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Abstract
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OBJECTIVES: The International Classification of Diseases (ICD-10) distinguishes a large number of causes of death (CODs) that could each be studied individually when monitoring time- trends. We aimed to develop recommendations for using the size of CODs as a criterion for their inclusion in long- term trend analysis.
Design: Retrospective trend analysis. Setting 21 European countries of the WHO Mortality Database.
Participants: Deaths from CODs (3- position ICD-10 codes) with ≥5 average annual deaths in a 15- year period between 2000 and 2016.
Primary and secondary outcome measures: Fitting polynomial regression models, we examined for each COD in each country whether or not changes over time were statistically significant (with α=0.05) and we assessed correlates of this outcome. Applying receiver operating characteristicROC curve diagnostics, we derived COD size thresholds for selecting CODs for trends analysis.
Results: Across all countries, 64.0% of CODs had significant long- term trends. The odds of having a significant trend increased by 18% for every 10% increase of COD size. The independent effect of country was negligible. As compared to circulatory system diseases, the probability of a significant trend was lower for neoplasms and digestive system diseases, and higher for infectious diseases, mental diseases and signs- and- symptoms. We derived a general threshold of around 30 (range: 28-33) annual deaths for inclusion of a COD in trend analysis. The relevant threshold for neoplasms was around 65 (range: 61-70) and for infectious diseases was 20 (range: 19-20).
Relationship between the likelihood for a COD to have a significant long-term trend with its size, corresponding ICD-10 chapter and country
V01.Y98 External causes of morbidity and mortality
Number of CODs 1992
Total number of deaths 3 005 539
Odds Ratio 1.20 (0.99 to 1.46)
Conclusions: The likelihood that long- term trends are detected with statistical significance is strongly related to COD size and varies between ICD-10 chapters, but has no independent relation to country. We recommend a general size criterion of 30 annual deaths to select CODs for long- term mortality- trends analysis in European countries.
Strengths and limitations of this study:
► The first study to develop a criterion to select causes of death for monitoring purposes based on their annual number of deaths.
► The analysis of a large sample of causes of death covering most European countries, using the WHO Mortality Database.
► Criteria for selection of causes were derived for different types of causes of death.
► Other criteria were not applied, such as causes of death that involve high healthcare costs or that are potentially modifiable.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Language: en |