Statistics Finland

Information and Statistical Services, Social Statistics

FI-00022 Statistics Finland

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".

Causes of death are classified by the 86 causes of the "European shortlist" of causes of death. This shortlist is based on the International Statistical Classification of Diseases and Related Health Problems (ICD).

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).

2001*
Updates 2001
- To rule A added codes I95.9,I99, J96.0, J96.9, P28.5 (WHO sugg impl year 2001)
- List of conditions unlikely to cause of death (sugg. impl year 2003)

2005*
Updates 2005
- Pneumonia rule enlargened with J18, J69, W78-W80 (WHO suggested impl year 2003)
- X40-X49  with mention of F10-F19 => code to X4-. (WHO suggested impl year 2006)
  Y10-Y15   with mention of F10-F19 => code to Y1-. (WHO suggested impl year 2006)
- J448-J449 as cause of J12-J22 =>  code to J440 (WHO suggested impl year 2006)
- F10.1-F10.9  with mention of E24.4, G31.2, G62.1, G72.1, I42.6, K29.2, K70.-, K86.0, O35.4 => code to mentioned code
- Rule to trivial conditions: " If the death was the result of an adverse reaction to treatment of the trivial condition, select the adverse reaction" (suggested impl year 2006)

2006*
Updates 2006
- New codes I27.2, K31.7, M72.6 (WHO suggested impl year 2003)
- I70.- with mention of I50.- => code I50.-
- I70.- as cause of I51.9 => code I25.1 (sugg impl year 2006)
- J18.1 can be due to F10.2 (sugg impl year 2006)
- I25.2 not to be used as underlying cause (sugg impl year 2006)
- Rule 3 enlargened with J15.0-J15.6, J15.8.-J15.9 (suggested impl year 2006)

2006**
Updates until 2006 except A09,X59 (implemented in year 2015)

Public Health.

In line with the regulation.

Those persons who according to the Population Information System are registered as present are permanent residents of Finland, either Finnish nationals or aliens. Finnish nationals residing temporarily abroad remain present if they intend to be absent from Finland not more than one year. The time limit of one year does not apply to Finnish nationals who are diplomats and to those working in development co-operations.

Staying in Finland for clearly more than one year is the prerequisite for registering of the foreign citizens into the population of Finland if a person does not have EU citizenship. The length of employment or studying from entry into the country or the length of employment contract must be two years for a foreign citizen to receive the right to a place of domicile. Staying in Finland for one year is the prerequisite for registering of the citizens of EU countries into the population of Finland if they have already lived a year in Finland.

Stillbirths include a fetus or a newborn who shows no signs of life at the time of birth and the duration of pregnancy is at least 22 weeks or the weight at least 500 grams. Miscarriages that occurred at an earlier stage of the pregnancy are not regarded as stillbirths and are not included in cause of death statistics.

Characteristics collected: gestational age and weight

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

Residents, non-residents and stillbirths.

Not considered residents.

Non-residents dying in Finland are covered as well as residents dying in Finland since 2013.

Included. Since 2013, a finnish death certificate is issued by a forensic pathologist based on information available from foreign documents/death certificate. 2021 64% of them has R98-R99 as cause of death.

Finland.

Time series available from 1994 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 before and after 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.

2021

Countries submitted data 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. The first data submitted according to the Regulation (EU) No 328/2011 is data with reference year 2011.
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.

Data may be released for purposes of scientific research and statistical surveys on society. The releasing of unit-level data is subject to a user licence, see https://www.stat.fi/meta/tietosuoja/kayttolupa_en.html 

Confidentiality and delivery of CoD-data is decreed in the Act on the investigation of the cause of death (1973/459) and in the Act on the Openness of Government Activities (621/1999).

Data are handled only by persons who need the data in their work. The use of data is restricted by usage rights. All persons employed by Statistics Finland have signed a pledge of secrecy, where they have obliged to keep secret the data prescribed as confidential by virtue of the Statistics Act or the Act on the Openness of Government Activities.

Researchers handling Statistics Finland's data also sign a pledge of secrecy.

The Finnish cause of death statistic is released annually, at the end of the following year of the reference year. The 2021 statistics was released in December 9 2022.

See Statistics Finland's homepage http://www.tilastokeskus.fi/index_en.html . Choose News - Release Calender.

Publication principles for statistics at Statistics Finland: see https://www.stat.fi/org/periaatteet/index_en.html

News notification service: see https://www.stat.fi/ajk/index_en.html

Annual.

News releases on-line. See Causes of death - Statistics Finland

On-line publication on our website. See Causes of death - Statistics Finland

The free of charge database: see Causes of death - Statistics Finland

Few.

See under https://tilastokeskus.fi/tup/mikroaineistot/aineistot_en.html subtitles "Cause of death data" and "Release of data to researchers" 

WHO - tabular data.

EMCDDA - drug-related deaths.

Few.

Not available.

> 90 %

Not available

See 18.4.1. Coding

Not available.

Faster completion of statistics.

Not available.

Criterias are fully met in the mandatory variables.

1. For mandatory variables:

    Complete since 2014. 2011-2013 Finland had the derogation not to provide region of occurrence (NUTS2) and country of residence/country of residence of the mother.

2. For voluntary variables:

   Not provided.

3. For additional variables:

• External CoD

         Complete.

• Place of occurrence for external CoD

          Not provided.

• Activity for external CoD

          Not provided.

Data on death are verified from the Population Information System. In case the information on 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.  

Not applicable.

Not applicable.

Not applicable.

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. Deaths have to be reported immediately either to a physician or to the police. The health care unit or the physician has to report the death to the Population Information System or its maintainer after the immediate examinations of determining the cause of death has been conducted and the permission of burial has been issued. In some cases, the notification of death can be delayed for weeks. Statistics Finland receives the updated data of vital events in machine-language format on a weekly basis. In order that a person obtains a personal identity code, he or she has to be registered in the Population Information System. He can become to a permanent or temporary inhabitant of a municipality of Finland. It is practically impossible to live in Finland without a personal identity code. A personal identity code is needed so that one can work legally, open a bank account, have dealings with authorities and so on.

The statistic doesn’t include persons declared dead nor deceased, whose death is registered after compilation time of statistics. The amended act (127/2005) on declaring someone as legally dead made it possible since 2005 in certain circumstances to speed up considerably the process of declaring someone as legally dead and thus make it possible to enter the death into the Population Information System from which they become available to Statistics Finland by the compilation time of the statistics. However, the cause of death can’t be obtained from persons declared death until the body is found. These two groups have few cases per year altogether.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable.

Death certificates missing

2011 0.3 %

2012 0.4 %

2013 0.5 %

2014 0.9 %

2015 0.7 %

2016 0.2 %

2017 0.3 %

2018 0.2 %

2019 0.2 %

2020 0.2 %

2021 0.6 %

Not applicable.

Not applicable.

Not applicable.

From data collection with reference year 2011 onwards, Eurostat asks for the submission of final data for the year N at N+24 months.

Statistic Finland published the data for the referance year N at N+12 months.

Not applicable.

Not applicable.

17-22 months

The data from all regions are comparable.

Not applicable.

Finland has used ICD9 1990-1995 and ICD10 1996 onwards.

Region of occurrence (NUTS2) and country of residence/country of residence of the mother are available since 2014.

Coherence of data with other statistics:

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 2021, the number of deaths was 57,659 which was 27 deaths more than in the cause of death statistics. The number of deaths under the age of one year was 88 in the vital statistics and 89 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 road traffic accidents include deaths that occurred on the day of the accidents and the most the 30 following days. The cause of death statistics are compiled on the basis of the day of the death no matter how long time ago the accidents occurred

• 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. The number of deaths from occupational accidents differs yearly very little from the figures in the cause of death statistics.

Not applicable, only annual data are available.

Not applicable.

No inconsistency between GEN and SBN files.

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

Annual data is final. There is no systematic revisions of previous year data.

No data revisions.

Not applicable.

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. The statistics on stillbirths are supplemented with data from the birth register of the National Institute for Health and Welfare (THL).

Constantly.

Information provided in the sub-concepts.

Table on certification (Percentage)

Special certificate for stillbirths and neonatal deaths which differs from the regular death certificate as follows:

additional information
- birth and death time (hhmm) for deaths aged 0-6 days
- gestational age and weight
- multiple pregnancy
- birth order in case of multiple pregnancy
- gender can be uncertain
- age, gender and home municipality of mother, country if not resident

causes of death are different
- child's main cause of death
- child's two other reasons to death
- mother's main reason contributing to death
- mother's two other reasons contributing to death 

What are the criteria (external source, local registers, …) used for the validation of the coverage?

The statistics cover all persons registered by the Population Information System as residents of Finland at their death, regardless of whether the death took place in Finland or abroad. Stillbirths are cross-checked with the Medical Birth Register.

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

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 approved certificates are sent on to Statistics Finland. Death certificates are received at Statistics Finland from THL either in paper form or electrically. Death certificates are scanned at Statistics Finland in picture format and part of the data is read optically to the database. During optical reading whenever the program is uncertain of a code interpretation a manual validation is performed. In case of an electronic death certificate picture of the certificate and part of the data is read automatically to the database.

Then diagnosis texts and cause of death codes issued by physician are compared with each other with the help of an electronic dictionary. If the diagnosis text matches with the dictionary the dictionary code is chosen unless the physician’s code is more precise one of the same disease. Then the physician’s code is chosen as well as in the case when there is no match in the dictionary. This part is done automatically.    

The process of determining underlying cause is done in the application window which consists of two parts, one window for the picture of the certificate and one window to which the cause of death codes are read from the database. When the case comes up for coding it goes through checks (see later). If error exists an error message is shown. The coder corrects the errors, examines the sequence reported on the certificate and modifies codes and their place on the certificate using selection and modification rules (except Rule C, linkage) to identify the tentative underlying cause. Then the coder let the application programmatically produce the underlying code using Rule C (linkage).

In that process application checks again that
- codes are valid ICD10-codes;
- there are no inconsistency between codes, gender and age;
- codes are not improbable;
- asterisk codes are with dagger codes;
- external codes are with S- and T-codes;
- intermediate cause is not without immediate cause;
- if different causes have same codes;
- there are no inconsistency between manner of death and the tentative underlying code;
- manner of death, place of death, grounds for investigating the cause of death, the tentative underlying cause has no missing values.

If no errors exists the application produces the underlying code. At the same time application checks that the final underlying code can be used as an underlying cause.  In some cases, the coder can manually modify the final underlying code. Finally all causes of death and rest of the data is stored to the database.

In case the information in the death certificate is deficient, inconsistent or difficult to classify a medical expert will be consulted or more information is requested from the issuer of the death certificate.

When the annual data is completed the data is run through Iris and the different outcomes between manual and MUSE underlying cause are checked and corrected if necessary. Important variables are cross-checked, frequency list are made of them and are compared with those of the previous year. Special groups concerning manner of death like occupational diseases, medical treatment or examination, homicide, war, undetermined intent are checked.

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):

See above.

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

See above.

Coding performed by a certifier:

Although the physician records the cause of death on the death certificate as a code and as text specifying the diagnosis, the final coding is done at Statistics Finland where the causes of death are coded on the basis of the diagnosis text and rearranged if necessary according to WHO's selection and modification rules. 

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

The certifier issues the information of autopsy, which she/he thinks is essential in the free text part of the certificate.

The certificate has a free text part in which the certifier describes circumstances of death: state of health prior to the onset of events which lead to death; progress of the disease which lead to the death; main examination results and treatment. If the death entailed a mortal injury or toxic condition, the external condition are described in detail.

The proportion of autopsy (forensic or medical) has decreased in Finland since 2010. Autopsy was performed for 17.6 per cent of dead persons in 2021.

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

No double coding exercises. Codification errors are very small. 

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

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

The statistics cover all persons registered by the Population Information System as residents of Finland at their death, regardless of whether the death took place in Finland or abroad. Stillbirths are cross-checked with the Medical Birth Register.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

None.