The value of cause of death data
Sources of cause of death statistics
The production of good-quality mortality statistics requires a system in which:
- All deaths are registered (with an assigned cause of death) by either the civil registration or the vital statistics systems, and that these two systems are integrated
- All deaths are medically certified using the WHO International Form of Medical Certificate of Cause of Death
- The underlying cause of death is correctly coded according to the rules and principles of the ICD-10.
The figure below shows different sources of COD data and how confident we are in the final diagnosis. Note that the categories aren’t mutually exclusive, in that an autopsy may occur as well as a physician medically certifying the death.
COD statistics in countries have typically originated from hospital records of inpatient deaths, consolidated at the district, subnational and national levels through various hospital information management systems. As discussed previously, hospital deaths are a biased source of COD data, as people die from different things in hospitals, as they do in communities.
A major challenge to quality COD statistics is that in low- and lower middle-income countries, a significant amount (two-thirds or more) of deaths take place outside of health facilities (see figure below). Most of these deaths are not registered in national CRVS systems or assigned a physician-certified COD. In these cases, there is a need for a verbal autopsy to provide information on the probable COD. Whether the COD is determined through medical certification or verbal autopsy, the aim is to generate usable statistics on causes of death that can inform public health decision making.
Mikkelsen L et al (2014). Strengthening vital statistics systems. Asia Pacific Observatory on Health Systems and Policies. 3:2.
World Health Organization (2014). Health facility information systems resource kit. Product of a Technical Consultation on Monitoring Results with Health Facility Information Systems. World Health Organization.