European Commission - Public Health: healthindicators.org

DOCUMENTATION SHEET FOR:

Indicator: 13. Disease-specific mortality

SHORTLIST sub-division: B) Health status

Status: implementation section

Date last modification documentation sheet: 09-08-2010

PDF version of documentation sheet

Operational indicators (Excel-file)

Definition

Deaths caused by specific diseases or disease groups per 100,000 inhabitants for the following ICD-10 codes:

Calculation

Number of deaths per 100,000 inhabitants (age-standardized rates). The (age-)standardized death rate is a weighted average of age-specific mortality rates. The weighting factor is the age distribution of a standard reference population. Standardization is carried out through the direct method. The standard reference population used is the European standard population as defined by the World Health Organisation (WHO). The annual average population available in Eurostat's demography database is used to calculate the rates.

Relevant dimensions and subgroups

• Calendar year
• Country
• Region (according to ISARE recommendations; see data availability)
• Sex

Preferred data type and data source

Preferred data type

Causes of death registries (administrative data)

Preferred data source

• For all selected ICD-10 groups except HIV/AIDS: Eurostat
• Preferred source for HIV/AIDS: CISID database (based on EuroHIV data collection)

Data availability

Time series for most EU-27 countries and EFTA (without Liechtenstein) are available in the Eurostat database from 1994 onwards. Regional data (NUTS level 2) are available for most of the countries (i.e. not completely in accordance with ISARE recommendations). Regional mortality data (age/sex breakdown of deaths by cause) have also been collected by the ISARE-3 project on regional data.

Data for “Deaths among AIDS cases - Incidence (cases per 100 000 population)” are available in CISID as of 1999 (provided by EuroHIV) for all EU-27 countries and for Albania, Bosnia & Herzegovina, Croatia, Iceland, Norway, Moldova, Serbia, Switzerland and FYR Macedonia.

Data periodicity

• Eurostat data are updated annually. Eurostat asks for the submission of final data for the year N at N+18 months. However, a number of countries still faces difficulties with this timetable and delivers data at their earliest convenience.
• Annual data on deaths among AIDS cases are available in CISID.

Rationale

Data on causes of death provide information on mortality patterns and form a major element of public health information necessary for planning of prevention and health care, and for the evaluation of policies.

Remarks

• ECHIM does not require mortality data by age group and by Socio-Economic Status (SES) to reduce number of indicator operationalisations. For further details on SES, see Eurothine project.
• Causes of death (COD) data are derived from death certificates. The medical certification of death is an obligation in all Member States. Countries code the information provided in the medical certificate of cause of death into International Classification of Diseases (ICD) codes according to the rules specified in the ICD10.
• COD data refer to the underlying cause which - according to the World Health Organisation (WHO) - is "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".
• The ICD-10 categories used in this indicator are based on the codes used in the Eurostat 65CoD shortlist. Note that there are discrepancies between the ICD codes relating to cancer in the Eurostat 65CoD list, which are used for this indicator, and the codes used for the cancer categories in Indicators 20 & 78.
• For AIDS mortality EuroHIV is the preferred source because countries report data to EuroHIV from national AIDS monitoring systems. These include confirmed AIDS cases, i.e. they are more accurate than routine vital statistics system (death certificates), because the accuracy and standardization of coding included on death certificates is much lower.
• EuroHIV project ended by 31 December 2007. As of that date ECDC and the WHO Regional Office for Europe (WHO/Europe) jointly coordinate HIV/AIDS surveillance in Europe. Data on HIV infections and AIDS diagnoses are collected in the joint database for HIV/AIDS surveillance.
• EuroHIV data on HIV/AIDS are not reported according to ICD-10. For EuroHIV cases are reported according to a uniform AIDS case definition originally published in 1982 and revised in 1985, 1987 and, for adults and adolescents (13 years and over), in 1993 (see references).
• Mortality data from Eurostat are age-standardized but data from CISID are probably not age-standardized as rates in EuroHIV report No. 75 were also not age-standardized. As most causes of death vary significantly with people's age and sex, the use of standardized death rates improves comparability over time and between countries.
• A new Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was signed by the European Parliament and the Council on 16 December 2008. This Regulation is the framework of the data collection on the domain. Within the context of this framework Regulation, a specific Implementing Measure is currently being developed - within the ESS - on Causes of Death statistics and, according to forthcoming agreement with the member States, Implementing Measures for other domains will follow.

References

• Health Indicators in the European Regions (ISARE) project
• Eurostat database, Causes of death - Standardized death rate (per 100,000 inhabitants)
• CISID database, for “Deaths among AIDS cases - Incidence (cases per 100 000 population)”
• Eurostat metadata on causes of death
• International Classification of Diseases (ICD)
• Metadata European Shortlist for Causes of Death 1998
• Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work
• EUROTHINE. Tackling health inequalities in Europe: an integrated approach. EUROTHINE Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam, 2007.
• European Centre for the Epidemiological Monitoring of AIDS. 1993 revision of the European AIDS surveillance case definition. AIDS Surveillance in Europe, Quarterly Report 1993; No. 37: 23-28.
• European Centre for the Epidemiological Monitoring of AIDS. European case definition for AIDS surveillance in children - revision 1995. HIV/AIDS Surveillance in Europe, Quarterly Report 1995; No. 48: 46-53.

Work to do

Wait for information from WHO/CISID and process in documentation sheet (request for clarification on age-standardization yes/no pending at WHO-Euro).