country comparability of coding * To document changes (coding, ICD revision or updates)

  32. Often due to ICD 10 Existing ACS : Sweden (1987), UK (1993), Italy (1995), France (2000)... Standard : ACME (NCHS) (necessity to adopt the same decision rules) Automatic coding systems in EU

  33. “Coding of causes of death in European Community 1998 Description of existing ACS and recommandations for the implementation of these systems “Production of methods and tools for improving causes of death statistics at codification level,” Specifications of a language independant system 2001 ACS Eurostat reports (Pavillon, Johansson et al.)

  34. IMPROVEMENT OF THE INTERNATIONAL COMPARABILITY AND QUALITY OF THE CERTIFICATION PROCESS

  35. European study on causes of death quality and comparability E Jougla, G Pavillon INSERM – CépiDc - France Epidemiological Center on Medical Causes of Death Automating coding systems for mortality data June 3-5, 2004 – Prague, Czech Republic

  36. France UK Fr/UK ”Avoidable“ mort 127,5 69,8 +85% Cancer lung 38,6 20,6 +90% Cirrhosis - alcoolism 22,3 11,7 +90% Cancer ”upper ways“ 17,3 7,8 +120% Suicides 21,0 11,2 +90% Traffic accidents 19,8 8,4 +140% Differences France / UK (Males <65 yrs – 1999)

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