Institute of Hygiene, Lithuania

State Register of Death Cases and Their Causes

Studentų g. 45A, LT-08107 Vilnius

Data on causes of death (COD) provide information on mortality patterns and form a major element of public health information. The objective is to produce and provide statistical information on the causes of death by sex, age, place of residence. COD data are derived from Medical death certificates and Medical perinatal death certificates. The medical certification of death is an obligation in Lithuania. 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".
The causes of death are classified according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Since April 2011 ICD-10-AM (Australian Modification) is using in Lithuania on a national level, but for Eurostat and the WHO, code conversion is made to be in-line with the International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10).
Annual national  data at national level are publicated in absolute numbers, crude death rates and standartised death rates.

Public Health.

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

Usual residence means the place where a person normally spends the daily period of rest, regardless of temporary absences for purposes of recreation, holidays, visits to friends and relatives, business, medical treatment or religious pilgrimage.

The following persons alone shall be considered to be usual residents of a specific geographical area:

(i) those who have lived in their place of usual residence for a continuous period of at least 12 months before the reference time;

(ii) those who arrived in their place of usual residence during the 12 months before the reference time with the intention of staying there for at least one year.

Resident population means all persons having their usual residence in the Republic of Lithuania at the reference time.

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 500g and gestational age from 22 completed weeks are included.

Birth weight, gestational age, and crown-heel length are collected.

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

The survey covers the deaths of usual residents of the Republic of Lithuania and the stillbirths born in Lithuania whose parents (or at least one of them) are usual residents of Lithuania or their origins are unknown.

The survey covers the deaths neonates of non-resident mothers whose father is  a permanent resident of Lithuania or their origins are unknown.

In the database of The State Register of Death Cases and Their Causes are collected cases of death of persons who died in the territory of the Republic of Lithuania and citizens of the Republic of Lithuania who died abroad and their causes.  Lithuanian causes of death statistics cover only all deaths of the residents of Lithuania.

Data causes of  deaths covers residents who died abroad.

Entire territory of the Republic of Lithuania.

Since 1994.

Not applicable.

The unit is number.

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

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.

Commission Regulation (EU) No 328/2011 of 5 April implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council on Community statistics on public health and health and safety at work, as regards statistics on causes of death.

Regulation (EC) No 223/2009 on 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.
Republic of Lithuania Law on Official Statistics and State Data Governance(only in Lithuanian).

Data Protection Regulation of State Register of Death Cases and Their Causes (only in Lithuanian).

Statistical information is published in accordance with an approved release calendars.

The  Official Statistics Calendar is placed on the Official Statistics Portal of Statistics Lithuania

Institute of Hygiene Health statistics release calendar (only in Lithuanian)

In Lithuania statistical information is published on the Institue of Hygiene Internet Site and  on   the Official Statistics Portal  on the  Database of Indicators (Population and social statistics -> Population -> Mortality->Deaths by cause of death)  (data available in Lithuanian and English).

Annual.

Regular news releases on Official Statistics Portal and Institute of Hygiene and irregular press releases.

Annual statistical yearbooks:

• Causes of Death;
• Health Statistics of Lithuania.

Database of Indicators (Population and social statistics -> Population ->Mortality)
Portal of health statistics

 Not available.

All causes of death are stored in database. A special extraction can be made on request.

Eurostat‘s database

World Health Organization database

Not available.

Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work;
Commission Regulation (EU) No 328/2011 of 5 April implementing Regulation (EC) No 1338/2008 of the European Parliament and the Council on Community statistics on public health and health and safety at work, as regards statistics on causes of death;
Methodological information of The State Register of Death Cases and Their Causes  (only in Lithuanian);
Medical death certificate forms are based on the template provided by the World Health Organization (WHO);
According to the WHO guidelines and the Eurostat recommendations were prepared the methodological manual of certification of cause of death „Instruction of filling medical death certificate“ (only in Lithuanian);
The cause of death is classified according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Since April 2011 ICD-10-AM (Australian Modification) is using in Lithuania on a national level, but for Eurostat and the WHO, code conversion is made to be in-line with the International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10);
Underlying causes of death are defined according to International Statistical Classification of Diseases and Related Health Problems rules – ICD-10 Vol.2

0.9

The quality of statistical information and its production process is ensured by the provisions of the European Statistics Code of Practice. Underlying causes of death are defined following the International Statistical Classification of Diseases and Related Health Problems rules – ICD-10 Vol. 2 and the recommended WHO's updates are applied.

Quality policy is defined in the State Register of Death Cases and Their Causes provisions (only in Lithuanian).

The quality of statistical information and its production process is ensured by the provisions of the European Statistics Code of Practice. Primary control of data entry is conducted at the State Register of Death Cases and Their Causes of Institute of Hygiene: completeness of mandatory data, data match with formats and defined logics. Data validation with several institutions - Register of Residents and Lithuanian Department of Statistics.

Quality of death statistics is evaluated using international indicators of quality of death statistics.

The main users of statistical information are State and municipal authorities and agencies, international organizations, the media, research and business communities.

Users satisfaction survey for 2022 (only in Lithuanian).

All indicators established by the legislation are published and available.
All mandatory data for Lithuania is provided in full detail and in timely manner.

1. For mandatory variables:

 All mandatory variables required by the Commission regulation n°328/2011 are transmitted to the European Commission.

2. For voluntary variables:

 The State Register of Death Cases and Their Causes are not able to provide parity and age of mother variables concerning stillbirth data. Age of mother variable falls into the regulation scope of the Law on Legal Protection of Personal Data of Republic of Lithuania.

3. For additional variables:

• External CoD

  are transmitted to the European Commission;

• Place of occurrence for external CoD

  are transmitted to the European Commission;

• Activity for external CoD

  are transmitted to the European Commission.

The source data, intermediate results and statistical  outputs are assessed and validated regularly: visual control of register data, logical control during data entry process, computerised control after data entry, control of time-series of indicators. Data quality assurance is performed by verifying the entered data against the information on deceased persons provided by Resident’s Register and Statistics Lithuania. The control procedures are described in Causes of death survey methodology.

Not applicable.

Not applicable.

Not applicable.

Not applicable

Not applicable

Not applicable. Data collection is from administrative sources.

Not applicable

The main problem is the loss of information (causes of deaths, place of death, circumstances external causes of deaths, etc.) when permanent Lithuanian residents died abroad (about 0.8  % of all deaths).

The ratio of the number of units with no information or not usable information to the total number of in-scope (eligible) units for period 2011–2018 average is 0.01.

Not applicable.

Not applicable.

Not applicable.

Final micro data are provided to Eurostat for the year T (“T + 18 months“).
National provisional annual statistical data is published at the beginning of April, final statistical data – at the beginning of August after the end of the reference year. Provisional monthly statistical information of a reference month is published after 45 days from the end of the reference month.

Not applicable.

Not applicable.

Statistical information is published in accordance with an approved Official Statistics Calendar
and Institute of Hygiene Health statistics release calendar. In case of delay, users are notified in advance by indicating the reason and a new date of publication.

Because of coding at  a central level, the COD data is treated in the same way in all the LT regions.

Not applicable.

The comparability of the data over time is checked before dissemination. It could be that in few categories of causes of death, for which not all EU Member States reported data, the EU average is not be strictly comparable over time due to different composition of countries.  

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

Since 1994.

The entered data is checked against information on deceased persons provided by the Resident’s Register and Statistics Lithuania.

Not applicable.

Not applicable.

Monthly and annual statistical indicators are coherent.

Administrative data are used. No response burden is caused.

 Revisions of statistical indicators are performed in accordance with The Rules of Statistical Information Publication and Revision, approved by Order No V-146 of 15 June 2015 of the Director of Institute of Hygiene (only in Lithuanian).

Users are informed about scheduled revisions in advance through a Calendar of Scheduled Revisions of Statistical Indicators.
Unscheduled revisions are performed when needed and users are informed immediately.

The difference between annual provisional and final data is insignificant: usually absolute numbers do not change, rates could be slightly different because of provisional and final number of population is used.

The statistics on causes of death are based on the information provided on medical death certificates. Medical death certificate form based on the template provided by the World Health Organization (WHO). The medical certification of death is an obligation. All deaths of residents and non-residents are collected. Database of State Register of Death Cases and Their Causes is the main data source of causes of death statistics. Lithuanian causes of death statistics covers all deaths of the residents of Lithuania.

Monthly, annual.

4. Stillbirths and Neonates: Do you have a different death certificate or do you code these data differently from other deaths? If yes, how?

a) Stillbirths

For stillbirths and neonates aged less than 7 days, a  Perinatal death certificate is used.
 

b) Neonates

For neonates, 7-27 days, used a Medical death certificate.

Table on certification (Percentage)

For stillbirths and neonates aged less than 7 days, a  Perinatal death certificate is used. For neonates, 7-27 days, used a Medical death certificate.

Data validation with several institutions - Register of Residents and State Data Agency.

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

 Coding is carried out at a central level. The specialists of State Register of Death Cases and Their Causes manually code multiple causes of deaths and select code of the underlying cause of death which is defined 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”. Causes of death are classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10-AM, Australian Modification) on a national level, but for Eurostat and WHO converted codes are provided to be in-line with ICD-10.  Underlying causes of death are defined in accordance with the International Statistical Classification of Diseases and Related Health Problems rules – ICD-10 Vol. 2. Automated Classification of Medical Entities (ACME) Decision tables are used to check the selection of the underlying cause. 

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

 The State Register of Death Cases and Their Causes database contains an automatic quality of data transcription assurance system which checks cause of death against the gender and age of the deceased.    

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

 Visual control of register data, logic control during data entry process, computerised control after data entry.

Coding performed by a certifier:

 Physicians issue medical death certificates, they do not perform coding of multiple causes of death

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

  Forensic medical experts and pathologist performed an average of 16.7 percent of autopsies of all deceased per year during 2011-2018. The underlying cause of death is determined after autopsy.

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

 No double coding exercises performed.

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

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

From Resident Register The State Register of Death Cases and their Causes  receive the deceased name, surname, sex, nationality, date of death, place of death, place of residence. From the State Data Agency The State Register of Death Cases and Their Causes receive „resident or non-resident“ attribute for a deceased person.

Causes of death survey methodology (only in Lithuanian).

Not applicable.

Statistical information for the reference year is compared with the previous year. If missing values are detected, errors are corrected.

Not applicable.

None.