Norwegian Institute of Public Health (NIPH)

Domain for Health Data and Digitalisation

Norwegian Institute of Public Health

PO BOX  973, Sentrum

N- 5808 Bergen,

Norway

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 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

Residency: A person that is living in Norway or intend to have residency in the country for 6 months or more, and is registered with an address by the Norwegian National Population Register.  

Definition of stillbirth: Gestational age:>= 22 weeks, weight: >=500 g (According to the Medical Birth Registry in Norway (MBRN))

Characteristics collected: Medical Birth Registry in Norway (MBRN) collects gestational age, births weight, crown heel lenghts, gender, pluarality, congenital malformations and deformations.

A person that is living in Norway or intend to have residency in the country for 6 months or more, and is registered with an address by the Norwegian National Population Register.  

Definition of stillbirth: Gestational age:>= 22 weeks, weight: >=500 g (According to the Medical Birth Registry in Norway (MBRN))

 Characteristics collected: Medical Birth Registry in Norway (MBRN) collects gestational age, births weight, crown heel lenghts, gender, pluarality, congenital malformations and deformations.

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

The neonates of non-resident mothers are not considered as residents in Norway.

From the reference year 2013 the non-residents dying in Norway are registered but not included in our national statistics (just residents). They have their own special statistics/tables. 

Norway includes residents dying abroad in our national statistics. However for about 90% of the deaths we do not know the causes of death for the persons dying abroad. When receiving a death certificate we classify the cause of death acording to ICD-10 codes if reported.

No, neonates of non-resident mother are not considered as residents in Norway.

From reference year 2013 the non-residents dying in Norway are included in our national statistics.

Yes, Norway includes residents dying abroad in our national statistics. However for about 90% of the deaths we do not know the causes of death for the persons dying abroad. When receiving a death certificate we classify the cause of death acording to ICD-10 codes if reported.

Norway.

Time series available from 1994 onwards.

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 before and after 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.

Not applicable.

The unit is number.

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.

COD-data are shared with researchers, students, health authorities, WHO, Eurostat and media.

The Norwegian Legal Regulation Concerning The Cause of Death Registry from 21.12.2001 provides the legal basis for sharing data from the The Cause of Death Registry.

All users have equal access to anonymous statistical releases from The Cause of Death Registry at the same time, according to the European statistics code of practice.

Access to confidential microdata for scientific purposes may only be granted based on approval by the Norwegian Regional Committees for Medical and Health Research Ethics (REC), according to the Health Research Act.

All confidential microdata are treated according to the Norwegian Health Registry Act and the Norwegian Personal Data Act (which incorporates the EU General Data Protection Regulation (GDPR)).

Everything we send of personally identifiable data is encrypted, only anonymous aggregated data is sent unencrypted.

We do not provide health data along with birth number or name. If directly identifiable data is provided, serial number and health data are provided on one data set and serial number and ID on another. The datasets can be connected by using serial numbers.

Statistics from the Cause of Death Registry are released annually. Statistics including the statistical year 2021 were released in June 2022.

Release dates for statistics published by the Norwegian Institute of Public Health (NIPH) can be found in the Institute's statistics calendar: https://www.fhi.no/hn/statistikk/statistikkalenderen/

• The European Parliament and Council Act (EU) no. 223/2009 for European statistics of March 2009, concerning the European Statistics System (ESS), is adopted as a regulation to the Norwegian Statistics Act.
• The superior principles for production of Norwegian statistics are elaborated through guidelines for European statistics (the European Statistics Code of Practice, generally referred to as the Code of Practice).
  • The aim of the guidelines is to ensure the trust of the general public in Norwegian Statistics by establishing principles for the development, production and distribution of the statistics.
  • Central in the Code of Practice are demands for professional independence for the institution that produces the Statistics.
  • The Ministry of Health and Care Services and The Norwegian Institute of Public Health agree that the Code of Practice should be adopted for the production of statistics from the central Norwegian health registers.
• In line with the Code of Practice, The Norwegian Cause of Death Registry provides equal access for all users to anonymous statistical releases from the registry at the same time, see link below. 

COD-data: http://statistikkbank.fhi.no/dar/

Annual.

News releases online.

https://www.fhi.no/nyheter/2023/dodelighet-2022/

https://www.fhi.no/nyheter/2023/stabil-trend-flere-overdosedodsfall-enn-i-2021-men-farre-enn-i-2020/

Publications for 2021 Causes of death data:

https://www.fhi.no/op/dodsarsaksregisteret/tall-fra-dodsarsaksregisteret-2021/

https://www.fhi.no/op/dodsarsaksregisteret/tall-for-covid-19-assosierte-dodsfall-i-dodsarsaksregisteret-i-2021/

Please consult free data online:

http://statistikkbank.fhi.no/dar/

Number of consultations/deliveries of CoD tables to different institutions and researchers.

It is possible to apply for access to microdata form Norwegian Institute of Public Health' health registries.

Here you will find guidelines, electronic application forms and other information: https://helsedata.no/

WHO - tabular data

NOMESCO - tabular data

Occasional reports on special subjects: fhi.no website

Not applicable

Documents for COD are available in the Norwegian Institute of public health

Norway has 98 percent metadata completeness

The Norwegian Cause of Death Registry has fully implemented the IRIS system, with its associated rules and guidelines for selection of underlying cause of death, for routine coding.

In addition, the cause of death is verified against other national health registries, such as the Medical Birth Registry of Norway and the Cancer Registry of Norway, as well as autopsy reports (approximately 8 percent of the deceased in Norway are autopsied), to improve quality.

If the medical data is incomplete, additional information is requested from the institution where the certificate was issued.

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

Not available

Users of the Norwegian Cause of Death Registry mainly need access to data, information and knowledge for the following purposes:

1. Monitoring causes of death over time
2. Preparation of national, regional and local statistics related to causes of death
3. Research
4. Planning, quality assurance and quality impovement in the Health and Care Services

Not available

 The cause of death data, as delivered by the Norwegian Institue of Public Health, has a coverage of about 98%.

1. For mandatory variables: 98 percent

2. For voluntary variables: Not applicable

3. For additional variables: 

• External CoD:
  • Place of occurrence for external CoD: 76 percent
  • Activity for external CoD: 23 percent

Not formally validated.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable.

There is approximately 2 percent under-coverage in divergence between the frame population and the target population

Not applicable

Not applicable. Data collection is from administrative sources.

Not applicable

In Norway, whenever information on cause of death is missing for a death recorded in the National Population Register, reminders are sent to the council where the death was registered.  For each year information on cause of death is incomplete for about 3 percent of the deaths.  

Whenever information on the death certificates is missing or incomplete, additional information is sent to the council physician or to the institutions that applied the death certificate. In Norway in 2021 additional information was requested for about 5 percent of the death certificates received.

Not applicable

Refer point 13.3.3

The processing of the data is in accordance with the European standard provided by the IRIS-institute

Not applicable.

From data collection with reference year 2011 onwards, Eurostat asks for the submission of 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.

All the geographical regions in Norway use the same death certificate, and all the death certificates are coded by the same group of coders at NIPH.

Autopsies influence determination of the underlying cause of death, but the autopsy frequncy may vary from region to region.

Over all, the degree of geographical comparability in the Norwegian Cause of Death registry is high. 

Not applicable.

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. From 2018 electronic death certificates started to be used and from 2022 it is compulsory to use electronic death certificate instead of paper version.

In the Norwegian Cause of Death Registry timeseries are available from 1951-2021.  Recording by different ICD-versions causes breaks in series. ICD-7, 1951-1968; ICD-8, 1969-1985; ICD-9, 1986-1995 and ICD-10, 1996-.

COD data are matched with The population registry mortality data. If there are any discrepancy we send requst to the municipality where the missing death certificate are located.

For residents dying in Norway, the coverage is about 99%.

Residents dying abroad: We received information for about 20% of Norwegian persons dying abroad. (The underlying cause is missing for nearly 90% of the residents dying abroad.)

The number of deaths in the Norwegian Cause of Death Registry is verified against mortality data in The National Population Register of Norway. In case of discrepancies, local authorieties are contacted to ensure that missing death certificates are issued. 

For residents dying in Norway, the coverage is about 99%.

For residents dying abroad, the coverage is about 20%. The underlying cause is missing for nearly 90% of the residents dying abroad.

Not applicable, only annual data are available.

Not applicable.

The Cause of Death statistics are internally coherent, consistent and comparable for all years preceding and including the reference year 2012. However, from the reference year 2013 The Norwegian Institute of Public Health (NIPH) has extracted data from two sources, The Cause of Death Registry and the Medical Birth Registry of Norway (MBRN). There may therefore be some inconsistencies in data from the two time periods.

The statistics are compiled on the basis of common standards recommended by WHO (ICD-10) and Eurostat (IRIS, MUSE, EU-regulation April 2011).

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

Not applicable.

There is no systematic revision of previous year data. 

Not applicable.

The Cause of Death data are based on information of the death certificates, medical and forensic autopsies and results from queries regarding missing information on the certificates.

Annual.

The source data is collected consecutively.

Table on certification (Percentage)

We use the same death certificate for the neonates as we do for other deaths. In addition, the Cause of Death Registry and the Medical Birth Registry cooperate and exchange data.

a) Stillbirths

A civil notification is reported to the Norwegian National Registry stating that the infant/fetus was stillborn. In addition, the Medical Birth Registry of Norway (MBRN) receives a notification with information that the fetus/infant was stillborn and also the above mentioned data (characteristics of the fetus and information about the mother and the pregnancy). If there is an autopsy, the MBRN gets a copy of the autopsy report, and the causes of death are coded by a physician at the MBRN using the ICD-10. 

b) Neonates

The Norwegian Cause of Death Registry gets supplementary information from the Medical Birth Registry of Norway (MBRN). In addition a medical adviser gives support in choosing the underlying code. No; Neonates of non-residents motheres are not considered as resident in Norway.

The statistics cover all persons registered by the The National Population Register of Norway (*) as inhabitants of Norway (residents) at their death, regardless of whether the death took place in Norway or abroad. In addition all non-resident persons dying in Norway are included, from the reference year 2013.

(*) The Norwegian Tax Administration is resposible ensuring that the The National Population Register of Norway is complete and up-to-date.

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

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 Norwegian Cause of Death Registry has fully implemented the IRIS system, with its associated rules and guidelines for selection of underlying cause of death, for routine coding. IRIS detects inconsistencies in the sequence in the death certificate and also rejects codes that cannot be the underlying cause of death.

Description of the measures taken in order to solve detected errors: If the medical data is incomplete, additional information is requested from the institution where the certificate was issued. The processing also includes reviewing and correcting the individual variables, including that the certificate is completed and that the above values are reasonable considering, among other things, the deceased's age and gender. 

Coding performed by a certifier: None

Estimation of the percentage of autopsy from which information is available for coding: Approximately 8 percent of the deceased in Norway are autopsied.

Description of double coding exercises and rate of codification errors for underlying cause of death: None

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

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

The coverage of the annual 2021 was 98 percent, after sending out reminders during the year

Not applicable.

The coding of diagnoses is according to ICD-10, and the underlying cause of death is identified by IRIS/MUSE.

The UC codes are further aggregated to the European Shortlist of causes of death (COD-SL-2012).

Not applicable.

Age adjusted rates are compiled by the European Standard Population (ESP2013).

Not applicable.

None.