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Whether you're a CRVS expert or just starting to learn about CRVS systems, you will enjoy exploring our range of resources. Discover more about strengthening and innovating CRVS systems, plus learn from our countries' challenges, experiences and successes.


A composite metric for assessing data on
mortality and causes of death: the vital statistics
performance index THUMBNAIL
A composite metric for assessing data on mortality and causes of death: the vital statistics performance index

We created a Vital Statistics Performance Index, a composite of six dimensions of VS strength, each assessed by a separate empirical indicator. The six dimensions impacted the accuracy of data to varying extents. VS performance declines more steeply with declining simulated completeness than for any other indicator

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Authors: Phillips, D.E., et al. 

Publication date: 2014

Resource type: CRVS clearinghouse

Source: Population Health Metrics


Thumbnail for a global assessment paper
A global assessment of civil registration and vital statistics systems: monitoring data quality and progress

Increasing demand for better quality data and more investment to strengthen civil registration and vital statistics (CRVS) systems will require increased emphasis on objective, comparable, cost-effective monitoring and assessment methods to measure progress. We apply a composite index (the vital statistics performance index [VSPI]) to assess the performance of CRVS systems in 148 countries or territories during 1980–2012 and classify them into five distinct performance categories, ranging from rudimentary (with scores close to zero) to satisfactory (with scores close to one), with a mean VSPI score since 2005 of 0·61 (SD 0·31).

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Authors: Mikkelsen, L, Phillips, D E, AbouZahr, C, Setel, P W, de Savigny, D, Lozano, R et. al.

Publication date: 2015

Resource type: CRVS clearinghouse

Source: Lancet


A shortened verbal autopsy instrument for
use in routine mortality surveillance
systems thumbnail
A shortened verbal autopsy instrument for use in routine mortality surveillance systems

We used data from the PHMRC validation study. Using the Tariff 2.0 method, we first established a rank order of individual questions in the PHMRC VAI according to their importance in predicting causes of death. Second, we reduced the size of the instrument by dropping questions in reverse order of their importance. We assessed the predictive performance of the instrument as questions were removed at the individual level by calculating chance-corrected concordance and at the population level with cause-specific mortality fraction (CSMF) accuracy. Finally, the optimum size of the shortened instrument was determined using a first derivative analysis of the decline in performance as the size of the VA instrument decreased for adults, children, and neonates.

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Authors: Serina, P., et al.

Publication date: 2015

Resource type: CRVS clearinghouse

Source: BMC Medicine


Abstract: Assessing the quality of COD data in six high income countries thumbnail
Abstract: Assessing the quality of cause of death data in six high-income countries: Australia, Canada, Denmark, Germany, Japan and Switzerland

Reprint of abstract for paper assessing the policy utility of national cause of death data in six high-income countries with highly developed health information systems.

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Authors: Mikkelsen, L, Moesgaard Iburg, K, Adair, T, Furst, T, Hegnauer, M, von der Lippe, E, Moran, L, Nomura, S, Sakamoto, H, Shibuya, K, Wengler, A, Willbond, S, Wood, P, Lopez, A.

Publication date: December 2019

Resource type: CRVS clearinghouse

Source: Springer International


Advocating for civil registration: guide to developing a business case for civil registration thumbnail
Advocating for civil registration: guide to developing a business case for civil registration

Practical information on the six-step approach to preparing and using a business case in support of a civil registration system.

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Author: Schmider, A

Publication date: November 2010

Resource type: CRVS clearinghouse

Related resources: Summary: CRVS systems are good for your health

Source: Health Information Systems Knowledge Hub


An economic evaluation of data collection methods for vital statistics thumbnail
An economic evaluation of data collection methods for vital statistics

A systematic framework to guide investment decisions by donors and governments on methods of data collection for vital statistics.

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Authors: Soto EJ, Nguyen KH, Dettrick Z, Hodge A, Lopez AD

Publication date: June 2013

Resource type: CRVS clearinghouse

Related resources: A framework for evaluating national CRVS systems at baseline

Source: Health Information Systems Knowledge Hub


Assessing the production, quality and use of national vital statistics: a case study of the Philippines thumbnail
Assessing the production, quality and use of national vital statistics: a case study of the Philippines

Findings from the review of the CRVS system in the Philippines (2009), which helped to understand how the system worked and identifying weaker areas.

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Authors: Hufana L, Catija J, Morante L, Lopez J, Tan CL, Mikkelsen L, Aung E

Publication date: Nov 2009

Resource type: CRVS clearinghouse

Related resources: Improving civil registration and vital statistics systems - Lessons learned from the application of health information tools in Asia and the Pacific


Avaliação da qualidade dos dados sobre mortalidade no 18 Brasil de 2000 a 2016 thumbnail
Avaliação da qualidade dos dados sobre mortalidade no 18 Brasil de 2000 a 2016

Chapter 18 of 'SAÚDE BRASIL 2018 - Uma análise da situação de saúde e das doenças e agravos crônicos: desafios e perspectivas'.

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Better health intelligence: a new era for civil
registration and vital statistics? thumbnail
Better health intelligence: a new era for civil registration and vital statistics?

The impetus and opportunities for improving birth, death, and cause of death data have never been more propitious. Renewed country commitment to strengthen vital registration systems is clearly evident, supported by nascent regional coalitions of technical and development organisations. The announcement of a major new investment by Bloomberg Philanthropies to strengthen data systems and capacity in selected countries has the potential to catalyse and realise significant improvements in the availability and quality of data for health. This will require technical leadership, strategic intervention choices, strong country partnerships, and efficient delivery and management of multiple technical interventions across participating countries.

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Authors: Lopez, A.D., and Setel, P.W.

Publication date: 2015

Resource type: CRVS clearinghouse

Source: BMC Medicine


Flaxman_thumbnail
Collecting verbal autopsies: improving and streamlining data collection processes using electronic tablets

As countries increase verbal autopsy surveillance, it is important to consider the best way to design sustainable systems for data collection. Electronic data capture has the potential to greatly reduce the time and costs associated with data collection. For long-term, large-scale surveillance required by national vital statistical systems, electronic data capture reduces costs and allows data to be available sooner. This study collected verbal autopsy interviews using paper and pencil, and using electronic tablets at two sites, and measured the cost and time required to process the surveys for analysis.

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Authors: Flaxman AD, et al

Publication date: 2018

Resource type: CRVS clearinghouse

Source: Population Health Metrics. 2018; 16(3) [creative commons attribution license https://creativecommons.org/licenses/by/4.0/]


Estimating the completeness of death registration: An empirical method
Estimating the completeness of death registration: An empirical method

Many national and subnational governments need to routinely measure the completeness of death registration for monitoring and statistical purposes. Existing methods, such as death distribution and capture-recapture methods, have a number of limitations such as inaccuracy and complexity that prevent widespread application. This paper presents a novel empirical method to estimate completeness of death registration at the national and subnational level.

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Authors: Adair T, Lopez AD

Publication date: May 2018

Resource type: CRVS clearinghouse

Related resources: Summary: A new method for estimating the completeness of death registration

Source: PLoS ONE


Hospital cause-of-death statistics: what should we make of them? thumbnail
Hospital cause-of-death statistics: what should we make of them?

Recommends the implementation of interventions to rapidly improve knowledge about the true causes of death in populations and avoid basing policy on flawed data.

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Authors: Rasika Rampatige, Lene Mikkelsen, Bernardo Hernandez, Ian Riley & Alan D Lopez

Publication date: 2014

Resource type: CRVS clearinghouse

Source: Bulletin of the World Health Organization


How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data thumbnail
How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data

Since 1980, approximately one billion births were registered and shared in public databases. Compared to estimates of fertility, this represents only 40.0% of total births in the peak year, 2011. Approximately 74 million births (53.1%) per year occur in countries whose systems do not systematically register them and release the aggregate records. Considering data quality, timeliness, and completeness in country-years where data are available, only about 12 million births per year (8.6%) occur in countries with high-performing registration systems. This study highlights the gaps in available data.

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Authors: Phillips DE, Adair T, Lopez AD

Publication date: 2019

Resource type: CRVS clearinghouse

Source: Population Health Metrics. 2019; 16(21) [creative commons attribution license https://creativecommons.org/licenses/by/4.0/]


Implementing the PHMRC shortened
questionnaire: Survey duration of open and
closed questions in three sites thumbnail
Implementing the PHMRC shortened questionnaire: Survey duration of open and closed questions in three sites

We use the PHMRC shortened questionnaire to conduct verbal autopsy interviews at three sites and collect data on the length of time required to complete the interview. This instrument uses a novel checklist of keywords to capture relevant information from the open response.

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Authors: : Flaxman AD, Stewart A, Joseph JC, Alam N, Alam S, Chowdhury H, et al.

Publication date: 2017

Resource type: CRVS clearinghouse

Source: PLoS ONE


Improving civil registration and vital statistics systems-Lessons learned from the application of health information tools in Asia and the Pacific
Improving civil registration and vital statistics systems - Lessons learned from the application of health information tools in Asia and the Pacific

A review of the application of the comprehensive CRVS assessment tool in Asia and the Pacific.

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Author: Mikkelsen, L 

Publication date: December 2012

Resource type: CRVS clearinghouse

Related resources: Assessing the production, quality and use of national vital statistics: a case study of the Philippines

Source: Health Information Systems Knowledge Hub


Improving COD certification practices in the Pacific
Improving COD certification practices in the Pacific

Findings of study to determine the efficacy and accessibility of the certification module of the WHO's web-based ICD training tool.

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Authors: Walker S, Rampatige R, Wainiqolo I, Aumua A

Publication date: April 2011

Resource type: CRVS clearinghouse

Related resources: Improving civil registration and vital statistics systems - Lessons learned from the application of health information tools in Asia and the Pacific

Source: Health Information Systems Knowledge Hub


Improving performance of the Tariff
Method for assigning causes of death to
verbal autopsies thumbnail
Improving performance of the Tariff Method for assigning causes of death to verbal autopsies

Tariff 2.0 addresses the main shortcomings of the application of the Tariff Method to analyze data from VAs in community settings. It provides an estimation of COD from VAs with better performance at the individual and population level than the previous version of this method, and it is publicly available for use.

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Authors: Serina, P., et al.

Publication date: 2015

Resource type: CRVS clearinghouse

Source: BioMed Central


Is the long-term decline in cardiovasculardisease mortality in high-income countries
over? Evidence from national vital statistics thumbnail
Is the long-term decline in cardiovasculardisease mortality in high-income countries over? Evidence from national vital statistics

We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35–74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study.

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Authors: Lopez, A.D., and Adair, T.

Publication date: 2019

Resource type: CRVS clearinghouse

Source: International Journal of Epidemiology


Measuring causes of death in populations:
a new metric that corrects cause-specific
mortality fractions for chance thumbnail
Measuring causes of death in populations: a new metric that corrects cause-specific mortality fractions for chance

We developed a baseline approach of random allocation and measured its performance analytically and through Monte Carlo simulation. We used this to develop a new metric of population-level estimation accuracy, the Chance Corrected CSMF Accuracy (CCCSMF Accuracy), which has value near zero for random guessing, and negative quality values for estimation methods that are worse than random at the population level.

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Authors: Flaxman, A., et al.

Publication date: 2015

Resource type: CRVS clearinghouse

Source: Population Health Metrics


Brazil
Meeting on strengthening the quality of information on causes of death in Brazil

The objective of the meeting was to discuss the improvement of the quality of the information on causes of death in Brazil, with the participation of the three spheres of Government, Civil Society, Universities, and International Institutions. This report summarises the main outcomes of the meeting, including each of the main sessions, comments from participants, and links to additional resources.

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Publication date: October 2017

Resource type: CRVS clearinghouse

Related resources: Fellowship profile: Investigating garbage codes to improve mortality statistics in Brazil

Source: Secretariat of Health Surveillance, Ministry of Health, Brazil


Performance of InSilicoVA for assigning
causes of death to verbal autopsies:
multisite validation study using clinical
diagnostic gold standards thumbnail
Performance of InSilicoVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards

We perform a standard procedure for analysing the predictive accuracy of verbal autopsy classification methods using the same data and the publicly available implementation of the algorithm released by the authors. We extend the original analysis to include children and neonates, instead of only adults, and test accuracy using different sets of predictors, including the set used in the original paper and a set that matches the released software.

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Authors: Flaxman, A.D., et al. 

Publication date: 2018

Resource type: CRVS clearinghouse

Source: BMC Medicine


Promoting the periodic assessment of the quality of medical records and cause-of-death data
Promoting the periodic assessment of the quality of medical records and cause-of-death data

A rare look into the validation of cause of death information from routine reporting systems.

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Authors: Rampatige R, Mikkelsen L, Gamage S, Peiris S

Publication date: November 2009

Resource type: CRVS clearinghouse

Related resources: Assessing the production, quality and use of national vital statistics: a case study of the Philippines


Rapid assessment of vital statistics systems
Rapid assessment of vital statistics systems

Evaluation of the application of the WHO/Health Information Systems Knowledge Hub tool in 26 countries in the Asia–Pacific region.

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Author: Mikkelsen L

Publication date: November 2010

Resource type: CRVS clearinghouse

Related resources: Improving civil registration and vital statistics systems - Lessons learned from the application of health information tools in Asia and the Pacific


Robustness of the Tariff method for diagnosing verbal autopsies: impact of additional site data on the relationship between symptom and cause thumbnail
Robustness of the Tariff method for diagnosing verbal autopsies: impact of additional site data on the relationship between symptom and cause

Verbal autopsy (VA) is increasingly being considered as a cost-effective method to improve cause of death information in countries with low quality vital registration. VA algorithms that use empirical data have an advantage over expert derived algorithms in that they use responses to the VA instrument as a reference instead of physician opinion. It is unclear how stable these data driven algorithms, such as the Tariff 2.0 method, are to cultural and epidemiological variations in populations where they might be employed. VAs were conducted in three sites in the Philippines, Bangladesh and Papua New Guinea as part of the Improving Methods to Measure Comparable Mortality by Cause (IMMCMC) study. Similar diagnostic criteria and cause lists as the Population Health Metrics Research Consortium (PHMRC) study were used to identify gold standard deaths. This paper presents the assessment of changes in Tariffs by examining the proportion of Tariffs that changed significantly after the addition of the IMMCMC dataset to the PHMRC dataset.

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Authors: Chowdhury, H, Flaxman, A, Joseph, J, Hazard, R, Alam, N, Riley, I, Lopez, A

Publication date: December 2019

Resource type: CRVS clearinghouse

Source: BMC Medical Research Methodology 


Strategic planning to strengthen civil registration and vital statistics systems
Strategic planning to strengthen civil registration and vital statistics systems

Guidance for using findings from a comprehensive assessment.

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Author: Mikkelsen L

Publication date: September 2012

Resource type: CRVS clearinghouse

Source: Health Information Systems Knowledge Hub


Strengthening civil registration and vital statistics for births, deaths and causes of death: Resource Kit thumbnail
Strengthening civil registration and vital statistics for births, deaths and causes of death: Resource Kit

This Resource Kit is designed to support countries in planning and implementing improvements to their civil registration and vital statistics (CRVS) systems. It has been compiled using critically assessed materials drawn from many sources, and is presented in a user-friendly way that is accessible to both experts and users with a general interest in evidence-based decision-making. The Resource Kit will enable all users to identify, locate and make use of core standards, tools, materials and country experiences.

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Authors: Lopez, A, Mikkelsen, L, Rampatige, R, Upham, S, AbouZahr, C (Consultant to Health Information Systems Knowledge Hub, School of Population Health, Gamage, S,  de Savigny, D, Schmider, A

Publication date: 2013

Resource type: CRVS clearinghouse

Source: World Health Organisation. Financial support was received from the Health Metrics Network hosted by WHO, and from the Health Information Systems Knowledge Hub, School of Population Health, University of Queensland, supported by the Australian Government


Strengthening health information systems in the Asia-Pacific region thumbnail
Strengthening health information systems in the Asia-Pacific region

Aims, objectives and contributions of the Health Information Systems Knowledge Hub at the University of Queensland, 2008-2013

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Author: HIS Knowledge Hub

Publication date: October 2013

Publication type: CRVS clearinghouse

Source: Health Information Systems Knowledge Hub


Strengthening mortality data for health policy and planning: the Bloomberg Data for Health Initiative in Latin America thumbnail
Strengthening mortality data for health policy and planning: the Bloomberg Data for Health Initiative in Latin America

This paper charts efforts and outcomes achieved through the Bloomberg Data for Health Initiative to improve mortality data in four Latin American countries since 2014: Brazil, Peru, Ecuador and Colombia.

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Authors: McLaughlin, D and Lopez, A

Publication date: December 2019

Resource type: CRVS clearinghouse

Related resources: Strengthening mortality data for health policy and planning: the Bloomberg Data for Health Initiative in Latin America [Portuguese] 

Source: Rev. bras. epidemiol. vol.22  supl.3 Rio de Janeiro  2019  Epub Dec 05, 2019


Symptom recall and the diagnostic accuracy of verbal autopsies
Symptom recall and the diagnostic accuracy of verbal autopsies

Determines how recall of item responses varied between interviews over time and how much loss of recall affected the accuracy of CSMFs.

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Authors: Serina P, Riley I, Hernandez B, Freeman M, Praveen D, Tallo V, Joshi R, Sanvictores D, Murray CJL, Lopez AD

Publication date: September 2013

Resource type: CRVS clearinghouse

Related resources: Intervention: Automated verbal autopsy

Source: Health Information Systems Knowledge Hub


Systematic review of statistics on causes of deaths in hospitals:
strengthening the evidence for policy-makers thumbnail
Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

We searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system.

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Authors: Rampatige, R., et al.

Publication date: 2014

Resource type: CRVS clearinghouse

Source: Bulletin of the World Health Organization


The quality of medical death certification of cause of death in hospitals in rural Bangladesh thumbnail
The quality of medical death certification of cause of death in hospitals in rural Bangladesh

Accurate and timely data on cause of death are critically important for guiding health programs and policies. Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death certification practices and medical record quality was poor. There is an urgent need to improve death certification practices and the quality of hospital data in Bangladesh if these data are to be useful for policy.

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Authors: Hazard RH, Chowdhury HR, Adair T, Ansar A, Quaiyum Rahman AM, Alam S, Alam N, Rampatige R, Streatfield PK, Riley ID, Lopez AD

Publication date: 2017

Resource type: CRVS clearinghouse

Related resources: Strategies for improving the quality of cause of death data in hospitals

Source: BMC Health Services Research


The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0 thumbnail
The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0

This VA instrument offers the opportunity to harmonise the automated diagnostic algorithms in the future

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Authors: Nichols, E, Byass, P, Chandramohan, D, Clark, S, Flaxman, A, Jakob, R, Leitao, J, Maire, N, Rao, C, Riley, I, Setel, P

Publication date: January 2018

Resource type: CRVS clearinghouse

Source: Plos Medicine


Using verbal autopsy to measure causes of death:
the comparative performance of existing
methods thumbnail
Using verbal autopsy to measure causes of death: the comparative performance of existing methods

Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. This study investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established.

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Authors: Murray, C.J., Lozano, R., Flaxman, A.D., et al.

Publication date: 2014

Resource type: CRVS clearinghouse

Publication source: BMC Medicine


What is the optimal recall period for verbal
autopsies? Validation study based on
repeat interviews in three populations thumbnail
What is the optimal recall period for verbal autopsies? Validation study based on repeat interviews in three populations

This study used information from the Population Health Metrics Research Consortium (PHMRC) Study, which collected VAs for “gold standard” cases where cause of death (COD) was supported by clinical criteria. This study repeated VA interviews within 3–52 months of death in PHMRC study sites in Andhra Pradesh, India, and Bohol and Manila, Philippines.

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Authors: Serina, P., et al.

Publication date: 2016

Resource type: CRVS clearinghouse

Source: Population Health Metrics


Thumbnail for widening inequalities in premature mortality in Australia document
Widening inequalities in premature mortality in Australia, 2006-16

This study uses Australian death registration data from 2006-2016 to measure the extent of and change in inequalities in premature mortality (under 75 years) by socio-economic status and remoteness.

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Authors: Adair, T, Lopez, A

Publication date: May 2020

Resource type: CRVS clearinghouse

Source: Australian Population Studies

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