Croatian Institute of Public Health

Croatian Bureau of Statistics

Croatian Institute of Public Health - Department of Mortality Statistics

Croatian Bureau of Statistics - Population Statistics Department - Vital Statistics and Migrations Unit

Croatian Institute of Public Health

Rockefellerova 7

10 000 Zagreb, Croatia

Croatian Bureau of Statistics

Branimirova 19

10 000 Zagreb, Croatia

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).

COD data are derived from death certificates and coding the underlying cause of death is in according to the rules specified in the ICD.

Data are broken down by sex, 5-year age groups, cause of death and by residency and country of occurrence. For stillbirths and neonatal deaths additional breakdows might include age of mother.

Annual national data are provided in absolute number, crude death rates at NUTS level 1, 2 and 3.

Death and cause of death are determined by the appointed coroner, who, then, fills out a DC and delivers them to the civil registry. The registrar uses this to record deaths into the Register of Deaths and fills out a statistical death report (DEM-2 form), which includes a DC, sent by the county statistics office. CBS collects DEM-2 forms on a monthly basis from all county offices and keeps their records. Pursuant to an agreement with the CBS, the CNIPH is responsible for the quality of data on the causes of death and performs tasks of determining and coding underlying causes of death. The coding is done centrally and manually, by employing the ICD-10 and Volume II coding rules. In Croatia, the ICD-10 has been applied since 1995, while update ICD-10 was introduced in mortality statistics in 2005. Aiming at quality mortality data, the CNIPH cooperates with all County institutes of public health (CIPHs), Forensic institutes and toxicological labs. Data missing from DCs are collected by employees of CIPHs based on a copy of the DC with a precise request.

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

* Note: In Croatia there is no official translation or implementation of the updates to the ICD-10 revision, the Second edition of ICD-10 is in use. For mortality statistics purposes the Official cummulative ICD-10 updates from Toronto, 2010 are used in Croatia. We could not apply the update that refers to activity for external causes of deaths, because we do not have possibility to collect the data. Since 2013 we apply the Second edition of ICD -10 which includes all previous updates.

Public Health

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

Data on deaths have been collected and processed in line with the definition of the usual residence. Data on deaths refer to all deceased persons who were permanent residents of the Republic of Croatia and have not been absent for longer than a year, as well as all deceased persons who were not permanent residents of the Republic of Croatia, but have been present for a year or longer.

A stillborn child (stillbirth) is considered every child that, after a complete expulsion or extraction from its mother, does not show any evidence of life, that is, who neither breathed nor showed any other evidence of life, providing that the pregnancy lasted for 22 weeks or longer and that the child weighted 500 grams or more. Data source for given data on stillbirths is Croatian National Institute of Public Health. All characteristics (gestational age, weight and crown-heel) are collected.

The statistical units are the deceased persons and the stillborns.

All registered deaths and stillbirths occurring in Croatia.

Neonates of non-resident mothers are not considered residents.

Non-residents are not included in national statistics, but we have causes of death and all other caracterictics for non-residents.

We do not include deaths of our residents due to the specific situation in Croatia, where a large number of people with permanent residence in Croatia actually live abroad for a longer period of years. There are a small number of deaths of our actually usual resident population that occurred abroad. In order to maintain the quality of data we do not include any of those deaths abroad.

Data are available at national and regional level of geographical detail. 

Time series are available from 1999 onwards.

Not applicable.

The unit is number.

The data are published in absolute numbers, crude death rate and standardised death rate.

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.

Cooperation between Croatian Bureau of Statistics and the Croatian Institute of Public Health.

Along with electronic Statistical Report on Death (DEM-2), the registrar submits to the Croatian Bureau of Statistics one copy of the Death Certificate form in paper form.

The Death Certificate is linked to the DEM-2 form in such a way that the identifier of the DEM-2 form is entered on the Death Certificate.

Death Certificates are submitted to the Croatian Institute of Public Health.

The cause of death is coded in the Croatian Institute of Public Health in accordance with the Cooperation Agreement (experts from the Croatian Institute of Public Health have the knowledge in the field of health necessary to conduct a survey of death statistics that the CBS does not have).

Using the DEM-2 application, the Croatian Institute of Public Health enters the code of the cause of death based on the diagnosis stated on the Death Certificate, and encodes other features on the DEM-2 record related to health reporting.

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.

National level:

The Official Statistics Act (OG, No 25/20)

Ordinance on the access to confidential stastistical data

Ordinance on conditions and terms of using confidential statistical data for scientific purposes

Causes of death are available at national and regional level of geographical detail.

Data are published according to the Publishing Programme and the Calendar of Statistical Data Issues.

The Calendar of Statistical Data Issues contains the review of publications planned to be issued in current year and by the end of June for the next year, which depends on when the processing of a particular survey can be finished and whether it is feasible to make a particular kind of publication or not.

Release calendar is available at the following link: https://dzs.gov.hr/

Data are published according to the Publishing Programme and the Calendar of Statistical Data Issues.

Annual.

First Release: Population Change in the Republic of Croatia.

Croatian Health Service Yearbook and Annual Report of Deaths.

Statistics records on deaths are released in the First Release "Natural Change in Population in the Republic of Croatia", in the Statistical Report: Natural Change in Population, and in other statistical publications (Statistical Information; Croatia in Figures; Women and Men in Croatia).

The online database is not available.

Information not available

Microdata are disseminated only to Eurostat and WHO.

Not applicable.

Not available.

Not applicable.

Since 2011 we have death certificate according the standards and rules in the ICD. The death certificate is legitimate by Ordinance of death certificate.

We have central and manual coding system. The updates of ICD-10 have been implemented since 2004.

The training for physician or another type of health professionals who are authorized for determining death is obligatory. Croatian Institute of Public Health and Ministry of Health is responible for this training. 

The procedures of collection of COD are homogenous on national level.

The data on quality are stored in database of quality information (DBQI), and the reports on quality are prepared on the bases of this information and will gradually be available on the Croatian Bureau of Statistics web site.

We have specific checks during the entry of causes of death. We developed very effective system of collecting additional or missing data on death certification.

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

Definition of death stated in Article 2 of Regulation 1260/2013 is applied.

The standard quality criteria indicate a good quality of mortality data: percentage of unspecified COD (ICD-10: R00-R99) is 0,6, the percentage of unknown COD (ICD-10: R98 and R99) is 0,5% and percentage of deaths due to senility (ICD-10: R54) is 0,003.

Data on causes of death provide information on mortality patterns and form a major lelment of public health information.

The relevance of an instrument has to be assessed in the light of needs of its users. As for the COD data collection the main users are the following:

- Instutional users

- Statistical user in Eurostat or in Member States - National Statistical Institutes to feed publications and

- End users - including te media - interested in health statistics in the EU.

The main users are Ministry of Health, Universities, Public Government agencies, international organizations and media.

We do not carry out research on customer satisfaction on causes of death data.

All data required under Regulation 328/2011 are available and delivered to Eurostat.

All data are disseminated on time which is specified in Annual Implementation Plan of Statistical Research.

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 % (the data is not available)

The COD have a high accuracy.

The EDIt validation tool for causes of death used before sending data to Eurostat.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable. Data collection is from administrative sources.

Not applicable. Data are from administrative cources.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Croatia can submit the causes of death data without delay.

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.

Statistics are comparable between geographical areas.

Not applicable.

Data on deaths are collected and processed in line with the Regulation (EU) No 1260/2013 of the European Parliament and of the Council on European demographic statistics.

Data on deaths have been collected and processed in line with the definition of the usual residence since 1998. Until 1997, data on deaths were processed according to a deceased person's permanent residence.

Data on deaths have been collected and processed in line with the definition of the usual residence since 1998. Until 1997, data on deaths were processed according to a deceased person's permanent residence.

Not applicable.

Not applicable, only annual data are available.

Not applicable.

All data are consistent.

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

There is no any change in a value of a statistic released to the public.

Not applicable.

There is no systematic revision of previous year data.

Not applicable.

Data source for deaths are registers of death kept in registrars' offices of every particular area. Data on deaths ared collected through the Statistical Report on Deaths (DEM-2 form) for each recording in the state registers of deaths.

Annual.

The data collection is based on the death certificates, which are filled in by the coroners. Coroners are health professionals, most of them are physician.

The information provided on the medical certificates od cause of death is coded into the International Statistical Classification of Diseases and Related Health Problems (ICD).

The coding is done manually and centrall in the Croatian Institute of Public Health.

Table on certification (Percentage)

We have a different certificate for registration of perinatal death. Coding is the same as for other deaths.

We don't have different certificate for registration of neonates.

Data sources for deaths are registers of deaths kept in registrats' offices of every particular area. Data cover all persons who were decceased in a particular calendar year and who were entered into registers of deaths.

These data are collected through the statistical reports. Reporting units are required to provide accurate, complete and updated data and in the content and form which determined by the Croatian Bureau of Statistics and within the timeliness determined by the Annual Implementing Plan. If the data stated by the reporting units are not accurate, complete and updated, the reporting units will be bound to correct them, and/or make additions, in conformity with instructions and within set deadlines.

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

The ICD-10 has been applied since 1995, while update ICD-10 was introduced in mortality statistics in 2005. Determining and coding of underlaying causes of death is performed at the Croatian Institute of Public Health according to ICD-10 methodology.

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):

We apply logical controls that are based on Comparability and Quality Improvement of the European Causes of Death Statistics (Standard Quality Cheks for COD data).

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

If the data stated by the reporting units are not accurate, complete and updated, the reporting units are bound to correct them, and/or make additons, in conformity with instructions and within set deadlines in cooperaton with Croatian Institute of Public Health.

Coding performed by a certifier:

No.

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

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

We don't perform double coding excercises.

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

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

Not applicable.

After the data on deaths has been collected on the forms and submitted to the Croatian Bureau of Statistics, begins the processing of the collected data. First is done coding and data entry, then data verification and all the logical and computational controls of data.

Not applicable.

Not applicable. No adjustments are made.

Not applicable.

None.