Approach To Evaluating The Impact Of Introducing Muse 55 On Mortality Statistics
We carried out a dual-coding study in which a sample of deaths registered throughout 2017, already coded using IRIS 4.2.3 software and the International Classification of Diseases, Tenth Revision version 2016 rules, were recoded using the Multicausal and Unicausal Selection Engine 5.5 and the ICD-10 version 2018 rules.
Why Do You Need To Know Your Ancestors Cause Of Death
Knowing an ancestors cause of death can give you insight into an early or untimely death. The cause of death can provide clues to other records!
In the case of Esther above, knowing she suffered from TB and knowing that her brother did as well, helped me locate Rueben in Asheville, NC. Why Asheville? A TB sanitorium was located there.
Knowing TB was in the family, led to further research into TB and where people went for treatment. That led to Asheville, NC which led to Rueben and another family member as well.
Does your ancestors death certificate indicate he/she died in an unusual way or as the result of a crime? If so, seek out an account of the incident in the newspapers. Seek out court records that were associated with the crime. Do not forget to check out inquest records, too!
Does a health condition run in a family line? Do a disporportionate number of childre in a family line die young? Consider if a genetic component could be involved.
Back To That ICD code..
I got lucky with both of my great grandmothers death certificates above. They are easy to read! Really, a typed record? How easy was that?
But.
We all have instances when we have difficulty deciphering an ancestors death certificate, especially the cause of death. Sometimes, the cause is poor handwriting on the physicans part.
Sometimes, the cause is an archaic medical term we are not familiar with, making it hard to understand.
Poor handwriting AND medical terminology? Thats just plain hard.
Xiv Diseases Of The Genitourinary System
There has been a statistically significant 2.8% decrease in the number of deaths coded to Diseases of the genitourinary system using MUSE 5.5. The majority of the decrease is explained by deaths that were previously assigned an underlying cause in the genitourinary system, mainly codes N18.5 and N18.9 now being assigned to the Mental and behavioural disorders chapter, specifically F01.9 and to the Diseases of the circulatory system chapter, specially I67.9 . This reflects a change in the priority given to different health problems where several have been listed on the death certificate.
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Heart Disease Or Failure
- State the pathology of the heart condition. Particularly:
Was it due to arteriosclerosis? If so, were the coronary arteries involved?
Was the condition due to rheumatic fever? If so, was it acute or chronic, ? If chronic, which valve or valves were involved?
Was the heart failure caused by hypertension? Was there renal involvement?
Iii Diseases Of The Blood And Blood
The number of deaths assigned to this chapter increased by 2.4%, which was not a statistically significant change. However, the sample of dual-coded data only contained a small number of deaths with an underlying cause assigned to this chapter. These findings should therefore be treated with caution because the change may not be generalisable to the whole dataset.
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Does The Application Of International Classification Of Disease Codes For The Cause Of Death On Death Certificates Reduce Garbage Codes
- Encyclopedia of Death and the Human Experience2009
- The SAGE Encyclopedia of Cancer and Society2015
- The SAGE Handbook of Qualitative Methods in Health Research2010
- Encyclopedia of Cancer and Society2007
- Encyclopedia of Death and the Human Experience2009
- Encyclopedia of Health Services Research2009
- Using Documents in Social Research2003
I Certain Infectious And Parasitic Diseases
Overall, the number of deaths assigned to the infections chapter decreased by 19.8% this is a statistically significant change. The biggest decrease was in deaths from sepsis or septicaemia and A41.5 . These deaths were re-coded in MUSE 5.5 to codes mainly in the Neoplasms, Diseases of the respiratory system and Diseases of the circulatory system ICD-10 chapters. This was because of a change in the coding rules to count more deaths with an immediate cause of sepsis as resulting from a serious health condition that preceded the infection.
There were few within-chapter coding changes. Where the underlying cause of death was assigned to the infectious disease chapter in both IRIS 4.2.3 and MUSE 5.5, the code remained the same in the majority of cases.
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Direct Cause Of Death
- Enter the disease or condition that occurred as the last part of the sequence of events or conditions leading directly to death.
- It can be the sole entry on the certificate when only one condition, such as viral myocarditis or asthma, was present at death.
- Or it may be a complication of another condition.
Note: Do not enter the mode of dying such as collapse, cardiac arrest or respiratory failure that information is of little value.
Xvi Certain Conditions Originating In The Perinatal Period
Chapter XVI has not been examined in this report, as there were less than 20 deaths assigned to this chapter in the sample. These deaths occurred in the post-neonatal period , while a substantial proportion of deaths assigned to this chapter via the routine cause of death coding processes occur in the neonatal period .
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Ix Diseases Of The Circulatory System
The number of deaths with an underlying cause in the Diseases of the circulatory system chapter showed a 0.8% decrease between IRIS 4.2.3 to MUSE 5.5. Although in absolute terms this was a relatively small drop, it was a statistically significant decrease owing to the large number of people who die from circulatory diseases.
This decrease is caused by an update to the selection rules where many deaths that were coded as having an underlying cause of death in the Diseases of the circulatory system chapter are now being coded as having an underlying cause in another chapter. These deaths were re-coded to 13 other chapters .
The largest change was from deaths being coded to an underlying cause of death in the External causes of morbidity and mortality chapter, specifically to code X59.9 in MUSE 5.5, which were coded to an I code in IRIS 4.2.3. This follows a change by the World Health Organization in the default coding of subdural haemorrhage from non-traumatic to traumatic where there is an indication on the certificate of an external event such as a fall.
Xx External Causes Of Mortality
There has been a non-statistically significant decrease of 1.5% in the number of deaths from external causes using MUSE 5.5. The largest decrease has come from deaths previously assigned to codes X59.0 and Y83.1 in IRIS 4.2.3, which are now being assigned to other cause codes in MUSE 5.5, for example J18.9 being one of the more common ones.
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Iv Endocrine Nutritional And Metabolic Diseases
There was a decrease of 0.1% in the number of deaths assigned to the chapter, Endocrine, nutritional and metabolic diseases, in MUSE 5.5. This was not a statistically significant change. This small decrease was caused by some re-coding to seven other chapters .
There were few within-chapter changes for Endocrine, nutritional and metabolic diseases. The biggest change was deaths with an underlying cause of E14.9 , which were re-coded to E14.6 at 37% . The next biggest within-chapter change was deaths with an underlying cause of E11.9 diabetes mellitus without complications), now coded to E11.6 diabetes mellitus with other specified complications) this was a change of 27% . This suggests that reported conditions that could be complications of diabetes are being more consistently taken into account.
Mortality Statistics Are Widely Used For Medical Research Monitoring Of Public Health Evaluating Health Interventions And Planning And Follow
Rules adopted by the World Health Assembly regarding the selection of a single cause or condition, from death certificates, for the routine tabulation of mortality statistics are provided to standardize the production of mortality data.
WHO lists here ICD guidelines and tools for cause of death recording and reporting.
Implementation of the ICD for mortality further requires establishing an infrastructure for finding the dead person , recording, reporting and storing information, information flows, quality assurance and feedback, and training for classification users working with the input or output of data.
It was agreed by the Sixth Decennial International Revision Conference 1948 that the cause of death for primary tabulation should be designated the underlying cause of death.
Effective public health interventions prevent harm or death by breaking the chain of events that lead to harm and death. WHO has defined the underlying cause of death as follows:
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
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What Pending Cause Of Death Means
Death certificates contain specific information for documentation purposes and state records. A death certificate will have the name of the person who died, time of death and cause of death. The first two pieces of information will be known in almost every instance. However, the last part is where there can be deviations.
Death certificates must be ordered within 72 hours, but the medical examiners investigation into a cause of death can take weeks or even months to complete. That means the cause of death will be noted as pending on the certificate. This is the default when the cause of death is still unknown. Its essentially a placeholder designation so that death certificates can be issued.
Coding The Underlying Cause Of Death
The death certificate used in England and Wales for deaths over 28 days of age is similar to that recommended by the World Health Organization . The cause of death information is set out in two parts. Part I gives the condition or sequence of conditions leading directly to death, while Part II gives the details of any associated conditions that contributed to the death but are not part of the causal sequence.
The process of coding cause of death consists of first converting each of the conditions mentioned on the death certificate into an International Classification of Diseases, Tenth Revision code and second, deciding which of the conditions is the underlying cause of death for statistical purposes. Rules for these decisions are provided by the WHO.
The General principle for selection of the underlying cause of death states that when more than one condition is entered on the death certificate, the condition entered on the lowest used line of Part I should be selected, but only if it could have given rise to all the conditions entered above it. If this is not the case, then the following selection rules are applied:
Rule 1. If there is a reported sequence terminating in the condition entered first on the death certificate, select the originating cause of this sequence.
Rule 2. If there is no reported sequence terminating in the condition first entered on the death certificate, select the first-mentioned condition.
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Interval Between Onset And Death
- Where the interval between the onset of each condition entered on the certificate and the date of death is known, even approximately, it should be entered in the column provided.
- This will provide a check on the sequence of causes in Part 1 and provide useful information about the duration of illness for certain diseases, especially cancers. It is also of critical importance to clinical coders when selecting the underlying cause of death for mortality statistics.
- The certifying practitioner has responsibility for deciding which condition led directly to death and what antecedent conditions, if any, gave rise to the direct cause.
Stillbirths And Neonatal Deaths
Table 2 lists the cause groups for stillbirths and neonatal deaths. For further information on the cause groups, see Causes of neonatal deaths and stillbirths: a new hierarchical classification in ICD-1o .
| Group and description |
|---|
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Underlying Cause Of Death
Table 2 shows the underlying causes of death and intercoder agreement by code classification level. The most common ICD-10 codes used for the 515 underlying causes of death were I21., I11.0 and I25. . The lowest level of agreement at the four-character level occurred with ICD-10 codes I50. , I42. and E11. . Level of agreement was also low for codes I09. , but frequency was also low.
Table 2
Level of intercoder agreement with respect to the underlying cause of death at the four-character, three-character and chapter level was 80.6%, 86.6% and 94.1%, respectively, and was inversely related to the code classification level . Differences were also observed in the number of causes of death per death certificate at the four and three-character level. The lowest level of agreement occurred at the four-character level in certificates with four or more causes of death, while the highest level of agreement was observed at the chapter-level in certificates with a single cause of death. In general, level of agreement decreased with increasing code classification level, from 80.6% at the four-character level, to 94.2% at the chapter level. No difference in level of agreement was found across age categories in any of the code classification levels. Cohens kappa coefficients of coding of underlying cause of death at the four-character, three-character and chapter level were 0.77 , 0.84 and 0.76 , respectively.
Table 3
Xi Diseases Of The Digestive System
There was a statistically significant increase of 3.2% of deaths with an underlying cause assigned to this chapter between IRIS 4.2.3 and MUSE 5.5. The main reason for this is that some deaths that were previously assigned to Certain infectious and parasitic diseases A41.9 or Diseases of the respiratory system J18.9 underlying cause are now assigned to a digestive system cause of death.
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Cause Of Death Coding
What changes are taking place in Irish mortality statistics?
Underlying Cause of Death will be classified according to International Classification of Diseases, Version 10 instead of to International Classification of Diseases, Version 9 . Simultaneously with the move from ICD9 to ICD10, we are changing from choosing Underlying Cause of Death manually in all cases to using the automated coding system developed by the U.S National Centre for Health Statistics .
What is the timetable for these changes?
All deaths registered on or after 1st January 2007 are being coded to ICD10. The Vital Statistics publication for Quarter 1 2007 will be the first in which cause of death statistics are specified using ICD10 codes.
Why are these changes taking place?
Most European countries, and many countries worldwide, code deaths using ICD10. Changing to ICD10 will make our cause of death statistics more easily comparable with these countries. Similarly, using an automated coding system will make our statistics more comparable.
What effect will these changes have on Cause of Death statistics?
What guidelines are being produced to help interpret these changes?
How does ICD10 differ from ICD9?
How can I find out more about these changes?
If you have any queries, or you want to find out more about these changes, contact the CSO at
What Happens After The Cause Of Death Is Determined
Once the medical examiner determines a cause of death their office will update the records with the state. At that time the pending status will be removed. The medical examiner will also contact the family and let them know about the update.
Any death certificates that are ordered before the cause of death is determined will list the cause of death as pending. These death certificates are still valid and can be used to arrange disposition services, access estate financial accounts and transfer ownership of assets. However, if the family decides they want updated death certificates with the official cause of death noted, then those can be ordered.
Luckily in Texas, this process is fairly easy. There is no need to contact the funeral home or order updated death certificates through the funeral home as you may have originally done. Instead the family can order death certificates that specify the cause of death online at the Texas Department of State Health Services website.
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X Diseases Of The Respiratory System
The dual-coded data show a decrease of around 0.6% of deaths with an underlying cause assigned to this chapter between IRIS 4.2.3 and MUSE 5.5 this change is not statistically significant. This decrease is largely because of deaths that were previously assigned to the Diseases of the respiratory system chapter now being assigned to Diseases of the nervous system G20 , which is a continuation of the trend in the 2014 coding changes.
The biggest within-chapter changes were more IRIS 4.2.3 underlying causes coded to J44.0 . More deaths were coded in MUSE as having an underlying cause of death of J44.0 than were coded in IRIS 4.2.3.
V Mental And Behavioural Disorders
The number of deaths with an underlying cause of Mental and behavioural disorders decreased by 0.8% this is a statistically significant change. This decrease was largely a result of deaths that were previously assigned an underlying cause of F03 being assigned to J44.0 in the Diseases of the respiratory system chapter.
This change represents a small rebound from the changes in 2014 reported in the publication, Impact of the Implementation of IRIS Software for ICD-10 2010 Cause of Death Coding on Mortality Statistics, England and Wales. Then, the number of deaths allocated to Mental and behavioural disorders increased by 7.0% , largely because of deaths that were previously assigned an underlying cause of respiratory disease being assigned to the Mental and behavioural disorders chapter .
There were very few within-chapter changes for Mental and behavioural disorders.
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