Reference metadata describe statistical concepts and methodologies used for the collection and generation of data. They provide information on data quality and, since they are strongly content-oriented, assist users in interpreting the data. Reference metadata, unlike structural metadata, can be decoupled from the data.
National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale - Inserm)
1.2. Contact organisation unit
US 10 - Centre d'épidémiologie sur les causes médicales de décès (CépiDc).
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
diffusion.cepidc@inserm.fr
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
Confidential because of GDPR
2.1. Metadata last certified
15 October 2026
2.2. Metadata last posted
15 October 2026
2.3. Metadata last update
15 October 2026
3.1. Data description
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 of death (UCD) which is defined by the World Health Organisation (WHO) as "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".
The regional breakdown is based on the NUTS 2 codes from the 2023 version of the Nomenclature of Territorial Units for Statistics (NUTS), see Commission Regulation (EU) 2023/674.
3.4.1. National definition used for usual residency
Place of residence as declared on the death certificate.
According to the instructions in section 3, subsection 6 of the General Instruction on Civil Status of 11 May 1999 (Annex) given to the civil servants in charge of drawing up acts of civil status, the place of residence declared on the death certificate is "the place where one has the center of one's interests, business, and relations". This definition may differ, in certain cases of dual residence, from that of "habitual residence", but it is consistent with the one used by France to establish its death statistics.
3.4.2. Stillbirth definition and characteristics collected
The French death certificate does not apply to stillbirths. Stillbirths information is collected from the « programme médicalisé des systèmes d’information » (PMSI) by the Directorate of Research, Study, Evaluation and Statistics (DREES) Population health office depending on the Health Ministry.
All stillbirths with weight births over 500 grams or with gestational ages of at least 22 weeks are collected. The terminations of pregnancy are included from 22 weeks (gestational age) onwards.
Agregated data on stillbirths provide information on :
country/region of residence
country/region of occurrence
year and month of occurrence
sex
gestational age
mother age
cause of death
Causes of deaths are provided using the "P95" and "P964" codes from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
3.5. Statistical unit
The statistical units are deceased persons and stillborns.
3.6. Statistical population
Residents and non-residents who died in France NUTS FR (see 3.7 for geographical scope).
3.6.1. Neonates of non-resident mothers
Neonates death certificates of non-resident mothers are included.
3.6.2. Non-residents
Non resident population is included.
3.6.3. Residents dying abroad
Residents dying abroad are not included.
3.7. Reference area
All French NUTS2, including Metropolitan France and overseas departments and regions (la Guadeloupe, la Martinique, la Guyane, la Réunion, Mayotte) + Saint-Martin, according to the French geographical nomenclature as of January 1st of the year of death established by the French National Institute of Statistics (Insee).
Deaths occuring in other overseas areas (i.e. overseas collectivities) or abroad are not included, except for Saint-Martin, which is included in NUTS 2 (FRY1).
3.8. Coverage - Time
Yearly from 2011 (included) onwards.
3.9. Base period
Not applicable.
The unit is number.
Data refer to the calendar year (i.e. all deaths occurring during the year).
6.1. Institutional Mandate - legal acts and other agreements
French law Article L2223-42 of the "Code général des collectivités territoriales" mandates Inserm- CépiDc as in charge of the establishment of causes of death (CoD) national statistics in France.
CoD data can only be used for public health purposes :
For monitoring and alert purposes, by the State, the regional health agencies (ARS) and the national public health agency (Santé publique France)
For the production of the national cause of death statistics and for public health research, by the National Institute of Health and Medical Research (Inserm)
For the processing of data relative to health, under the conditions set out in Article L1461-3 of the Public Health Code
For inclusion into the National Health Data System (SNDS) defined in Article L1461-1 of the same Code
For the production of statistics within the framework of the Article 7 bis of the law n° 51-711 from 7 june 1951 on the obligation, the coordination, the statistical secrecy, by the National Institute of Statistics and Economic Studies (Insee), or by the statistical services of the Minister of Health (DREES). These datasets must be kept separatly from the National register for the identification of individuals data owned by the National Institute of Statistics and Economic Studies (Insee)
7.1. Confidentiality - policy
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.
According to Article L1461-1 of the Public Health Code, the persons responsible for processing personal health data from the National Health Data System, as well as those implementing it or authorised to access the personal data resulting from it, shall be subject to professional secrecy under the conditions and under the penalties laid down in Article 226-13 of the Penal Code which states that the disclosure of secret information by a person who is in possession of it either by virtue of his or her status or profession, or by virtue of an office or temporary assignment, is punishable by one year's imprisonment and a fine of 15,000 euros.
The French Council of State decree referred to in Article L1461-7 of the Public Health Code draws up the list of State services, public establishments or bodies entrusted with a public service mission authorised to process personal data from the National Health Data System (SNDS) for the purposes of their missions.
7.2. Confidentiality - data treatment
All age groups showing a total mortality of less than 5 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 neonatal figures, no breakdown by parity is displayed to ensure confidentiality.
8.1. Release calendar
Following Regulation (EC) No 328/2011, Inserm-CépiDc has to send data to Eurostat at the latest 24 months after the end of the year of death. National releases follow as soon as possible.
Data are released on the website of CepiDc, freely accessible.
Annual.
10.1. Dissemination format - News release
The dissemination of the 2024 cause of death data, on June 23th 2026, was coupled with three publications and a news release. This mirror the approach taken in 2020, 2021, 2022 and 2023, where the cause of death data was also disclosed with a new release and two accompanied publications. All the relevant news releases and publications can be accessed on the CepiDc website.
For 2021, data dissemination included two publications:
Fouillet A, Ghosn W, Rivera C, Clanché F, Coudin É. Grandes causes de mortalité en France en 2021 et tendances récentes. Bull Épidémiol Hebd. 2023;(26):554-69.
Cadillac M, Clanché F, Coudin E, Fouillet A, Riviera C. Les grandes causes de décès en France en 2021 : une année encore fortement impactée par le Covid-19. Études et Résultats. 2023;(1288)
For 2020, data dissemination included two publications:
Fouillet A, Ghosn W, Naouri D, Coudin E. Covid-19 : troisième cause de décès en France en 2020, quand les autres grandes causes baissent. Bull Épidémiol Hebd. 022;(Cov_16):2-15.
Naouri, D., Fouillet, A., Ghosn, W., Coudin, E. (2022, décembre). Covid-19 : troisième cause de décès en France en 2020, quand les autres grandes causes de décès baissent. DREES, Études et Résultats, 1250.
and Rey, 2016 : "Death certificate data in France: Production process and main types of analyses", La revue de medecine interne, doi : J.revmed.01 January 2016
Documentation on quality management can be found on the CepiDc website.
And on annual production reports available on the website.
11.1. Quality assurance
The causes of death data are based on European regulation and European Statistics Code of Practice, which defines scope, definitions of variables and characteristics of the data, and on the WHO guidelines. France follows these clear and detailed guidelines for recording and coding the causes of deaths using the ICD-10 classification published by the WHO.
France also performs a review stage after an initial coding, especially for the most complex cases and the most frequent errors. In order to ensure cause of death coding quality, checks on specific types of coded death certificates are performed regularly. Those manual checks are performed though the Iris coding software user interface.
inconsistencies between age or sex and cause of death
applying explicit checks on certain causes of death (violent deaths, maternal deaths, neonatal deaths, COVID-19, ...)
addressing technical issues identified in the automatic coding process (automatic coding could be incorrect)
ensuring coding quality :
for sensitive causes of death (infant mortality, AIDS, ...) for human coding of complex or new coding rules
Random quality checks are also made to assess the quality of automatic coding and the consistency of manual coding.
For deaths in 2018 and 2019, produced in a context of production catch-up, all usual checks are not performed in the same way as usual. The production report details which types of checks amongst those listed above were performed, entirely, partially or let apart.
An assessment of coding quality was carried out each year for those years in which the coding of causes of death was based on a combination of rule-based automated coding, AI-assisted coding and assisted manual coding (i.e. since 2018, except for 2020 ). The evaluation for 2018 and 2019 are extensively documented in Zambetta et al 2023. This evaluation compares the results of a three-mode campaign with those of a conventional coding campaign – which relies on rule-based automated coding and assisted manual coding – and provides a comprehensive analysis by cause of death, organised by chapter.
11.2. Quality management - assessment
Quality assesment is conducted within the INSEE quality approach framework.
Following an evaluation process by the Official Statistics Authority, French cause of death statistics produced by the Inserm-CépiDc was given a quality label by the november 14, 2017 notice for a duration of 5 years. At the end of 2022, the CépiDc did not ask for a renewal of the label as the structural delay for transmitting to Eurostat and disseminating annual CoD data was not solved yet. As of 2024, the dissemination delay problem is now resolved. In 2025, the CépiDc asked for a renewal of the label of quality to the Official Statistics Authority.
Number of deaths, broken down by four cross-classified variables:
by the European COD shortlist
by region of residence of the deceased (NUTS2);
by sex;
by 10-year age group (separating those under one year of age and aggregating those aged 95 or older);
Age-standardized mortality rates by cause of death:
by the European COD shortlist
by region of residence of the deceased (NUTS2);
by age group (0–64 years, 65–84 years, and 85 years or older).
12.1. Relevance - User Needs
The main users of COD data are Research institutes, Universities, Public Government agencies. The main request from cause of death data users and stakeholders is the access to more recent data.
12.2. Relevance - User Satisfaction
Not available.
12.3. Completeness
100
12.3.1. Data completeness - rate
1. For mandatory variables: 100
2. For voluntary variables: 100
3. For additional variables:
External CoD : 100
Place of occurrence for external CoD : 100
Activity for external CoD : 0
13.1. Accuracy - overall
The main issue limiting the accuracy of the cause of death statistics is data coverage : each year, around 98% of civil state registered deaths in France match a death certificate received at Inserm-CépiDc. For the other 2% medical death certificates are missing. These remaining 2% are identified by the impossibility of indirect record linkage between civil state mortality data (collected by INSEE) and the medical death certificate data. They are at the end added to the CoD data with "unspecified cause of mortality". Missing data is non random and overrepresents suspicious deaths for which the death certificate can be blocked at various stages of the process, as described in Transmission of death certificates to CepiDc-Inserm related to suspicious deaths, in France, since 2000 (doi.org/10.1016/j.respe.2017.11.006), or some specific small geographical areas, which failed to provide data. However, the accuracy is rather good overall, and at the NUTS 2 level.
13.2. Sampling error
Not applicable. Data collection and processing are based on exhaustive administrative data.
13.2.1. Sampling error - indicators
Not applicable.
13.3. Non-sampling error
Some due to under-coverage
For the reference years 2022, 2023 and 2024, the final stage of the full synchronization of deaths registered by the INSEE and death certificates received by the CépiDc was not performed, as it would lead to undercoverage. Consequentely, there is a small discrepancy between the total of deaths in the demographic data (2022: 675 271, 2023: 639 426, 2024: 643 332) and the total number of deaths reported in the cause-of-detath data (2022: 675 413, 2023: 639 441, 2024: 643 355).
Duplicates of certificates (which can happen for e-certificates) are removed during the synchronisation process of CoD deaths with deaths registered to INSEE.
Stillbirths and neonatal births do not come from the same source (death certificates vs « programme médicalisé des systèmes d’information ») and those two sources are not linked allowing one to check and correct for double counts. Hence, there is a small risk of overestimating perinatal mortality due to double counting in each source of deaths/stillbirths at day 0.
13.3.1.2. Common units - proportion
Not applicable. Data collection is from administrative sources.
13.3.2. Measurement error
Not applicable.
13.3.3. Non response error
Only partial non-response.
13.3.3.1. Unit non-response - rate
Not applicable, deaths with no death certificates are added to the final data set with unknown cause of death.
13.3.3.2. Item non-response - rate
Total non-response (not receiving causes of death for a person deceased in France) is added to the dataset with COD coded as R99. Information on age, gender and region of death is available. CepiDc-Inserm does not receive around 2% of deaths certificates.
13.3.4. Processing error
In accordance with WHO recommendations, the physician's description of the cause of death is not questioned when compiling the statistical database. Inserm-CépiDc uses an external service provider to receive, digitize and standardize paper death certificates. Standardization also applies to electronic certificates that are not automatically coded with IRIS/MUSE. During this data entry phase, errors are limited by the use of a transcription software. The service provider sends both the scanned images and the digitized text to Inserm-CépiDc. During the coding phase, the IRIS/MUSE coding software is used both for batch coding and as an interface for manual coding (assisted coding). If the text on a death certificate appears to be inconsistent, the coding team checks the data entry using the scanned image.
For deaths in 2018 and 2019, data were produced in a context of production catch-up: certificates that were not automatically coded by the rule-based coding system (IRIS/MUSE, 62%) were either coded by deep learning algorithms trained on 2011-2017 and 2020 data (33%), or coded manually (3%). This may result in some errors for specific categories. Those are detailed in Zambetta et al. (2023) also reported in the appendix of the present metadata page.
For deaths in 2021 onwards, AI coding is integrated as a third mode of coding in regular production. 62,6% of death certificates in 2024 are automatically batch coded up to the UCOD determination by IRIS/Muse, 20,5% by AI and the remaining by the coding experts (via assisted coding with IRIS/Muse, 15,1%). Manual coding is targeted to certificates the more complex to code. 1.8% of the medical certificate in 2024 were missing
Year
IRIS/Muse
(%)
Assisted expert coding (%)
AI (%)
[Missing certificates]
2018
61.7
3.0
32.8
2.5
2019
62.5
3.1
32.0
2.5
2020
53.7
44.1
2.2
2021
61.4
14.0
22.5
2.0
2022
61.4
12.9
23.7
2.1
2023
62.3
14.8
20.8
2.0
2024
62.6
15.1
20.5
1.8
13.3.5. Model assumption error
Not applicable.
14.1. Timeliness
See table 14.1 Timeliness in annexCOD_CODNSI_A_2024_Annex
14.1.1. Time lag - first result
For 2024, there was no provisional data.
14.1.2. Time lag - final result
For 2024 – Final data were sent to Eurostat in June 2026.
14.2. Punctuality
From 2020 onwards, data are delivered on time with respect to the announced calendar.
14.2.1. Punctuality - delivery and publication
From 2020 onwards, data are delivered on time with respect to announced calendar.
See table 14.2.1 Punctuality- delivery and publication in Annex at "COD_CODNSI_A_FR_2024_Annex"
15.1. Comparability - geographical
The cause of death coding is centralized at Inserm-CépiDc. With the exception of Martinique and French Guiana, each region has a coverage rate of over 95%.
Région
2016
2017
2018
2019
2020
2021
2022
2023
2024
Auvergne-Rhône-Alpes
2,0
3,4
2,6
2,5
2,2
2,1
1,9
2,0
2,0
Bourgogne-Franche-Comté
4,1
2,2
2,3
2,0
1,3
1,3
3,4
2,5
1,3
Bretagne
0,9
0,9
0,9
0,9
1,0
0,8
0,7
0,8
0,9
Centre-Val de Loire
1,0
1,3
1,4
2,1
1,4
1,3
1,2
1,3
2,1
Corse
4,5
3,2
4,6
5,6
5,1
3,3
3,6
2,5
3,4
Grand Est
1,6
2,0
2,1
1,7
1,7
2,2
2,2
1,3
1,4
Guadeloupe
6,3
14,2
12,1
2,8
3,6
3,3
5,5
4,9
5,5
Guyane
4,2
7,0
19,6
5,9
6,7
7,3
6,8
10,5
9
Hauts-de-France
1,6
2,5
2,4
2,5
2,3
2,9
1,6
2,0
1,8
Ile-de-France
5,0
6,0
4,2
4,5
4,4
3,2
3,3
3,0
2,9
La Réunion
0,5
1,7
5,8
2,1
1,5
4,7
8,8
2,2
1,1
Martinique
2,1
1,6
7,6
1,0
3,7
5,1
11,0
8,1
6,5
Mayotte
10,2
19,4
29,3
17,0
16,2
8,7
4,1
3,2
5,1
Normandie
1,8
3,7
2,5
2,1
1,6
1,2
1,3
1,7
1,3
Nouvelle-Aquitaine
1,1
1,1
1,3
1,5
1,4
1,6
1,7
0,9
1,0
Occitanie
3,0
2,2
3,0
2,7
2,3
2,0
1,7
1,8
1,9
Pays de la Loire
1,7
2,3
1,5
3,2
1,1
1,0
1,1
1,7
1,1
Provence-Alpes-Côte d'Azur
6,0
2,7
2,1
2,1
2,4
1,7
1,8
3,4
1,7
France
2,7
2,8
2,5
2,5
2,2
2,0
2,1
2,0
1,8
Some regions (Île-de-France) do not send a countable part of their death certificates on a regular basis. This concerns in particular suspicious deaths in the event of a forensic investigation. The total number of deaths for these kinds of causes is therefore subject to variable underestimation over the territory and over time. The medico-legal institute of Paris transmitted medical causes for deaths subject to autopsy occurring from 2018 onwards.
Death certificates can be paper-back or electronic – the rate of electronic death certificates increased in 2020 from 20% at the beginning of the year to 29% in December 2020, around 32% in 2021, 35% in 2022, 41% in 2023 and 47,4% in 2024. The certificate model remains consistent, whether is electronically filled or paper, without risk of lack of transmission of data to CepiDc-Inserm for e-certification.
Year
% of electronic certificates
2015
9,1
2016
11,2
2017
11,9
2018
15,5
2019
18,7
2020
25,1
2021
31,7
2022
35,2
2023
41,1
2024
47,4
Since 2018, a new model of certificate was introduced. This new model of death certificate allows certifiers to provide additional information on manner of death especially for external causes of death, which enables to identify more accurately suicides for instance. E-certification was adapted to this new model in January 2018. Its use has been more progressive for paper-back certificates. The old model continues to be used especially by certifiers who do not certify deaths very often. The rates of dissemination can differ on a geographical basis.
15.1.1. Asymmetry for mirror flow statistics - coefficient
Not applicable.
15.2. Comparability - over time
The 10th revision of the International statistical classification of diseases and related health problems (ICD-10) has been implemented by Inserm-CépiDc from reference year 2000 onwards for cause of death statistics production. Except for very specific causes of death, there has been no major changes enough to warrant the designation of a break in series since.
Breaks in time comparability include e-certification deployment since 2007, 2017 new model of death certificate (at stake in 2018), and coverage of causes of deaths when forensic investigations occur as detailed above.
On electronic death certification, introduced in 2007,
title : "Evolution of the electronic death certification in France from 2011 to 2018"
creator : Anne Fouillet, Dominique Pigeon, Isabelle Carton, Aude Robert, Isabelle Pontais, Céline Caserio-Schönemann and Grégoire Rey
Checks are done with death records (INSEE) every week, with indirect record linkage every month and at the end of the coding of a given year, and final data includes demographic information also for missing death certificates.
15.3.1. Coherence - sub annual and annual statistics
Data are interpretable by month of death.
15.3.2. Coherence - National Accounts
Not applicable.
15.4. Coherence - internal
The coding team follows the same rules to code the causes of death.
Incoherence between cause of death and age or sex are identified and corrected.
Cause of death statistics production costs approximately 2 million euros annually. This bugdet does not cover the cost of the data collection process and its transmission to Inserm-CépiDc.
The cost and burden of the data collection is reduced by using automatic coding systems and by the increasing coverage of electronic death certification.
17.1. Data revision - policy
There is no data revision and no data revision policy. The reference years 2018 and 2019 are exceptions due to the release of provisional data.
17.2. Data revision - practice
Not applicable.
17.2.1. Data revision - average size
Not applicable.
18.1. Source data
French death certificates comply with the WHO standards. There are two different templates the neonatal death certificate for deaths occuring on the day of birth up to the 27th day of life and the general (adult) model of death certificate for deaths occuring from the 28th day of life (included) onwards. From 2018 on (and slightly 2017) a new template of the adult death certificate has been disseminated (but has not totally replaced the old ones). The new template offers more details on death circumstances, which has an impact in evaluating external causes of death.
18.2. Frequency of data collection
Daily.
18.3. Data collection
Data from administrative sources, collected either electronically or on paper.
18.3.1. Certification
Regarding training, not applicable because there is no survey conducted on death certification training or post mortem examination.
Regarding queries related to medical part of the death certificate, approximately 2000 to 3000 problematic death certificates have been queried for each reference year, with an estimated 50% response ratefor reference years prior to 2017. Since deaths occurring in 2018, around 50 certifying officers have been contacted regarding sensitive deaths (for example those of children). The proportion of deaths where the underlying cause is changed as a result of the query is unknown.
See table 18.3.1 Certification in Annex at "COD_CODNSI_A_FR_2024_Annex"
18.3.2. Automated Coding
See table 18.3.2 Automated Coding in Annex at "COD_CODNSI_A_FR_2024_Annex"
18.3.3. Underlying cause of death
See table 18.3.3 Underlying cause of death in Annex at "COD_CODNSI_A_FR_2024_Annex"
18.3.4. Availability of multiple cause
See table 18.3.4 Availability of multiple cause in Annex at "COD_CODNSI_A_FR_2024_Annex"
18.3.5. Stillbirths and Neonatal certificates
French death certificate does not apply to stillbirths. Stillbirths information is collected from the « programme médicalisé des systèmes d’information » (PMSI) by the Directorate of Research, Study, Evaluation and Statistics (DREES) Population health office depending on the Health Ministry.
All stillbirths with weight births over 500 grams or with gestational ages of at least 22 weeks are collected. The terminations of pregnancy are included from 22 weeks (gestational age) onwards.
18.4. Data validation
Inconsistencies between the cause of death and other information on the death certificate (age, sex, manner of death) are detected with alerts during coding using the Iris software, so coders can check the original death certificate and correct it. Consistency checks are also run on specific categories (children under 15, pathologies of particular interest for public health, maternal deaths, external causes) and randomly.
Coverage validation is done by indirect record linkage with population registers (Insee).
18.4.1. Coding
Description of coding procedure (central level, distributed among other bodies, etc.) :
The production process is centralised at Inserm-CépiDc. The coding procedure relies on the automated coding system Iris. 58 % of 2017 death certificates and 62,6% for 2024 were coded automatically by Iris. Rejected certificates are either manually revised by trained coders, and experts if they remain not yet coded, either by coded by AI (for 2018, 2019 and from 2021 on).
For deaths in 2018 and 2019, coding was also performed by predictive deep learning algorithms trained on past data. From 2021 on, coding strategy relies on the three modes of coding - automatically by the rule-based system IRIS/MUSE (62,6% in 2024), manually and assisted by IRIS/MUSE (15,1%) and predictive deep learning (20,5%). Deep learning algorithms are used both to predict CoD (multiple causes and UC) and to target certificates with low confidence levels in predictions to send them to manual coding. Manual coding therefore focuses on deaths of special interest for public health and research (maternal deaths, children, AIDS/HIV, research databases) plus those for which AI algorithms performance is not so good (other external causes, blood diseases, musculoskeletal system diseases, accidental poisoning...)
See Zambetta et al (2023) for details also reported as appendix to this metadata web page, with applications/quantification for 2018 and 2019 data.
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) :
Inconsistencies between the cause of death and other information on the death certificate (age, sex, manner of death) are detected with alerts during coding using the IRIS/MUSE software, so the coders can check the original death certificate and correct it. A consistency check is also run for the detection of inconsistencies at the end of a given sample coding.
Checks on cause of death coding quality are performed regularly. The manual inconsistency checks performed via the IRIS/MUSE coding software user interface concerns:
inconsistencies between age or sex and cause of death
applying explicit checks on certain causes of death (violent deaths, maternal deaths, neonatal deaths, COVID-19, AIDS...)
addressing automated coding accuracy
Random quality checks are also considered to assess quality of automated coding quality and consistency of manual coding.
Description of the measures taken in order to solve detected errors:
Errors detected are corrected manually by expert coders using the Iris software.
In the case of death certificates presenting a blank medical part, an e-mail or a paper mail may be sent to the certifier, but most of these queries remain unanswered.
Coding performed by a certifier:
no
Estimation of the percentage of autopsy from which information is available for coding:
Unknown.
Description of double coding exercises and rate of codification errors for underlying cause of death:
Unknown
18.4.2. Unspecified CoD code
See table 18.4.2 Unspecified CoD code in Annex at "COD_CODNSI_A_FR_2024_Annex"
18.4.3. Unknown country or region
See table 18.4.3 Unknown country or region in Annex at "COD_CODNSI_A_FR_2024_Annex"
Before 2023, deaths certificates received by France from overseas collectivities, which are not part of French NUTS except Saint-Martin (Saint-Barthélémy, Wallis-and-Futuna, French Polynesia, Saint-Pierre-and-Miquelon, French Southern and the Clipperton Island) were encoded as "UN99". Starting from 2023, they are encoded as any other foreign countries (ISO2-code + 99). Only the Antarctic Lands is left as UN99.
18.4.4. Validation of the coverage
By indirect record linkage with the population registers.
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 of death (UCD) which is defined by the World Health Organisation (WHO) as "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".
The statistical units are deceased persons and stillborns.
Residents and non-residents who died in France NUTS FR (see 3.7 for geographical scope).
All French NUTS2, including Metropolitan France and overseas departments and regions (la Guadeloupe, la Martinique, la Guyane, la Réunion, Mayotte) + Saint-Martin, according to the French geographical nomenclature as of January 1st of the year of death established by the French National Institute of Statistics (Insee).
Deaths occuring in other overseas areas (i.e. overseas collectivities) or abroad are not included, except for Saint-Martin, which is included in NUTS 2 (FRY1).
Data refer to the calendar year (i.e. all deaths occurring during the year).
The main issue limiting the accuracy of the cause of death statistics is data coverage : each year, around 98% of civil state registered deaths in France match a death certificate received at Inserm-CépiDc. For the other 2% medical death certificates are missing. These remaining 2% are identified by the impossibility of indirect record linkage between civil state mortality data (collected by INSEE) and the medical death certificate data. They are at the end added to the CoD data with "unspecified cause of mortality". Missing data is non random and overrepresents suspicious deaths for which the death certificate can be blocked at various stages of the process, as described in Transmission of death certificates to CepiDc-Inserm related to suspicious deaths, in France, since 2000 (doi.org/10.1016/j.respe.2017.11.006), or some specific small geographical areas, which failed to provide data. However, the accuracy is rather good overall, and at the NUTS 2 level.
The unit is number.
No operation is performed.
French death certificates comply with the WHO standards. There are two different templates the neonatal death certificate for deaths occuring on the day of birth up to the 27th day of life and the general (adult) model of death certificate for deaths occuring from the 28th day of life (included) onwards. From 2018 on (and slightly 2017) a new template of the adult death certificate has been disseminated (but has not totally replaced the old ones). The new template offers more details on death circumstances, which has an impact in evaluating external causes of death.
Annual.
See table 14.1 Timeliness in annexCOD_CODNSI_A_2024_Annex
The cause of death coding is centralized at Inserm-CépiDc. With the exception of Martinique and French Guiana, each region has a coverage rate of over 95%.
Région
2016
2017
2018
2019
2020
2021
2022
2023
2024
Auvergne-Rhône-Alpes
2,0
3,4
2,6
2,5
2,2
2,1
1,9
2,0
2,0
Bourgogne-Franche-Comté
4,1
2,2
2,3
2,0
1,3
1,3
3,4
2,5
1,3
Bretagne
0,9
0,9
0,9
0,9
1,0
0,8
0,7
0,8
0,9
Centre-Val de Loire
1,0
1,3
1,4
2,1
1,4
1,3
1,2
1,3
2,1
Corse
4,5
3,2
4,6
5,6
5,1
3,3
3,6
2,5
3,4
Grand Est
1,6
2,0
2,1
1,7
1,7
2,2
2,2
1,3
1,4
Guadeloupe
6,3
14,2
12,1
2,8
3,6
3,3
5,5
4,9
5,5
Guyane
4,2
7,0
19,6
5,9
6,7
7,3
6,8
10,5
9
Hauts-de-France
1,6
2,5
2,4
2,5
2,3
2,9
1,6
2,0
1,8
Ile-de-France
5,0
6,0
4,2
4,5
4,4
3,2
3,3
3,0
2,9
La Réunion
0,5
1,7
5,8
2,1
1,5
4,7
8,8
2,2
1,1
Martinique
2,1
1,6
7,6
1,0
3,7
5,1
11,0
8,1
6,5
Mayotte
10,2
19,4
29,3
17,0
16,2
8,7
4,1
3,2
5,1
Normandie
1,8
3,7
2,5
2,1
1,6
1,2
1,3
1,7
1,3
Nouvelle-Aquitaine
1,1
1,1
1,3
1,5
1,4
1,6
1,7
0,9
1,0
Occitanie
3,0
2,2
3,0
2,7
2,3
2,0
1,7
1,8
1,9
Pays de la Loire
1,7
2,3
1,5
3,2
1,1
1,0
1,1
1,7
1,1
Provence-Alpes-Côte d'Azur
6,0
2,7
2,1
2,1
2,4
1,7
1,8
3,4
1,7
France
2,7
2,8
2,5
2,5
2,2
2,0
2,1
2,0
1,8
Some regions (Île-de-France) do not send a countable part of their death certificates on a regular basis. This concerns in particular suspicious deaths in the event of a forensic investigation. The total number of deaths for these kinds of causes is therefore subject to variable underestimation over the territory and over time. The medico-legal institute of Paris transmitted medical causes for deaths subject to autopsy occurring from 2018 onwards.
Death certificates can be paper-back or electronic – the rate of electronic death certificates increased in 2020 from 20% at the beginning of the year to 29% in December 2020, around 32% in 2021, 35% in 2022, 41% in 2023 and 47,4% in 2024. The certificate model remains consistent, whether is electronically filled or paper, without risk of lack of transmission of data to CepiDc-Inserm for e-certification.
Year
% of electronic certificates
2015
9,1
2016
11,2
2017
11,9
2018
15,5
2019
18,7
2020
25,1
2021
31,7
2022
35,2
2023
41,1
2024
47,4
Since 2018, a new model of certificate was introduced. This new model of death certificate allows certifiers to provide additional information on manner of death especially for external causes of death, which enables to identify more accurately suicides for instance. E-certification was adapted to this new model in January 2018. Its use has been more progressive for paper-back certificates. The old model continues to be used especially by certifiers who do not certify deaths very often. The rates of dissemination can differ on a geographical basis.
The 10th revision of the International statistical classification of diseases and related health problems (ICD-10) has been implemented by Inserm-CépiDc from reference year 2000 onwards for cause of death statistics production. Except for very specific causes of death, there has been no major changes enough to warrant the designation of a break in series since.
Breaks in time comparability include e-certification deployment since 2007, 2017 new model of death certificate (at stake in 2018), and coverage of causes of deaths when forensic investigations occur as detailed above.
On electronic death certification, introduced in 2007,
title : "Evolution of the electronic death certification in France from 2011 to 2018"
creator : Anne Fouillet, Dominique Pigeon, Isabelle Carton, Aude Robert, Isabelle Pontais, Céline Caserio-Schönemann and Grégoire Rey
