Statistics Netherlands

Health and Welfare

Henri Faasdreef 312, 2490 HA Den Haag, The Netherlands

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 medical certification of death is an obligation in the Netherlands. Statistcs Netherlands codes the information provided in the medical certificate of cause of death into ICD codes according to the rules specified in the ICD.

Public Health.

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

The usual residency in the population statistics compiled by Statistics Netherlands are the people registered in the population register. 

A stillbirth is a fetus who was born lifeless after an gestational age of at least 24 weeks. Within this dataset only the stillbirth second group (gestational age of at least 27 weeks) are included.

The statistical unit is the deceased person and the stillborns. 

Residents, non-residents and stillbirhts.

They are not considered residents 

Non-residents are not included in the national statistics, but are included in this data delivery.

Data is recorded in the population register, but in most cases the cause of death is unknown.

All people registrered in Dutch population register, died in the Netherlands as well as abroad. And all other persons deceased in the Netherlands but not registered in Dutch population register.

Time series are available from 1994 onwards. Time series for data on stillbirths starts in 2011 and no information on previous data is available.

Not applicable.

The data are provided in absolute numbers only.

Data refer to the calendar year 2023 (i.e. all deaths occurring during the year 2023).

Statistics Netherlands is in the Netherlands the institute who receives and processes the cause of death forms. This is stated in the burial act.

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 sharing by Statistics Netherlands is regulated in the CBS law.

Common specifications with the World Health Organisation (WHO) were used in the data collection up to 2010; in addition, Eurostat asks for NUTS level 2. From 2011 onwards, Eurostat changed the specifications to take into account the data collected through the Regulation No 328/2011.

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.

All age groups showing a total mortality of less than 4 cases are considered as confidential. Therefore, any 'confidential' age group 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). Since the Netherlands is not a small country no extra measures are taken. 

For stillbirth and neonatal figures, no breakdown by parity is displayed to ensure confidentiality.

Provisional data is released on t + 6 months. Final data is released on t + 11 months.

Not applicable.

Data is released on the website of Statistics Netherlands for the public, freely accessible.

Annual.

News releases online.

On the website of Statistics Netherlands

Our cause of death data is published on our website in different tables: 

Dutch tables: Opendata cbs website, Opendata cbs website dataset, Opendata cbs website table, Opendata cbs website, Opendata cbs website.

English tables: Deaths; cause of death (extensive list), age and sex, Deaths; underlying cause of death (shortlist), sex, age.

* new calculation method implemented, this table includes both visits to the Dutch and English tables. 

Microdata send to Eurostat. Other researchers or research institutions through remote access accounts with restrictions.

Information can be found here: CBS website - Causes of death statistics.

Information on number of consultations are reported in internal documents. 

More information can be found here: CBS website - Causes of death statistics.

All metadata is provided. More information can be found here: CBS website - Causes of death statistics.

The quality of COD data is subject to the way in which the information on causes of death is reported and classified in each country. The Netherlands follow the standards and rules specified in the ICD.

However, national differences in interpretation and use of ICD rules exist and as a result important quality and comparability issues remain. The Netherlands is working towards further improving certification and coding procedures, for example by training doctors on certifying COD forms.

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

Statistics Netherlands is part of the IRIS core group and is working on keeping the quality on a high level.

The main users are Research Institutes, Universities, Public Government agencies, Private, Commission services and Business companies. The data needs of these users is collected regularly.

Data is published with a good quality and on a timely basis.

See subconcept 12.3.1

1. For mandatory variables:

 complete

2. For voluntary variables:

 none

3. For additional variables:

• External CoD

 complete

• Place of occurrence for external CoD

 complete

• Activity for external CoD

 none

For people in the Dutch population register: All deceased persons registered in the Dutch population register, not all have death certificates for example when died abroad.

For people not registered in Dutch population register, but deceased in the Netherlands: only received death certificates.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable. Data collection is from administrative sources.

Not applicable.

Non response, as in not receiving a cause of death form for a Dutch citizen died in the Netherlands, is added to the data set with a cause of death as R99. Information on age, gender and region of death and recidence is known.

Non response, as in not receiving a cause of death form for a Dutch citizen died in the Netherlands, is added to the data set with a cause of death as R99. Statistics Netherlands does not receive around 3,5% of the cause of death forms for Dutch citizens who died in the Netherlands.

 Statistics Netherlands does not receive around 3,5% of the cause of death forms for Dutch citizens who died in the Netherlands, therefore 3,5% of the causes of death are unknown and set to the ICD10 code R99. All information on gender, age and residence is available, even for citizens without a cause of death form.

Coding of the COD forms is primarily done with the Iris software. However, about 80% of the number of COD forms are still paper forms and have to be typed manually for further processing in Iris. Typing errors are kept to minimum by controlling the typed data.

Not applicable.

Statistics Netherlands sents final data for the year N at N+24 months.

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. 

There is a complete comparability of the different regions of the Netherlands. 

The process of collecting, coding and transmission is the same for all the regions in the Netherlands. 

Not applicable.

The comparability of the data over time is checked before dissemination. 

Time series on causes of death for the Netherlands on ICD10 start in 1996. A break in the series can be found in 2013, because Iris was implemented in 2013.

A check is done (on a daily basis) between the death records (the data provided by demography) and the processed death certificates.

There is a minor discrepency of 2% caused by not received death certificates, excluding residents who died abroad. If we include residents who died abroad the discrepency is about 3.5% of the death certificates. 

Not applicable, only annual data are available.

Not applicable.

For people in the Dutch population register: All deceased persons registered in the Dutch population register, but not all have death certificates for example when deceased abroad.

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

The dates of both the provisional data and the final data are published. 

There is no systematic revision of previous year data. 

Not applicable.

Death certificates

On a daily basis

Data are collected by the collection of death certificates filled out by physicians, these certificates are sent to Statistics Netherlands either as a physical certificate our via secure e-mail. The physical certificates are scannend and loaded into a software pogramme were the written text is transferred to typed text which can by translated into ICD-10 codes. About 50% of the certificates are coded automatically by IRIS-software, the other half is coded manually.  

Table on certification (Percentage)

In 2013 we started (partly) coding with IRIS, due to which we didn't query any death certificate.

*All pathologists are trained in post-mortem examinitions, including autopsies, all certfiers are trained in the external examination of the dead body. 

** Due to working from home no queries could be sent 

There are no different death certificates for neonates or stillbirhts.  However for stillbirths data from the mothers of the stillbirths are recorded on stillbirth cards with the population register. 

The Dutch population register is used to validate the number of deaths.

Also checks are performed on: certain diseases which are gender specific and gender, perinatal death and age, and other diseases which are mostly seen in the eldery and age. 

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

Central level

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):

Crosstabulations are done on gender specific conditions (specific for a gender), perinatal deaths and age, maternal deaths, and age specific conditions (conditions which are mostly seen in the eldery). 

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

Re-code the death certificate and manual checks. 

Coding performed by a certifier:

Not Available, Dutch certifiers do not code. 

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

Not Available

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

Not Available

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

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

The Dutch registers are considered complete.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

None.