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The value of cause of death data

Medical certification of cause of death

Coding causes of death to statistical categories
The International Classification of Diseases

Cause of death: where there is no physician
Verbal autopsy diagnostic algorithms

Automated verbal autopsy
What is automated verbal autopsy and how does it differ from medical certification of cause of death?

Incorporating verbal autopsy into the civil registration and vital statistics system

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The value of cause of death data

Uses of cause of death statistics

COD information can be used in many ways to evaluate the health of local, regional and national populations. COD information is commonly used to:

  • Describe and explain levels, trends and differentials in mortality
  • Identify emerging diseases and conditions
  • Track changes in the burden of disease in different population subgroups
  • Guide priorities for intervention programs
  • Monitor the impact of health programs
  • Identify and contribute to epidemiological, sociomedical and biomedical research priorities
  • Allocate and distribute resources within the health sector.

As shown in Introduction to CRVS back to basics, time series data on causes of death, produced in the same way for different countries, are of enormous value in understanding evolving patterns of mortality and stimulating health authorities to introduce interventions to combat rises in preventable mortality.

Perhaps the most eloquent example is how rising lung cancer mortality rates alerted health researchers to the possible link with an upsurge in smoking prevalence that occurred some 20 years earlier. This epidemiological evidence, coupled with research findings on the biological effects of tobacco use, provided the evidence base for acting to reduce tobacco use. Subsequent falls in smoking prevalence have since been reflected in declines in lung cancer mortality around the world. 

This kind of analysis has implications far beyond the health sector. For example, the rising toll of deaths due to road traffic accidents led to a range of measures across sectors, such as the introduction of seat belts, improvements in vehicle and road design, and strict limitations on alcohol consumption. More recently, evidence of the negative health impact of environmental pollution on health is being used to introduce measures to improve air and water quality.

death_rate_motor_vehicle_accidents

Source: ABS, 2007, GRIM Database

One of the most striking health trends of recent decades has been a shift in the underlying causes of death and disease around the world. This so-called ‘health transition’ affects men, women and children in all countries and stems from changes in three interrelated and mutually reinforcing elements – demographic structures, patterns of disease and risk factors.

  • The demographic transition is characterised by lower mortality rates among children under five years and declining fertility rates which result in an ageing population. 
  • The epidemiological transition reflects a shift in the main causes of death and disease away from infectious diseases such as diarrhoea and pneumonia (diseases traditionally associated with poorer countries) towards noncommunicable diseases such as cardiovascular disease, stroke and cancers (long considered to be burden of richer countries). 
  • The risk transition is characterised by a reduction in risk factors for factors like infectious diseases, undernutrition, unsafe water and poor sanitation, and an increase in risk factors for chronic diseases (such as being overweight, and use of alcohol and tobacco).

This health transition, which is occurring at different rates in different population groups and in different countries, is increasing the demand for reliable and timely data on causes of death.

Demographic_change_graph_Sweden

Source: Montgomery Keith. The Demographic Transition . University of Wisconsin Colleges website. Data from: Chesnais J C (1992). The demographic transition: Stages, patterns, and economic implications : a longitudinal study of sixty-seven countries covering the period 1720-1984. Oxford [England: Clarendon Press.


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