Directorate for Health Information and Research, Ministry for Health Malta

National Mortality Registry

Directorate for Health Information and Research

95, Gwardamangia Hill,

Gwardamangia

PTA 1313

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).

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

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

Persons who have been residing regularly in Malta for at least the previous year  

Deaths in foetuses from 22 weeks gestation onwards &/or 500g at birth or over.

Gestational age and birthweight are collected 

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

All deaths of residents occurring in the Maltese Islands or residents dying abroad for whom we receive a death certificate are included. Deaths of non resients dying in the Maltese Islands are counted separetly.

Neonates of non-resident mothers are only considered residents if the father is a resident. 

Statistics on non- residents dying in Malta are also collected in the same National Mortality Register and data is comprehensive. However statistics on non residents are usually issued separately unless specifically asked to include. 

Any death certificates for residents dying abroad which are received are included in the national data. However not all these death certificates will include a cause of death as this depends on the country of death. Also it is not known how comprehensive data collection for residents dying abroad is. However, for anyone who is buried in Malta we receive a death certificate.  

Data on causes of death is collected for the whole of Malta i.e. the Maltese Islands

Data in electronic format using ICD-10 is available from 1995. 

Not applicable.

The unit is number.

Latest year provided is deaths for the calender year 2021

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.

Mortality data is transmitted on a yearly basis to Eurostat and WHO. This does not include personal identifiers.

Data collection requested by researchers need to complete online form found on the Directorate for Health Information and Research Website and may require other permissions depending on the nature of the data request.

Introduction (gov.mt)

Request For Data Form (gov.mt)

Registries (gov.mt)

All data is collected and processed in accordance with the General Data Protection Regulation, adopted in the Data Protection Act XX of 2018. On the 8th of October 2019, Legal Notice 263 of 2019 was published. This Legal Notice is intended to enact the Processing of Personal Data (Secondary Processing) (Health Sector) Regulations (S.L. 528.10 of the Laws of Malta) (“the Regulations”).

Only aggregate data is published and available online.

Not applicable

Not applicable

Users may access published data online e.g. the Annual Mortality Report.

They may also request data by completing the online request forms:

Request For Data Form (gov.mt)

Annual Dissemination

Annual Mortality Report

Ad hoc Fact Sheets

Annual Mortality Report

Ad hoc Fact Sheets

Deaths (gov.mt)

International databases which include data for Malta are:

Eurostat: https://ec.europa.eu/eurostat/data/database

WHO: https://gateway.euro.who.int/en/

Not applicable

Access to Micro data with causes of death is only possible after a request to our department which vets the requests and may refuse or accept, or accept seeking further permissions e.g. data protection, ethical approval.

Request For Data Form (gov.mt)

Not applicable

Not applicable

A Standard Operation Procedure is available which details all the steps involved in the day to day work of the Mortality Register.

Not applicable

Not applicable

Rules and updates of the International Classification of Diseases ICD-10 are followed as well as automated coding IRIS software is used. General checks to demographic information are also regularly done before submitting any data. 

Not applicable

Users of mortality data include both national and international organisations such as the National Statistics Office of Malta, Eurostat, WHO, Euromomo and EMCDDA.

Locally users include policy makers both within the Ministry of Health and other Ministries as well as other entities, researchers and students.  

Not applicable

Completeness of the core variables for Mortality data is around 98%

1. For mandatory variables:

data completeness is around 98% for mandatory variables

2. For voluntary variables:

data completeness is around 95%

3. For additional variables:

• External CoD

for cause of death completeness varies depending on autopies which may take time for them to be finalised. However other than that external COD are around 95% complete.

• Place of occurrence for external CoD

80% was known in 2021

• Activity for external CoD 

not known

Close liaison is kept with the Police Authorities, the Mortuary Department and with the Public Registry. We also have access to other medical registers (e.g. cancer registers) from were we get further information as to the cause of death when needed.

However no formal assessment has been recently carried out.

Not applicable. Data collection is from administrative sources.

Not applicable.

refer to specific errors below

Coverage is estimated to be close to 98% overall. However some variables on the death certificate are more well completed then others. 

Minimal if any

Not applicable. Data collection is from administrative sources.

Data on the decesaed persons is entered on a database which links demographics from a common database and therefore minimises demographic errors. The main demographic data namely age and sex and also cross-checked with individual data from the National Statistics Office on a yearly basis. All underlying causes of death entered are double checked.

Missing variables are mainly found in variables of occupation and marital status. These are often left unknown unless other sources can be linked to complete the missing value. 

Missing information on causes of death is very low, often less than 1%. These are often death certificates which are still provisional and awaiting a final cause of death - pending investigation. 

not applicable

All data is checked and processed according to national and international guidelines.

Not applicable.

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.

Data on the whole of Malta is collected in one national register, so no issues with comparability between regions

Not applicable.

Some issues which may effect comparability over time include changes in the ICD version, changes in the ICD rules and also changes in the coders at a local level.

Last change in ICD version was in 1995 when ICD-10 was implemented, so a break in series would be before that mainly.

Causes of death are checked with other medical registers e.g. cancer registry

Additional informatiom on external causes of death e.g. for accidents are obtained from newspapers, suicides from the police

Demograpahic information is checked with a general demogrpahic database and also checks are done with the NSO.   

Not applicable, only annual data are available.

Not applicable.

No differences

Currently the main new costs envisiaged are the implementation of ICD-11 and its associated IT software and training as well as updating the mortality electronic database to be able to autome certain requests. 

Not applicable

Not applicable

Not applicable

The main source of data is the Medical Death Certificate. As described, additional sources of information are used to improve the accuracy of the mortality statistics when possible. 

Annual.

The main source of information is the medical death certificate. Currently all causes of death are coded using ICD-10.

Table on certification (Percentage)

No there is no different death certificate for stillbirths or neonatal deaths. On the general death certificate there is a section regarding birth weight and gestational age to be completed only for infants.

Data on the decesaed persons is entered on a database which links demographics from a common database and therefore minimises demographic errors. The main demographic data namely age and sex and also cross-checked with individual data from the National Statistics Office on a yearly basis. All underlying causes of death entered are double checked.

Once data for a particular year is produced this is also compared to previous year to check for any major differences. 

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

 Coding is done by a nurse and then checked by a public health doctor

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):

 cross checks with other sources of information e.g. other medical registers are used

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

 errors are corrected and documented

Coding performed by a certifier:

 not done locally

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

  8-9%

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

 not done

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

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

We validate as much as possible with the Public Registry Department. 

Not applicable.

Not applicable.

No adjustments  to the data are done

When comparing with other countries the same standardised popluation is used.

Not applicable.

None