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Quality Description:Causes of death 2014

• 1. Relevance of statistical information
• 2. Methodological description of survey
• 3. Correctness and accuracy of data
• 4. Timeliness and promptness of published data
• 5. Accessibility and transparency/clarity of data
• 6. Comparability of statistics
• 7. Coherence and consistency/uniformity

1. Relevance of statistical information

In the statistics on causes of death, statistical data are produced annually on the causes of death of persons permanently resident in Finland. The statistics are compiled on the basis of death certificates. The data are supplemented with and verified against data on deaths from the Population Information System of the Population Register Centre. Statistics Finland has death certificates and data on causes of death from 1936 onwards.

Cause of death data are highly significant for general information systems describing the population's state of health. Cause of death data are used in various medical surveys, and by combining the data with other Statistics Finland's data files, it is possible to study, for instance, differences in mortality between different population groups.

Investigating the cause of death and the related procedures including the production of statistics and archiving of death certificates is based on the act (1973/459) and decree (1973/948) on the investigation of the cause of death. In April 2011, Commission Regulation (EC) No 1338/2008 was passed and it confirms the variables, specifications and metadata which the EU Member States have to supply as concerns statistics on causes of death.

Consepts

Causes of death are obtained from death certificates. Data on underlying causes of death have been collected in database tables from 1969 onwards and from 1987, in addition to the underlying cause of death, there are also data on immediate, intermediate and contributing causes of death :

• The underlying cause of death is the disease which has initiated the series of illnesses leading directly to death. In accidental or violent deaths, the underlying cause of death is the external reason which caused the injury or poisoning leading to death. The underlying cause of death issued by the physician’s death certificate is not directly applied to statistics compilation, but it is used when forming the underlying cause of death in the statistics.

• The statistical underlying cause of death is determined according to the selection and application rules of the International Classification of Diseases (ICD-10) compiled by the World Health Organisation (WHO). On their basis, the underlying cause of death is determined from the causes of death given by the physician in the death certificate. Annual causes of death statistics are made according to the underlying cause of death determined for the statistics. Other causes of death are mainly used in surveys.

• The immediate cause of death refers to the disease, failure or injury whose symptoms cause the person to die. However, the mechanisms of death, e.g. cardiac arrest, are not regarded as immediate causes of death.

• The intermediate cause of death refers the condition which leads from the underlying cause to the immediate cause of death.

• The contributing cause of death are other significant circumstances that contributed to the death recorded in the part II of the death certificate but are not related to the cause-consequence chain in part I of the death certificate.

In the case of stillbirths and infants dying before the age of 28 days the statistical data include the child's main cause of death, the mother's main reason contributing to the child's death, and two other reasons contributing to the child's death.

Stillbirths include a foetus or a newborn who shows no signs of life at the time of birth after a pregnancy lasting at least 22 weeks or the newborn weighing at least 500 grams. This concept has been used in Finnish annual tables since 1987. In the earlier used definition, stillbirths were newborns or foetuses when the duration of pregnancy had been at least 28 weeks. The changed concept also influenced the definition of perinatal deaths for stillbirths. Terminations of pregnancy prior to the 22nd week of pregnancy are considered miscarriages. Terminations of pregnancy are not included in the cause of death statistics.

Infant mortality refers to the share of deaths in infancy (at under one year) per thousand live births. Neonatal mortality refers to the share of deaths during the four first weeks of life per thousand live births. The figure is often given in tables as per mil. Early neonatal mortality refers to the number of deaths during the first week of life relative to the live births. Late neonatal mortality refers to the number of deaths which occur at the age of 7 to 27 days relative to the live births.

Perinatal mortality refers to the share of stillbirths and deaths during the first week of life among all births (incl. stillbirths). The age during the first week is calculated in hours.

Perinatal mortality is calculated by dividing the number of stillbirths and deaths during the first week of life by the number of all births during the statistical year. The age during the first week is calculated in hours.

More concepts of the cause of death statistics can be found at: http://tilastokeskus.fi/til/ksyyt/kas_en.html

2. Methodological description of survey

The cause of death statistics data are total data including all deaths in Finland or abroad of persons permanently resident in Finland at the time of their death. Statistics on stillbirths are made separately; cases of stillbirths are not included in deaths during the statistical reference year. The statistics on stillbirths are supplemented with data from the birth register of the National Institute for Health and Welfare (THL).

Death certificates are issued by the physician establishing the death. If determining the cause of death requires an autopsy, the death certificate is issued by a forensic pathologist after the information acquired from the autopsy is complete. The physician issuing the death certificate delivers the certificate to the regional unit of the National Institute for Health and Welfare (THL) where the deceased was a resident. A forensic pathologist there verifies the correctness of the certificate and the certificates are sent on to Statistics Finland. In addition, the health care unit or the physician has to report the death to the Population Information System. At Statistics Finland, the death certificate data are compared with data on the deceased obtained from the Population Information System and lists of missing death certificates are sent to THL for monitoring purposes. The data files on causes of death are supplemented with other demographic data from the Population Information System.

Death certificates are received at Statistics Finland in paper form from THL. Death certificates are scanned at Statistics Finland in picture format and part of the data is read optically to the database. Diagnosis texts and cause of death codes issued by physicians are checked with the help of an electronic dictionary. The statistical underlying cause of death is determined according to the selection and application rules of the International Classification of Diseases (ICD-10) compiled by the World Health Organization (WHO). Some of the statistical underlying causes of death are coded automatically with the application and part manually utilising the description of events written by the physician.

Since 1996, causes of death have been coded according to the international ICD-10 classification (International Statistical Classification of Diseases and Related Health Problems). The ICD-10 classification is an international classification maintained by the World Health Organization (WHO) describing causes of death, illnesses, accidents and reasons for using health care services. The classification can be found on WHO’s pages . Causes of death are coded mainly in the most accurate level of the classification, the 3-digit level is the publication level. In certain cases, specifying codes according to the Finnish national classification of diseases are used. THL maintains the Finnish version of the ICD-10 classification of diseases.

In the publication, the mortality rate can be measured with the general mortality rate, where the number of deaths is divided by mean population and multiplied by one thousand or one hundred thousand. The mortality rate can also be calculated by age group, when deaths in each age group are expressed as a proportion to the population of corresponding age.

Age-standardised mortality rate refers to mortality where the effect of age structure is eliminated by age standardisation. The standardisation used in cause of death statistics is made by using direct age standardisation (standardised death rate, SDR), which means that mortality figures for the year in question have been used to calculate how many people would die if the age structure of the population remained the same throughout time. The formula for direct standardisation is as follows:

SDR = ∑ (mi Pi / P) × 100 000

mi = mortality rate in age group i

Pi = standard population in age group i

P = standard population

Mortality and the generality of causes of death are heavily dependent on age. For this reason, age standardisation is used in the statistics when comparing mortality differences of different times and areas. In the publication on cause of death statistics, the 'new' standard population of Europe has been used since 1996 as the standard population when calculating age-standardised mortality rates (Appendix 5). Different standard population has been used in the age-standardised mortality figures published by Eurostat, for which reason the figures differ from those released by Statistics Finland.

3. Correctness and accuracy of data

The death certificate form is confirmed by the Ministry of Social Affairs and Health. The physician records the cause of death on the death certificate as a code and as a text specifying the diagnosis. At Statistics Finland, the causes of death are coded mainly on the basis of the diagnosis text.

In case the information in the death certificate is deficient, inconsistent or difficult to classify, the information about the event recorded on the death certificate or a medical expert will be consulted or more information is requested from the issuer of the death certificate. In cases of alcohol and medicinal poisonings, the additional information used consists of the research results from the register of forensic chemistry. The underlying cause of death is determined from the event information in the death certificate in about 1,000 cases yearly. Around 700 cases are handled by a medical expert every year. Additional information is requested from the issuer of the death certificate in about 100 cases per year. Additional information is obtained for some 200 cases per year from the register of forensic chemistry.

In practice, the coverage of the cause of death statistics is around 100 per cent, because the data on death are verified from the Population Information System. The number of deaths on which no information on the cause of death is obtained has previously been 100 to 150 per year, but in the last few years the number of missing death certificates has been growing. In 2014, there were 477 missing death certificates. Of them, 12 were deaths abroad on which only a notification on death was obtained. The data derived from late death certificates are combined to the survey database and death certificate archives.

Number of death certificates missing from statistics yearly

Year	Number	Proportion of all deaths, %
2000	40	0,1
2005	118	0,2
2006	135	0,3
2007	139	0,3
2008	146	0,3
2009	157	0,3
2010	107	0,2
2011	132	0,3
2012	226	0,4
2013	267	0,5
2014	477	0,9

Most causes of death are based on clinical data, but qualitatively better data for death certificates are derived from autopsies. The share of autopsies in all deaths were highest in Finland of all Nordic countries. The number of forensic autopsies has decreased fast in Finland since 2010, however. In 2014, a forensic autopsy was performed for 17 per cent and a medical autopsy for 5 per cent of dead persons.

Share of forensic and medical autopsies in death cases in 1975 to 2014

4. Timeliness and promptness of published data

Cause of death data are produced yearly and they are completed at the end of the following year. The data are final and describe the deaths during the previous calendar year of persons permanently resident in Finland. After the data are published, death certificates are not added afterwards to the annual data of the statistics, but they are included in research data and death certificate archives.

5. Accessibility and transparency/clarity of data

The data of the cause of death statistics are published yearly under the topic Health on the home pages of the cause of death statistics and the tables are released in Statistics Finland’s StatFin database. The tables of the cause of death statistics are made according to the underlying cause of death.

The cause of death statistics are available starting from 1936. The data for 1936 to 1968 are in table format in the paper publications. From 1969, there are data as a time series database. Tailored tables and research data can be made from unit-level data at Statistics Finland to customer needs. A licence is always needed for unit-level research data. The application for licence can be found on Statistics Finland’s home page . Cause of death data can also be combined to other datasets by means of the person number (e.g. with population census and employment statistics data).

Cause of death data are also published for international sources and databases, such as:

— The Nordic Statistical Yearbook “Health Statistics for the Nordic Countries” http://nowbase.org/Publications.aspx

— Eurostat’s database, e.g http://ec.europa.eu/eurostat

— WHO’s databases, e.g European Health for All database, http://www.euro.who.int/en/data-and-evidence

Statistics Finland also maintains Finland's death certificate archive. The archive contains Finnish residents' death certificates from 1936 onwards. Copies of death certificates and unit-level cause of death data are released from the archive to the purposes prescribed in the act on the investigation of the cause of death (459/1973). They are mainly released to the dead person's next of kin, pension institutions and official use and for scientific research and statistical surveys. Instructions for applying for death certificates and on the licence procedure can be found on Statistics Finland's web pages.

6. Comparability of statistics

The classification of causes of death used in the statistics has changed a number of times. Since 1996, causes of death have been coded according to the ICD-10 classification (International Statistical Classification of Diseases and Related Health Problems). Between 1987 and 1995, the data were coded using the national classification of diseases 1987 and from 1969 to 1986, the international classification ICD-8 was in use.

To improve the comparability of cause of death data from different years, Statistics Finland has made time series classifications. The longest comparable national time series classification (54 categories) contains data from 1969 onwards. In addition, use is made of a 72-category classification where data are available from 1998. This classification complies in main aspects with the 65-category European shortlist classification used by the EU, which was used by Eurostat from 1998 to 2013. Since the beginning of 2014, an updated 86-category European shortlist 2012 classification has been available on Eurostat's website. This classification has also been available on the data of the causes of death statistics at Statistics Finland.

7. Coherence and consistency/uniformity

The cause of death statistics are the only comprehensive statistics on causes of death in Finland. Other Statistics Finland’s statistics describing the mortality rate and causes of death are vital statistics, statistics on road traffic accidents and occupational accident statistics .

The data on deaths published by Statistics Finland's vital statistics are comprehensive statistics on the number of deaths. The number of deaths per year differs somewhat from the number of deaths in the cause of death statistics. The difference is mainly caused by that the vital statistics do not contain deaths registered as deaths after the compilation time of the statistics (the end of the following year's January). In the vital statistics for 2014, the number of deaths was 52,186, which was 223 deaths fewer than in the cause of death statistics. The number of deaths under the age of one year was 124 in the vital statistics and 125 in the cause of death statistics. When calculating infant mortality, the number of deaths under the age of one in the vital statistics is used in official connections.

The statistics on road traffic accidents compile statistics on deaths in road traffic. Data are obtained from the information system of the police. The coverage of the data is checked against those of the cause of death statistics. The figures deviate from those in the cause of death statistics by some tens of cases each year. The deviation is due to the following differences in the statistical criteria:

• The statistics on road traffic accidents contain all deaths in traffic in the area of Finland, whereas the cause of death statistics include all deaths of the permanent population of Finland occurring either in Finland or abroad.

• The cause of death statistics are compiled on the basis of the day of the death, but the time period of the statistics on road traffic accidents is the day of the accident and at most the 30 following days.

• In the cause of death statistics suicides committed in traffic are included in suicides, in the statistics on road traffic accidents they are regarded as road traffic accidents.

Occupational accident statistics are compiled on the basis of information on insurance activities and the statistics include all those accidents at work on which insurance institutions have paid compensation. By contrast, in the cause of death statistics the information on occupational accidents is derived from death certificates as defined by the physician. The number of deaths from occupational accidents differs yearly very little from the figures in the cause of death statistics.

Source: Causes of death, Statistics Finland

Inquiries: Airi Pajunen 029 551 3605, Jari Hellanto 029 551 3291, kuolemansyyt@stat.fi

Director in charge: Jari Tarkoma

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Updated 30.12.2015