Abstract
Multiple cause of death (MCOD) data have been used to recalculate mortality levels attributed to a given condition, and to determine the most frequent associations of causes involving this condition. In this article, we begin with a description of how the MCOD data is collected, and we discuss data quality. After presenting the main indicators specifically developed to analyse these data, we provide a concrete illustration of the method based on a comparison of cancer-related mortality in Italy and France. The results for the two countries are strikingly similar. The change in mortality levels is modest for most anatomic sites: cancer is often selected as the underlying cause of death (UCD). The most notable exception (cancer of the prostate) potentially exemplifies future trends, with more effective treatments and increased incidence of this disease among elderly people due to population ageing, cancers may more often play a contributing role in mortality. For all anatomic sites, the reporting of a neoplasm as both underlying and contributing cause of death is a feature of cancer-related mortality. We then categorize all other associations into five patterns (‘degeneration of the contributing cause’, ‘risk factor for the UCD’, ‘common cause’, ‘consequence/complication of the UCD’ and ‘symptom of the UCD’) that reflect current medical knowledge.
Résumé
La prise en compte pour l’étude de la mortalité de l’ensemble des causes mentionnées sur les certificats de décès (causes multiples) répond généralement à deux objectifs : réévaluer la contribution des différentes causes de décès dans la mortalité générale et repérer les combinaisons entre causes principales et causes associées particulièrement fréquentes. Dans cet article, après avoir rappelé les modalités de la collecte des causes multiples de décès, nous évaluons la qualité de ces données. Nous présentons ensuite les différents indicateurs qui ont été proposés pour en faire l’analyse. Enfin, nous illustrons cette approche dans le cas des cancers en comparant deux pays : la France et l’Italie. Les résultats obtenus dans les deux pays sont très proches. Pour la plupart des sites, les niveaux de mortalité sont peu modifiés par la prise en compte des causes associées : les cancers sont souvent sélectionnés en tant que cause principale du décès. Le cancer de la prostate constitue une exception notable qui, à terme, pourrait concerner un nombre croissant de cancers : à mesure que l’efficacité des traitements s’améliore et que l’allongement de l’espérance de vie conduit à poser le diagnostic d’un cancer chez des personnes déjà âgées, les cancers pourraient être plus fréquemment mentionnés en cause associée du décès. L’examen des associations entre causes montre que la mention sur un même certificat d’un cancer en cause principale et en cause associée est très courante. Nous proposons pour terminer une typologie des différentes associations mises au jour en cinq catégories («aggravation de la cause associée» , «facteur de risque» , «cause commune» , «conséquence/complication» et «symptôme»).
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Notes
Multiple causes include both underlying and contributing causes.
Detailed tables are available since 2003 on the Istat website.
Note that both the selection of the underlying cause and the reporting of the contributing causes of death are potentially affected by inadequate/insufficient training.
The two certificates are displayed in the Appendix.
Part I is for the diseases or conditions that directly led to death. Part II is for any other significant condition that unfavourably influenced the course of the morbid process but is not related to the condition directly causing death. In many cases, it is difficult to decide whether a condition should be mentioned in part I or part II. If not explicitly specified, all indicators presented in this article are computed taking into account entries in parts I and II.
When excluding these causes from the computation, the difference between the two countries narrows (2.4 in France vs. 3.0 in Italy).
Note that we considered as redundant information and removed from the databases any recorded cause that, for a given death, is exactly identical (at the four-digit level of the ICD-10 classification) to another already registered cause.
As the indicator is based on the ratio of averages, age distributions of its components (ud c,x /ud x and d c,x /d x ) may affect the value of the CDAI. Nevertheless, we find that for cancers as UCD, the correlation between CDAIs and the age structure of the components is close to zero.
More precisely, the two series of indicators computed for a given contributing cause and various underlying causes are proportional (the denominator is the same for each UCD), so the conclusions are unchanged. The correlation between the two series of indicators computed for a given UCD and various contributing causes is generally very close to one.
So, we do not exclude associations between an underlying cause and a contributing cause belonging to the same group.
The standard population is the WHO 2003 European population by sex and five-year age groups.
See the list of the groups in the Table 5 in appendix.
Only malignant neoplasms with well-defined anatomic sites are presented.
The standard deviation was calculated taking into account all the values of the CDAI in the two countries.
See abbreviations in the Table 5 in appendix.
‘Mental and behavioural disorders due to use of tobacco’ (ICD-10 F179 code) is classified in the ‘Other Mental and behavioural disorders’ group.
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Désesquelles, A.F., Salvatore, M.A., Pappagallo, M. et al. Analysing Multiple Causes of Death: Which Methods For Which Data? An Application to the Cancer-Related Mortality in France and Italy. Eur J Population 28, 467–498 (2012). https://doi.org/10.1007/s10680-012-9272-3
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DOI: https://doi.org/10.1007/s10680-012-9272-3