HELLENIC STATISTICAL AUTHORITY

POPULATION, EMPLOYMENT & COST OF LIVING STATISTICS DIVISION

POPULATION AND MIGRATION STATISTICS SECTION

HELLENIC STATISTICAL AUTHORITY

Pireos 46 & Eponiton Str.

18510 Piraeus

GREECE

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).

Data are broken down by sex, age, cause of death and by NUTS2 Country of residence and place of occurrence. In hellenic data, age of mother and parity as well, are not currently available for neonatal deaths (available only for stillbirths).

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

In Greece CoD pertain to Population and Migration Statistics Section.

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

Usual residence means the place at which a person normally spends the daily period of rest, regardless of temporary absences for purposes of recreation, holiday, visits to friends and relatives, business, medical treatment or religious pilgrimage or, in default, the place of legal or registered residence. Only the following persons shall be considered to be usual residents of the geographical area in question:(i) those who have lived in their place of usual residence for a continuous period of at least 12 months before the reference date; or(ii)those who arrived in their place of usual residence during the 12 months before the reference date with the intention of staying there for at least one year.

‘Stillbirth’ means   foetal   death, namely death prior to the complete expulsion or extraction from its mother of a product of conception,irrespective of the duration of pregnancy. Death is indicated by the fact that after such separation from its mother the foetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Stillbirths having weight from 500gr and gestational age from 22 completed weeks are included.

Birth weight and gestational age are available for stillbirths (crown-heel length is not collected).

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

The deceased persons and stillbirths within the Hellenic territorial borders. In addition, cases of refugees/ migrants who died while border-crossing  before being registered in the Country or have drowned in the Hellenic territorial waters, are included in the datasets sent to Eurostat and WHO according to the scope of Causes of death statistics, as specified in the Article 1 of the Regulation (EU) No 328/2011 on statistics on causes of death that is: "European statistics in the domain of ‘causes of death’ shall concern all registered deaths and stillbirths occurring in each Member State, distinguishing residents and non-residents." On the contrary, these cases are excluded from the national CoD data and from the Hellenic Population Figures in accordance with guidelines from Unit F2 (Population & Migration).

Are considered to be residents.

Are included.

Are not included.

At national level: Total Geographical country.

Geographical level of data analysis: Municipality.

Data are available since 1956.

Not applicable.

The unit is number (absolute number of individuals).

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

The legal framework concerning the organization and operation of ELSTAT consists of Law 3832/2010 as amended.

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.

Data are sent to International organizations (Eurostat, WHO etc.). Common specifications with the World Health Organization 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 (EU) 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.

The issues concerning the observance of statistical confidentiality by ELSTAT are regulated by articles 6,7 and 8 of the Law 3832/2010, as amended by article 90 paragraph 8 of the Law 3842/2010 and by article 10 of the Law 3899/2010, as well as by article 8 of the Law 2392/1996, which was brought back into force, in accordance with article 90 paragraph 8 of the Law 3842/2010.

Furthermore, ELSTAT disseminates the statistics in compliance with the statistical principles of the European Statistics Code of Practice and in particular with the principle of statistical confidentiality.

➢ ELSTAT protects and does not disseminate data it has obtained, or it has access to, which enable the direct or indirect identification of the statistical units that have provided them by the disclosure of Individual information directly received for statistical purposes or indirectly supplied from administrative or other sources. ELSTAT takes all appropriate preventive measures so as to render impossible the identification of

individual statistical units by technical or other means that might reasonably be used by a third party. Statistical data that could potentially enable the identification of the statistical unit are disseminated by ELSTAT if and only if: a) These data have been treated, as it is specifically set out in the Regulation on Statistical Obligations of the agencies of the Hellenic Statistical System (ELSS), in such a way that their dissemination does not prejudice statistical confidentiality or b) The statistical unit has given its consent, without any reservations, for the disclosure of data.

➢ The confidential data that are transmitted by ELSS agencies to ELSTAT are used exclusively for statistical purposes and the only persons who have the right to have access to these data are the personnel engaged in this task and appointed by an act of the President of ELSTAT.

➢ ELSTAT may grant researchers conducting statistical analyses for scientific purposes access to data that enable the indirect identification of the statistical units concerned. The access is granted provided the following conditions are satisfied: a) an appropriate request together with a detailed research proposal in conformity with current scientific standards have been submitted; b) the research proposal indicates in sufficient detail the set of data to be accessed, the methods of analyzing them, and the time needed for the research; c) a contract specifying the conditions for access, the obligations of the researchers, the measures for respecting the confidentiality of statistical data and the sanctions in case of breach of these obligations has been signed by the individual researcher, by his/her institution, or by the organization commissioning the research, as the case may be, and by ELSTAT.

➢ Issues referring to the observance of statistical confidentiality are examined by the Statistical Confidentiality Committee (SCC) operating in ELSTAT. The responsibilities of this Committee are to make recommendations to the President of ELSTAT on:

• the level of detail at which statistical data can be disseminated, so as the identification, either directly or indirectly, of the surveyed statistical unit is not possible;

• the anonymization criteria for the microdata provided to users;

• the granting to researchers access to confidential data for scientific purposes.

➢ The staff of ELSTAT, under any employment status, as well as the temporary survey workers who are employed for the collection of statistical data in statistical surveys conducted by ELSTAT, who acquire access by any means to confidential data, are bound by the principle of confidentiality and must use these data exclusively for the statistical purposes of ELSTAT. After the termination of their term of office, they are not allowed to use these data for any purpose.

Annual data are announced two years after the reference year at the latest.

Data are available simultaneously to all interested parties in accordance with the releases calendar through announcements (https://www.statistics.gr/en/calendar#112021) and posting tables (https://www.statistics.gr/en/statistics/pop ,Sections: Health, Demography: Years 2000-2016: Deaths-Causes of death (ICD-9)/ Years 2014-2021: Deaths-Causes of death (ICD-10).

Equal access of users to the data is covered by Eurostat’s European Statistics Code of Practice respecting professional independence and in an objective, professional and transparent manner by which all users are treated with equality. There is no access to the data by any user before the announcement.

Annual.

Annual data are announced two years after the reference year at the latest. The most recent announcement concerns the CoD of 2020 while the 2021 CoD announcement is scheduled for February 23, 2024. 

Not applicable

https://www.statistics.gr/en/statistics/pop(Deaths-Causes of death ICD-9 & ICD-10)

If further disaggregation is needed, please refer to: data.dissem@statistics.gr

Not available.

Microdata are not disseminated at the moment. Nevertheless, there is an ongoing process of developing the dissemination format of Public Use Files and Scientific Use Files.

Users can have access to ELSTAT’s digital library through the link:

http://dlib.statistics.gr/portal/page/portal/ESYE/.Moreover, tables can be found at the following link & path: https://www.statistics.gr/en/statistics/pop

Sections: Health, Demography: Years 2000-2016: Deaths-Causes of death (ICD-9)/ Years 2014-2021: Deaths-Causes of death (ICD-10)  as well as at Eurostat’s website: https://ec.europa.eu/eurostat/data/database (health > Causes of Death).

Finally, there is the possibility of providing data (usually via e-mail) upon request to the Data Dissemination Section. In that case, requests can be submitted online at ELSTAT’s website (https://www.statistics.gr/en/statistical-data-request) or can be addressed to the following e-mails: data.dissem@statistics.gr and data.supply@statistics.gr

Not available.

Information (tables, methodology) is available on the website of ELSTAT (http://www.statistics.gr/en/home/) following the path: Statistics/ Population and Social Conditions/Demography.

Most metadata elements are provided.

The quality of CoD data is subject to the national certification and coding procedures. Greece follows the standards and rules specified in the ICD while all rational and numeral checks safeguarding quality are being performed.

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

Comparative checks are being performed.

ELSTAT’s Quality Policy and Quality Guidelines are applied:

https://www.statistics.gr/en/quality-asurance-framework

Due to legal obligations and ELSTAT's quality checks, errors in CoD are very rare and results are considered to be of high accuracy. Furthermore, concepts, definitions and methodology follow European and international standards and guidelines.

The main data users of hellenic data are researchers (university community, international organizations, research centers etc.), Ministries and journalists. User requirements are mainly time series for different variables.

The Data Dissemination Section of ELSTAT conducts a survey on user satisfaction, at: http://www.statistics.gr/en/user-satisfaction-survey

User satisfaction survey report for the year 2021 can be found at:

Data cover the 95% of the users' requirements. All the obligations arising from the Regulations (EC) No 1338/2008 and (EU) No 328/2011 are met.

1. For mandatory variables:

All variables required by the Commission regulation no 328/2011 are transmitted to the European Commission.

2. For voluntary variables:

Information on parity and age of mother in case of NND is not collected and there is no imminent provision of changing that for the time being although there are ongoing discussions on additions need to be made on death certificates and such suggestions have been made.

3. For additional variables:

• External CoD

          Where external Causes are reported, injury and poisoning ICD-10 codes are also provided.

• Place of occurrence for external CoD

  It is provided (as 1 digit at the specific column instead of the fourth digit of the ICD-10 code used until 2018).

• Activity for external CoD

  Only accidents at work are reported (when mentioned in death certificates).

  
  

Data are compiled by reliable administrative sources and forensic physicians.

Not applicable. Data collection is from administrative sources.

Not applicable.

Due to the nature of the data (administrative sources) non-sampling errors that may occur relate only to measurement errors and processing errors. The detection is achieved through detailed checks both from administrative sources and from ELSTAT. We consider that there are no non-sampling errors because in general, all registrars disseminate the data, coders are professionals and relevant data have primarily been checked.

No coverage error is observed since the registration of a death is crucial for the burial.

There is no considerable over-coverage problem.

Not applicable. Data collection is from administrative sources.

This kind of error can be due to wrong information provided in some variables from the questionnaires researched units or administrative records and can be corrected after communication with relevant bodies.

Minimum non response error.

No error is observed because registration of death is mandatory for the burial.

In general, registrars and forensic physicians provide the mandatory variables. There are only a few cases of missing variables from Registries or non-reported CoD from forensic physicians.

This error relates to incorrect values on data entry or incorrect results when processing, which are detected and corrected by performing logical checks and audits on the annual changes.

Not applicable.

Not applicable.

24 months.

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.

The process of collecting, coding and transmitting the data is the same for all regions. Thus, there are not any comparability problems between regions.

Not applicable.

Nationally, data are available for comparison since 1956. It is also noted that a limitation to comparability over time can be due to a classification change, for which, however, users are informed. From 2014 onwards there has been a transition from the ICD-9 Classification of diseases to the ICD-10 (2008 edition) Classification of diseases, however, to enable comparisons, data for the years 2014-2016 are available in both ICD-9 and ICD-10.

Time series are available since 1956. Comparability issues may occur due to Classification changes (1956-1978 ICD-08, 1979-2016 ICD-09, 2014-2021 ICD-10)

In Greece CoD pertain to Population and Migration Statistics Section. Thus, mortality data available from demography are revised after the processing of the data on the causes of death. The only discrepancy concerns cases of refugees/ migrants who died while border-crossing before being registered in the country or have drowned in the Hellenic territorial waters, which are included in the datasets sent to Eurostat and WHO according to the scope of Causes of death statistics, as specified in the Article 1 of the Regulation (EU) No 328/2011 on statistics on causes of death that is: "European statistics in the domain of ‘causes of death’ shall concern all registered deaths and stillbirths occurring in each Member State,distinguishing residents and non-residents." On the contrary, these cases are excluded from the national CoD data and from the Hellenic Population Figures in accordance with guidelines from Unit F2 (Population & Migration).

Not applicable, only annual data are available.

Not applicable.

Statistics are very consistent within a given data set. In order to ensure the internal coherence, common data collection framework (concepts, definitions, classifications, etc.) in all geographic areas and a common methodology in the compilation of results are applied. In addition, all causes of death are coded at a central level from a single team of coders.

The cost and burden of the data collection is reduced by using validation and dissemination IT tools. Nevertheless, it hasn’t been estimated.

Data, if necessary, can be revised according to the most recently updated data always pursuant to the Revision Policy of ELSTAT. Relevant link:

https://www.statistics.gr/documents/20181/1195539/ELSTAT_Revisions_Policy_25_10_2018_EN.pdf/604b51dd-5dc2-4c7c-8b74-2766bda16e5e

There is no systematic revision of previous year data.

Not applicable.

Sources of information for CoD are Administrative records (Death Certificates) provided by Registries from all around the country and forensic physicians' reports in cases of violent or sudden deaths.

Annual.

Employees of Registry Offices register the Death Certificates in the Registrations Information System of the Ministry of Interior. ELSTAT draws the information required for statistical purposes from the Ministry’s central database. In addition, every year ELSTAT inquires the underlying cause of death (UC) for pending cases of violent or sudden deaths from forensic physicians.

Table on certification (Percentage)

There are no different death certificates for neonates but we additionally collect information on age in months/days or hours/minutes as well as death within marriage or out of wedlock or within registered partnership.

In case of stillbirths, common birth certificates are used where information on birth weight, gestational age, age of mother and parity is collected.

Local registers are the criteria for the validation of the coverage. In addition to the checks carried out by the administrative sources, validation checks are carried out by ELSTAT and Eurostat.

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

Coding is performed according to the ICD principles and only at a central level.

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):

Errors originated from physicians cannot be easily detected but a number of rational checks are carried out. 

Description of the measures taken in order to solve detected errors:  When an error appears, we communicate with registrars in order to clarify the matter.

Coding performed by a certifier: No

Estimation of the percentage of autopsy from which information is available for coding: 95%

Description of double coding exercises and rate of codification errors for underlying cause of death: No double coding exercises are performed (rate of codification errors: 3%).

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

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

Local registers are the criteria for the validation of the coverage. In any case, the registration of a death is crucial for the burial. In addition to the checks carried out by the administrative sources, validation checks are carried out by ELSTAT and Eurostat.

Not applicable.

Not applicable.

Not applicable.

Not applicable.