The Danish Health Data Authority

Analytics, Statistics and Economics 

AMTR@sundhedsdata.dk

Data on causes of death (CoD) provide information on mortality patterns and form a major element of public health information.

CoD data refer to the underlying cause which - according to the World Health Organisation (WHO) - is "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".

CoD data are derived from death certificates. The information provided in the medical certificate of cause of death is mapped to the International Statistical Classification of Diseases and Related Health Problems (ICD).

Eurostat's CoD statistics build on standards set out by the World Health Organisation (WHO) in the International Statistical Classification of Diseases and Related Health Problems (ICD).

The regional breakdown is based on the Nomenclature of Territorial Units for Statistics (NUTS 2).

Classification and updates applied by years

Public Health

Concepts and definitions are described in the Commission regulation (EU) No 328/2011 in articles 2 and 3.

Persons with a valid Social Security number residing in Denmark

Stillbirth is defined as all births after gestination of 22 weeks (>=22+0), where the child shows no signs of life at birth

The statistical units are the deceased persons and the stillborns, respectively.

Residence in Denmark at the time of death. 

No, neonatals of non-resident mothers are not considered residents. 

Non-residents are not included in the National statistics. 

No, residents dying abroad are not included in national statistics. 

National 

Time series for most EU-28 countries and EFTA are available from 1994 onwards (Belgium, Germany: 1992, Ireland: 1993). For some countries data are only available from 1995 (Bulgaria), 1996 (Latvia and Slovakia), 1999 (Cyprus, Poland and Romania) or 2010 (Liechtenstein) onwards.

Note that due to the fact that 2011 data is the first data collection with a legal basis (and few changes in the requested variables and breakdowns), the data between 1994-2010 and starting from 2011 are not always comparable (In part due to the different groupings of causes of deaths). Moreover time series for data on stillbirths starts in 2011 and no information on previous data is available.

Not applicable.

The unit is number.

Data refer to the calendar year (i.e. all deaths occurring during the year).

CoD data was submitted to Eurostat on the basis of a gentleman's agreement established in the framework Eurostat's Working Group on "Public Health Statistics" until data with reference year 2010.

A Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was signed by the European Parliament and the Council on 16 December 2008. This Regulation is the framework of the data collection on the domain.

Within the context of this framework Regulation, a Regulation on Community statistics on public health and health and safety at work, as regards statistics on causes of death (EU) No 328/2011 was signed by the European Parliament and the Council on 5 April 2011. 

CoD data according to this regulation is submitted to Eurostat since reference year 2011.

Common specifications with the World Health Organisation (WHO) were used in the data collection up to 2010; in addition, Eurostat asks for NUTS level 2. From 2011 onwards, Eurostat changed the specifications to take into account the data collected through the Regulation No 328/2011.

Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.

All age groups showing a total mortality of less than 4 cases are considered as confidential. Therefore, any 'confidential' agegroup is grouped with another one to have higher numbers. In practice, this problem mainly occurs for young ages so, either the ages from 0 to 14 years old, or the ages from 0 to 14 and 15 to 24 years old are grouped. The age groups considered as confidential show then the value ':' and the age group '0-14y' (and '15-24y' if needed) shows the sum of all ages before 15 years old (or between 15 and 24 years old). In addition, special measures for ensuring confidentiality may be taken for small countries.

For stillbirth and neonatal figures, no breakdown by parity is displayed to ensure confidentiality.

December the following year. 

https://www.esundhed.dk/Emner/Aktuelt/Udgivelseskalender

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

Annual.

News releases on-line.

In our publication "Dødsårsagsregister", and on our website: www.eSundhed.dk

https://www.esundhed.dk/home/registre/doedsaarsagsregisteret

Please consult free data on-line or refer to contact details.

Yes

No

https://www.esundhed.dk/Dokumentation

Documents for COD are available in CIRCABC, Causes of Death section.

The quality of COD data is subject to the way in which the information on causes of death is reported and classified in each country (i.e. national certification and coding procedures). In general, all countries follow the standards and rules specified in the ICD, and the overall procedures for the collection of COD data are relatively homogenous between European countries (medical certification of cause of death, use of ICD).

However, national differences in interpretation and use of ICD rules exist and as a result important quality and comparability issues remain. Based on the report "Comparability and Quality Improvement of the European Causes of Death Statistics" countries work towards further improving certification and coding procedures.

Ongoing work is reported to Eurostat's Working Group "Public Health Statistics" (documents available on circabc).

The causes of death data are based on a regulation, which defines scope, definitions of variables and characteristics of the data.

A quality assessment of Eurostat's COD statistics was organised in May and June 2008. In that framework, a questionnaire was sent to Eurostat's partners (data providers) for COD statistics and a user survey was set up on Eurostat's website, for which 25 partners and 34 users answered. A questionnaire was also filled in by responsible people of COD statistics in Eurostat.

Based on the 34 answers received from the web survey, the main users are Research Institutes,  Universities, Public Government agencies, Private, Commission services and Business companies. On these 34 answers, Eurostat data on Causes of Death are "essential", "important", or "used for background information" for 25 respondents.
Asking about the availability of needed data in the Eurostat production, users are divided in two equivalent part: 12 answered that they do not need statistics on the field not currently available from Eurostat and 13 answered that they need, giving information about defects and lacks of the Eurostat data.

Users were asked to assess each of the classical elements that characterise the quality of statistics.

Respondents generally give high scores to the different dimensions of data quality and to the supporting service that is perceived as "Good or Very Good" by the users (14 out of 21 respondents expressing opinions about this). The overall quality, comprising both data quality and supporting service, is perceived as "Good" or "Very good" by 16 out of 24 respondents to those questions.

Among different data quality dimensions, coherence and comparability receive the higher satisfaction. The less appreciated dimension is the completeness.

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1. For mandatory variables:

 100 percent.

2. For voluntary variables:

 100 percent.

3. For additional variables:

• External CoD

Not available

• Place of occurrence for external CoD

Not available

• Activity for external CoD

 Not available

The data for 2018 are based on 97 pct. of all incoming death certificates. In those cases were we didn't get the certificate electronically the cause of death is "unknown" in the data. 

Not applicable. Data collection is from administrative sources.

Not applicable.

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Not applicable.

Not applicable.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

From data collection with reference year 2011 onwards, Eurostat asks for the submission of final data at national and regional level and related metadata for the year N at N+24 months, according to the Implementing Regulation (EC) No. 328/2011, Article 4.

There is a small difference in missing certificates across regions. However coding and transmission are equal for all regions. 

Not applicable.

Up until 2018 Denmark have included neonatal deaths where an abortion procedure was performed. These special cases results in a livebirth and therefore they were included in both the General and infant mortality statistics, they were recorded as neonatal deaths (NND). 

As of 2019 these case have been removed from both datasets. 

From 2007 the repaorted death data were electronic.

The data is checked with the national demographic data called CPR-register. The discrepency in total deaths is denoted as Unknowns in the death cause registry. 

Not applicable, only annual data are available.

Not applicable.

The data source between neonates and the general mortality are different. However there should not be any inconsistencies. 

The cost and burden of the data collection is reduced by using validation and dissemination IT tools.

Not applicable.

There is no systematic revision of previous year data. Data are occasionally revised, e.g. if the "NUTS" changes or if a country notifies Eurostat about any changes in the data.

Not applicable.

Our CoD database is based on the reported death certificates. In Denmark the death certificates are reported electronically. Almost 98 pct. of all page 2 certificates are reported electronically at the time when the annual statistics is published. Since it is possible to report certifcates afterwards, data for 2019 and before that will getting more complete over the years. 

Annual.

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Table on certification (Percentage)

There is no special death certificate for neonates and stillbirths. 

The national death registry is compared to the CPR registry. 

Description of coding procedure (central level, distributed among other bodies, etc.): 

Coding is done manually by employees of the responsible government agency

Description of the procedures to detect errors (i.e.errors such as potential inconsistency in the death certificate or error due to mistake when filling the deaths certificates):

 The IRIS algorithm evaluates all data for consistency with WHO guidelines and corrects where necessary. Certain of these corrections as well as select groups of causes are flagged for manual validation 

Description of the measures taken in order to solve detected errors:

 Trained professionals evaluate the output of IRIS with supplementary information on the death certificates and contact the submitting doctors where necessary

Coding performed by a certifier:

IRIS is an algorithm developed and maintained by Federal Institute for Drugs and Medical Devices (BfArM) in Cologne. This is based on up-to-date guidelines for coding with ICD10 as decided by WHO.

Estimation of the percentage of autopsy from which information is available for coding:

Autopsy findings can be written on any death certificate but the fields are not mandatory. The information in these fields is available for review but is text-based and thus not harmonized as quantifiable data points.

Description of double coding exercises and rate of codification errors for underlying cause of death:

ICD codes for the underlying cause (% of the Total)

Unknown country/region (%) for residents and non-residents who died in the country

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Not applicable.

Not applicable.

Not applicable.

Not applicable.