National Institute of Statistics (NIS)

Department of Studies, Demographic Projections and Population Census

Bl. Libertăţii nr. 16, Sector 5, Bucureşti 050706, ROMANIA

Romania’s NIS compiles death and causes of death statistics since 1980 into electronic databases. Causes of death were codified between 1980 and 1992 using the WHO’s ICD-9 classification; beginning with 1993, the ICD-10 classification was used. National causes of death statistics are complied in collaboration with the Ministry of Health and its subordinate Public Health Directorates. NIS’ main role consists in collecting, validating and disseminating the vital statistics, including the causes of death statistics, while the Ministry of Health is involved in the codification of causes of death.

Until 2011 the causes of death statistics were produced using the concept of permanent residence (known as “domicile” in Romania); beginning with the data for the reference year 2011 national statistics are produced using the concept of usual residence, and in parallel using statistics recorded by the population with either permanent residence/domicile and usual residence.

Data are available for Romania in the Eurostat database under the “Health” topic. Romania's National Institute of Statistics is responsible with the transmission of the CoD data to EUROSTAT beginning with reference year 2014. Before 2014, for the period 2011-2013, absolute data on COD under European regulations were submitted to Eurostat by National Institute of Public Health (NIPH) - National Centre of Statistics and Informatics in Public Health (NCSIPH).

According to the laws and regulations in force in Romania, the Civil Status Services within the city halls of municipalities, cities and rural communes must fill-in a Death Statistical Bulletin for each death act regardless if the deceased whom the death act pertains is a Romanian citizen or a foreigner. The statistical bulletins of death data are transcribed from the civil status acts, from the medical certificate for ascertaining death that include the causes of death and other information obtained based on the declaration made by a family member, the certifying doctor or anyone else aware of the death.

As requested in the Commission Regulation (EU) no 328/2011 of  5 April 2011 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, Romania’s NSI sends COD microdata to Eurostat both for residents’ deaths using the usual residence concept, as well as non-residents who died in Romania.

Public Health

National definitions are according with the regulation and are described below.

Usual residence is 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.

Only people who have lived at an usual residence for a continuous period of at least 12 months prior to the reference moment are considered having their usual residence in that specific geographic area.

Late foetal deaths represent a product of conception completely extracted or ejected from the mother's body after at least 28 weeks of pregnancy, which after this separation gives no sign of life.

Characteristics collected (gestational age, weight, crown-heel):

For stillbirths NIS collects the following data:

• Locality of registration (rural commune/city/municipality/Bucharest’s sector if case)
• Date of registration
• Civil status act number
• Name (it will not be inputted in the database)
• Sex
• Date of birth
• Place of birth
• Assistance at birth
• Gestational age (length of pregnancy)
• Weight at birth
• Parity of birth
• Legal status of the stillbirth (born within marriage and other situation)
• Causes of death classified according to the IDC-10 classification issued by the WHO

1. Underlying cause of death
2. Other morbidity causes

•  Mother’s date of birth
•  Mother activity status
•  Mother’s education
•  Mother’s permanent residence: country, county, locality and rural commune or Bucharest’s sector if it is the case
•  Mother’s usual residence, as defined by the Art.2(h) of the Commission Regulation (EU) 328/2011, broken down: country, county, locality and rural village or Bucharest’s sector if it is the case
•  Mother’s date of marriage (only for first marriages)
•  Number of mother’s births, of live-births, of stillbirths and of children still alive
•  Whether the mother had prenatal check-ups and from which month of pregnancy.

For deaths NSI collect the following data:

•  Locality (rural commune/city/municipality/Bucharest’s sector if case)
•  Date of registration of death
•  Civil status act number
•  Transcript act (Yes/No)
•  Personal numeric code
•  Name (will not be inputted in the database)
•  Sex
•  Children born during lifetime (for women only)
•  Dates of death and birth for the deceased person
•  Occupation
•  Education
•  Citizenship
•  Ethnicity
•  Permanent residence: country, locality and rural village or Bucharest’s sector if case
•  Usual residence, as defined by the Art.2(h) of the Commission Regulation (EU) 328/2011, broken down: country, locality and rural village or Bucharest’s sector if case
•  Place of death (health unit or home)
•  Countries of death and births
•  Causes of death classified according to the IDC-10 classification issued by the WHO
•  Type of death (natural, accidental, suicide, homicide, unknown)
•  Autopsy performed (Yes/No)

The statistical unit is the deceased person.

Deaths of residents and of non-residents that deceased in Romania and whose deaths were registered by the civil status register offices are included. Specific information relating to this concept are included in the sub-concepts.

Neonates of non-resident mothers are not considered residents.

The COD microdata transmitted to Eurostat refer to deaths with usual residence in Romania and non-residents who died in Romania.

Data disseminated in the Romanian national statistics is broken down by two concepts of residence (permanent or usual). Therefore, Romania’s NIS disseminates two sets of data, ones for persons having their usual residence [as defined by the Art.2(h) of the Commission Regulation (EU) No. 328/2011] in Romania, and another for persons having either their permanent residence or their usual residence in Romania. Foreigners are included in national vital statistics only if they have either their usual residence or their permanent residence in Romania.

Deaths of Romanian citizens or persons who have their permanent residence in Romania, but have their usual residence abroad are included in national statistics upon transcription in Civil Status Register of the death acts received from abroad.

Deaths of Romanian citizens who have their usual residence in Romania are included in national statistics upon transcription in Civil Status Register of the death acts received from abroad.

Deaths of foreign citizens who died abroad, but who have their usual residence in Romania are not included in national statistics because according with national law the transcription in Civil Status Register of the death acts is made only for Romanian citizens.

The area covered by the collection of statistical data of deaths covers all the death that occurred on the whole territory of Romania, and also includes the deaths of Romanian residents having Romanian citizenshipthat occurred abroad and whose death certificates were transcribed in Civil Status Registers from Romania.

Data was transmitted to Eurostat beginning with 1999. Until 2011 data was sent using the notion of “domicile” (permanent residence) as residence.

Starting with reference year 2011, the usual residence as defined by the Art.2(h) of the Commission Regulation (EU) No. 328/2011 was used. Also, starting with 2011, the data of non-residents that died in Romania became available and was transmitted to Eurostat.

Not applicable.

The unit is number

Data on deaths refers to the calendar year 2021.

INS is responsible for demographic statistics in Romania. The legal framework and the institutions with which INS collaborates for the production of statistics on causes of death are presented in the following points.

Law No. 226/5 June 2009 on the organization and functioning of the official statistics in Romania, with subsequent amendments and supplements.

Romania submitted data to Eurostat on the basis of a gentleman's agreement established in the framework Eurostat's Working Group on "Public Health Statistics" during the period from 1999 to 2010.

The first data submitted according to the Regulation (EC) No. 1338/2008 and Regulation (EU) No. 328/2011 is data with reference year 2011.

NIS is responsible for collecting and processing data and National Institute of Public Health is responsible for coding causes of death, by the physicians of Territorial Public Health Directorates.

Data confidentiality has been a priority throughout the implementation of vital statistics data collection, and especially the collection and processing of death statistics, including COD. The measures to ensure the data confidentiality is in compliance with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) and the Law No. 226/2009 (updated) on the organization and functioning of official statistics in Romania.

In order to ensure the confidentiality of the data, NSI’s Norms of Confidentiality were applied.

The specifications regarding the obligation to comply with the data confidentiality were included in each Death Statistical Bulletin where are  printed the following:

• This Death Statistical Bulletin is “Approved based on Law no. 226/2009 on the organization and functioning official statistics in Romania, with subsequent amendments and completions. According to the provisions of Regulations (EU) no. 1260/2013 and (EU) no. 205/2014 on European demographic statistics, Regulation (EU) no. 328/2011 on the causes of death and the provisions of the Regulation (EU) 2016/679 on the protection of individuals with regard to processing of personal data and free movement of such data”.
• “Individual data are confidential and are used only for statistical purposes” ;
• “INS and the County / Regional Directorates of Statistics store the personal data registered in this statistical bulletin from the date of receipt of the bulletin statistically from the Civil Registry Office (in the reference month), until the end of the following month, when they are anonymized (by encryption)“.

In addition, when hired, Romania’s NIS employees, as well as those of the Territorial Statistical Directorates, sign a "Confidentiality commitment".

Dissemination of statistical data was made under the rules of statistical data confidentiality.

Ensuring data confidentiality starts with the collection and continues until the dissemination.

Identification data (including personal identification code) are stored in separate files during processing data on deaths. After the completion of the primary processing, one month after the collection, the primary data are anonymized (by encryption).

Strict working procedures are implemented for demographic statistics and only one or two people from each County / Regional Directorate of Statistics receive and process statistical bulletins, and the PCs on which the processing is done are secured with user and access password.

NSI disseminates on a monthly bases data on vital events which include data on total number of deaths, but not on causes of deaths.

The Press Release Calendar on Vital statistics is available on the NIS website at the following link: https://insse.ro/cms/en/comunicate-de-presa-view, in the Population section.

INS implements a protocol on impartial access to statistical data for all users.

The COD data are published according to the dissemination terms provided in the Annual National Statistical Program approved by Government Decision. Also, the publications and their dissemination terms are presented on the INS website in the Catalogue of publications.

Annual

Vital events are disseminated by Romania’s NIS as a Press release usually on the 10^th of each month (as provisional data). No statistics on causes of death are disseminated with the press release.

NIS disseminates the data in print copies (together with a CD) on a yearly basis. The following publications contain causes of death statistics:

• Demographical events in 2021 (semi-final data) https://insse.ro/cms/en/content/demographic-events-2021
• 2021 Statistical Yearbook (semi-final data) https://insse.ro/cms/en/content/romanian-statistical-yearbook-book-format-4

Also, the 2015 Demographic Yearbook contains statistics on causes of death for previous years. This yearbook is usually published on a five-year basis but, by exception, the next one will be published after the ending of activities relating to the Population and Housing Census 2021.

The final data are disseminated in Romania’s NIS online database “TEMPO-Online”.

Consultations of tables in TEMPO database are not available. The Demographical events publication excel tables are free to be downloaded from NIS site.

Romania’s NIS online database “TEMPO-Online” may be found free of charge at: http://statistici.insse.ro:8077/tempo-online/#/pages/tables/insse-table

Eurostat online database: http://ec.europa.eu/eurostat/data/database

Information not available.

Access to microdata is in compliance with the national and European legislation on the personal data confidentiality, based on a standard Contract for access to microdata.

Current European and national legal framework on access to available anonymized microdata, only for scientific research purposes, is represented by:

- Regulation (EC) No. 223/2009 of the European Parliament and of the Council of 11 March 2009 on European statistics;

-  Commission Regulation (EU) No 557/2013 implementing Regulation (EC) No 223/2009 of the European Parliament and of the Council on European Statistics as regards access to confidential data for scientific purposes;

- Law No. 226/5 June 2009 on the organization and functioning of the official statistics in Romania, with subsequent amendments and supplements.

The access to anonymized microdata is made, based on a request to the Department for dissemination of statistical information within Romania’s NIS, and by concluding a contract for using the microdata. The contract includes information on the contracting parties (supplier and beneficiary), legal framework, the object of the contract, obligations of the beneficiary, conditions under the contract may be cancelled and ways to resolve disputes.

The data may be consulted free of charge in the Institute’s library and dissemination rooms. Also, data might be disseminated as per request of interested parties.

The metadata can be consulted on the INS website at the following link: Vital statistics death methodology

In line with the Community legal framework and the European the NIS metadata base presents in structured fashion the methodologies on which the statistical researches from the Annual National Statistical Program are developed by the NIS, the definitions of the resulting indicators and of the most useful statistical terms, as well as theoretical statistical information. The NIS metadata base, the classifications system and the online TEMPO database are connected such that the user can navigate on any of them.

The metadata of the Statistical Indicators describe each indicator by its characteristics i.e.: definition, statistical activities in which the indicator becomes relevant or from which they derive, its source, the linked indicators, end year of time series, mathematical formula and the latest update also.

The link between indicators and statistical activities is interactive such that the user can access its related metadata starting solely from the indicator. Also, starting from just a statistical activity all deriving indicators, the linked indicators and statistical terms can be viewed.

The metadata associated to statistical activities comprise all of the statistical process' key elements: domain, objective, the type of the statistical activity, national and European law framework, coverage, the method for data collection, the activity periodicity, the methods used for dissemination and the dissemination periodicity, beneficiaries of the result etc.

Metadata and methodological notes on Vital statistics of deaths collected by the Romania’s NIS are available at the following link: Vital statistics death methodology

The metadata database of the INS presents the metadata regarding the demographic events: live births, deaths, marriages or divorces. Causes of death are only one feature of the demographic phenomenon of deaths.

According to the structure of the metadata base of the INS, all the information is provided, so we can say that the completion rate of the metadata is 100%.

In order to apply the NIS policies that insures the quality and produce vital statistics of high quality, the NIS team considered the national legislation and the European Regulations and Methodological recommendations issued by Eurostat, while designing and deploying the vital statistics survey. The laws and regulations that have been considered are listed below:

- 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 2011 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 (EU) No 1260/2013 of the European Parliament and of the Council of 20 November 2013 on European demographic statistics;

- Commission Implementing Regulation (EU) No 205/2014 of 4 March 2014 laying down uniformed conditions for the implementation of Regulation (EU) No 1260/2013 of the European Parliament and the Council on European demographic statistics, as regards breakdowns of data, deadlines and data revisions;

- Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation);

- Principles and Recommendations for a Vital Statistics System, Revision 3 – United Nations, 2014;

- Methodological principles produced by Eurostat.

-  Law 119 from 16th October 1996 (republished) pertaining to civil status acts;

-  Government Resolution nr. 64/2011 regarding the approval of the Methodology on the uniform implementation of the provisions on civil status;

-  Law No. 226/2009 (updated) on the organization and functioning of official statistics in Romania.

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

At national level, statistical data collected through the Death Statistical Bulletins is inputted manually at the Territorial Statistical Directorates; the resulting database is validated using a series of checks by the operator and inconsistent data is double-checked with the civil status service that completed the statistical bulletin.

The causes of death collected from certifiers are transcribed in the Death Statistical Bulletin from the death act and are encoded by physicians at the Territorial Public Health Directorates using the IDC-10 classification issued by the WHO. Again, the inconsistent or erroneous causes of death are checked with the certifiers that completed them into the death act.

While performing the vital statistics survey, the NIS general quality policy are applied. Aspects regarding quality insurance are present in all stages of the survey.

During the design stage of statistical tools, for designing the death statistical bulletin were considered the following issues: the topics included in the bulletin are complying with the Commission Regulation (EU) No. 328/2011 and the 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 and the Eurostat methodology is ensuring data comparability at European level; the variables within the bulletins are easy to understand and their sequence is following a logical flow; coverage of all possible answers (there are no answers that cannot be coded).

When designing the death statistical bulletin it was taken into account that they are easily to be completed by the civil servant in charge.

When developing the survey methodological notes all measures to ensure the quality terms for performing the survey were taken into account. To ensure the data quality and a good data collection, in the methodological notes were distinctly included the responsibilities of civil servants from city halls of municipalities, cities and rural communes, civil servants from the Territorial Statistical Department and the civil servants from NIS.

During the data collection, the survey responsible in each Territorial Statistical Directorate had, among its attributions, to ensure the quality of collected data and was permanently in touch with the civil servants from city halls of municipalities, cities and rural communes, asking, if needed, the NIS additional methodological specifications for the particular situations encountered. The NIS staff provides solutions that are sent simultaneously to all Territorial Statistical Directorates, for the attention of the vital statistics survey responsible persons.

In order to ensure a good data collection, after the data collection the survey responsible in each Territorial Statistical Directorate checked the number of death statistical bulletins (integrity of materials received) and the way the answers in the bulletins were coded.

During the data checking, processing and validation process the following were considered:

• checking the integrity of the volume of completed bulletins;
• coding the variables for which classifications are used;
• implementing an IT application (with validation rules) to allow data checking at local and central level, in successive stages;

When analysing and presenting the results, the data checking in terms of logic and numbers is considered, making comparisons with previous year data. Also, to disseminate the results, the most relevant indicators are selected and analysed.

Data on causes of death provide information on mortality patterns and form a major element of public health information.
The relevance of an instrument has to be assessed in the light of the needs of its users. As for the COD data collection the main users are the following:

• Institutional users like DG SANTE or other Commission services;
• Statistical users in Eurostat or in Member States National Statistical Institutes to feed publications; and
• General users – including the media - interested in health statistics in the EU.

The Vital Statistics provides the necessary information for analysing the vital events that occurred within the population of Romania. The information collected pertaining to causes of death allows the sizing of the deaths within the total population and the comparative analysis by sex and age group, by residence area, by education and occupational status. Natality and mortality statistics are fundamental to demographic analysis. They are fundamental to demographic analysis and, also, to health analysis. 

 For national purposes, the main categories of users of statistical data on causes of death are the following:

• The policymakers: the Romanian Government, the Parliament, the Senate;
• The ministries with responsibilities in financing, developing and implementing strategies and policies on health, labour, social protection;
• National Health Insurance House with responsibilities in developing and implementing health policies;
• Institutes tasked to monitor the National Health Program, subordinate to the Ministry of Health or to the Ministry of Labour and Social Protection with monitoring responsibilities in morbidity.
• The policymakers with responsibilities in elaborating development plans at local level within Local Councils;
• Research institutes (mortality statistics are one of the most reliable and important statistics for health researchers);  
• Mass-media;
• Students and scholars.

The main indicators that are requested and disseminated for national purposes on causes of death refers to the mortality and infant mortality broken down by causes of death. The main indicators are also broken down by gender, area of residence. NIS can provide data at the local level at users’ request, in compliance with the legislation on personal data confidentiality.

A survey on user satisfaction on the causes of death statistics has not been carried out by Romania’s NIS.

All data received are disseminated on Eurostat's website. Statistics on deaths (including Causes of Death) were carried out according to the Commission Regulation (EU) No. 328/2011 and the 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, and using Eurostat's concepts, definitions and classifications on vital statistics.

Thus, Romania provided all variables required by the Regulation to Eurostat.

The data transmitted by Romania to Eurostat are consistent and thus, the entire data set is used to calculate European indicators on causes of death, and these indicators are published in the Eurostat database in the field of Population and social conditions / Health / Causes of death, at the following link: https://ec.europa.eu/eurostat/data/database 

1. For mandatory variables: 100%

 All compulsory variables required by the Commission regulation no.328/2011 are transmitted to the European Commission.

2. For voluntary variables:

Almost all voluntary variables required by the Commission regulation no.328/2011 are transmitted to the European Commission (except the variables that refer to deaths and other deaths that occurred abroad, which are optional data and cannot be provided). Concerning the variable specified at the pt. 6 of the Annex of the Commission regulation no. 328/2011: „Region of Occurrence (NUTS2)”: the data for residents who died abroad is available at NUTS0 level only. The weight of those deaths within the total deaths is very small. ​

3. For additional variables:

• External CoD - 100%
  
• Place of occurrence for external CoD - 100%
  
• Activity for external CoD - 100%

The accuracy of statistical outputs in the general statistical sense is the degree of closeness of estimates to the true values. Statistics can be different from the true values because of random variability and/or bias (for example, in case of administrative data the lack of information for a subpopulation).

Cause of death statistics are compiled using the data from the Civil Status Registry, established by law.

The microdata sent to Eurostat are slightly sub evaluated due to late-registered death certificates, mainly death certificates transcribed from abroad. The data has a high reliability due to the fact that the number of late-registered deaths is very small in relation to the total number of deaths.

To ensure the accuracy and reliability, the death registered in a reference year are cross-checked with the National Register for Persons (RNEP).  Moreover, due to late-registered death certificates, death data (including COD data) is settled in the revisions, which are according with a NIS Revision Policy, and the NIS Calendar of Revisions. The demographic revised data (data regarding live-births and deaths, including COD data) are transmitted to Eurostat in accordance to EU Regulation no. 205/2014.

Microdata for causes of death statistics are highly accurate.

Not applicable.

Not applicable.

The main raw errors that can arise in the vital statistics of deaths and causes of death are:

- coding errors;

- inputting errors (during inputting statistical bulletin variables in the database);

- logical errors (between each statistical bulletins' variables).

A series of checks are performed on the statistical bulletins in order to reduce the volume of errors. The validation and error solving process is a complex one, made both at the local level (County Public Health Departments code the causes of death while County Statistic Directorates input the statistical bulletins into the database) and at national level, by the NIS experts responsible for producing vital statistics that aggregate the data. The validation process is described in section "18.4. Data validation".

The civil status register records all death that occurs on Romania’s territory (including persons having either their usual or their permanent residence in Romania and foreigners whose death occurred in Romania). The death certificates are registered inside the register using consecutive numbers beginning with 1 on January 1st and ending with the last number registered on December 31st.

Registering a death begins with a verbal declaration made by a family member, the certifying doctor or anyone else aware of the death to the civil status officer, within 3 days from death (48 hours in case of a suicide, accident, other violent cases of death or for a found body). The death is then registered immediately within the civil status register.

Romanian citizens that die while being abroad may have their foreign death certificate transcribed in Romania at the Local Public Directorate of Persons Record and Civil Status where the deceased had its last Romanian residence (or to the Public Directorate of Persons Record and Civil Status of the 1st Sector of Bucharest municipality if the last Romanian residence cannot be established). This has to be done within 6 months after the death. Optionally, the death can be registered at the diplomatic missions and consular offices of Romania, which forward the death certificate to the Public Directorate of Persons Record and Civil Status of the 1st Sector of Bucharest municipality within 30 days from the recording.

Due to the difficulty of enforcing the transcription of death certificates there is a quantity of late registrations that might affect the vital statistics in a specific moment of time.

An extremely small number of late registrations occur in case of violent deaths, where the certifier withholds the delivery of a death certificate until a judicial inquest is performed or if the death of some Romanian citizens with usual residence in Romania occurred abroad.

Due to the scope and mode of reporting a slight under-coverage of the deaths late-registrations is possible. For the reference period 2014-2021 the weight of late-registrations was between 0.3% - 0.5%.

There are no over- coverage errors.

There are no over- coverage errors.

There are no deaths registered in the Civil Status Registers that are not included in the mortality statistics and causes of death statistics.

As the causes of death are registered using Death Statistical Bulletins filled in based on the information present in the Civil Status Register, there are no non-response errors, due to the fact that all death registered in the Civil Status Register are also transcribed in a corresponding Death Statistical Bulletin. There could be Romanian citizens having their usual residence in Romania that die while abroad and whose death are not transcribed in Romania, their number cannot be estimated.

The unit non-response rate cannot be computed. There is a small amount of incomplete death statistical bulletins that cannot be used in death and cause of death statistics due to the missing of important variables. These statistical bulletins are eliminated before inputted in the database and cannot be counted. As an example, NSI does not include into the microdata database bulletins with missing birth and/or death date, or missing all informations on usual residence.

The item non-response rates were 1.5% in 2014, 1.3% in 2015, 1.4% in 2016, 1.5% in 2017, 1.6% in 2018, 1.7% in 2019, 1.3% in 2020 and 1.5% in 2021 (final data) for the variable cause of death.

During the data collection, the survey responsible in each Territorial Statistical Directorate had, among its attributions, to ensure the quality of collected data and was permanently in touch with the civil servants from city halls of municipalities, cities and rural communes, asking the NIS for additional methodological specifications for the particular situations encountered. The NIS staff provides solutions that are sent simultaneously to all Territorial Statistical Directorates, for the attention of the vital statistics survey responsibles.

In order to ensure a good data collection, after the data collection, the survey responsible in each Territorial Statistical Directorate checked the number of death statistical bulletins (integrity of materials received) and the way the answers in the bulletins were coded.

-        During the data checking, processing and validation process the following were considered:

-        checking the integrity of the volume of completed bulletins;

-        coding the variables for which classifications are used;

-        implementing an IT application (with validation rules) to allow data checking at local and central level, in successive stages;

-        imputing of partially non-responses was made using automated corrections and statisticians expertise.

When analyzing and presenting the research results, the data checking in terms of logic and numbers is considered, making comparisons with previous year data.

Not applicable.

Eurostat asks for the submission of final data for the year N at N+24 months for data collection with reference year 2011 onwards.

Not applicable.

Not applicable.

Not applicable.

In Romania, the results of the Vital Statistics are comparable at national and regional level (NUTS0, NUTS1, NUTS2, NUTS3) and the causes of death are codified unitary by the physicians of Territorial Public Health Directorates, under coordination of c on the base of common specifications with the World Health Organisation (WHO) on ICD 10 for causes of death .

Not applicable.

There is a break in series in 2011, when data started to be disseminated according to the concept of usual residence as defined by the Art.2 (h) of the Commission Regulation (EU) No. 328/2011. Prior to that date, vital statistics (including statistics on death and causes of death) were collected using the notion of permanent residence (“domicile”) as residence.

Considering the classification of causes of death (WHO’s IDC-10 classification):

-         microdata transmitted to Eurostat are coded according to the ICD-10 classification

-         at national level, between 1980 and 1992 the ICD-9 classification was used, and beginning with 1993 the ICD-10 was used.

CoD data from 1994-2010 are not completely comparable with those reported from 2011 onwards, due to the change incurred in certain groups of causes of death. More so, stillbirths were reported beginning with 2011.

2011-2021

Causes of Death statistics and death statistics are produced by the NSI, using the same statistical survey. Information pertaining to deceased persons collected through the death statistical bulletin include causes of death.

From a methodological point of view there are no differences between the two series of data - death statistics and causes of death statistics.

There is a small amount of late registrations of deaths. In addition, deaths of Romanian citizens having their usual residence in Romania and deceasing abroad are also registered much later than the month of occurrence. The late registration of deaths is estimated at less than 1%.

Analysing the datasets sent for Demography domain and the Health domain (causes of death), the main differenced are derived from the data transmission methodology. While for the Demography domain data are transmitted only for deceased having their usual residence in Romania, for the Health domain, within the causes of death dataset are transmitted both data for deceased having their usual residence in Romania and for non-residents that deceased within Romania. Nevertheless, some inconsistencies were identified that were produced by the different moment of data transmission to Eurostat. NIS considered reviewing the data for the  2013 - 2020 period.

Not applicable, only annual data on causes of death are disseminated.

Not applicable.

At national level, the data on deceased persons having their usual residence in Romania are used to compute the usual residence population, while data on deceased persons having their permanent residence (“domicile”) in Romania are used to compute the permanent resident population.

Romania’s NIS did not establish a separate budget for the Vital Statistics Survey (including causes of death statistics). The survey is included in the Annual National Statistical Program that is signed into law with a Government’s Ordinance, being a part of the activities of the Institute and the cost is covered by its general budget.

One of the major expenses of the survey are the statistical bulletins, printed yearly in a number that matches the forecasted events during the year to follow.

NIS adopted a policy review that defines standard rules and principles for the revision of statistics, in accordance with the 2011 European Statistics Code Of Practice, the ESS Guidelines on Revision Policy for PEEIs and its annexes which include the principles of a common policy of revision for European statistics and with the Quality Guidelines for Romanian Official Statistics – Romania (2009).

In this regard, statistical output quality is measured by the six components of quality: relevance, accuracy, timeliness and punctuality, accessibility and clarity, coherence and comparability.

Usually, the statistics are subject to revisions. The review process data on death statistics including statistics on causes of death are mainly generated by the need to transfer national data sets in terms stipulated by European regulations and the subsequent need to include through the review of data late-registered records.

Nationally this review process is determined by the fact that a dimension of quality in statistics is the opportunity, meaning timely users’ access to statistical data. To produce timely vital statistical data, results (including deaths, excluding causes of death) are disseminated monthly as provisional data, annually (including causes of death) as semi‑final data and at Y+13 months as final data, where Y is the year of reference. Beginning with 2013, NIS started to review the data (by means of including vital events late-registered, generally from abroad) at Y+31 months.

The COD data for the 2013-2020 period were previously revised, according to the Romania's National Institute of Statistics (NIS) Revision Schedule and transmitted to Eurostat according to EU regulation no 205/2014.

Data for causes of death statistics are revised with the addition of Death Statistical Bulletins that have been registered later than the death occurred, especially those that were registered for Romanian citizens that died abroad.

The revised data on vital events (deaths) for the year Y represents the absolute final data related to vital events (deaths) recorded in year Y, to which were added vital events (deaths) belatedly recorded in years (Y+1), (Y+2) and the first four months of (Y+3), that occurred in year Y.

The revision of the data series for the 2014 – 2019 period included 728 late deaths (0.3%) in 2014,  a number of 1148 late deaths (0.4%) in 2015, 1189 late death (0.5%) in 2016, 919 late deaths (0.4%) in 2017 and 1052 deaths (0.4%) in 2018, 988 deaths (0.4%) 2019, 1266 deaths (0.4%) in 2020 and 1054 deaths (0.3%). The revision of the data for 2021 is planned for 2024.

Data source is the monthly statistical survey on vital statistics (death statistics and causes of death statistics are part of this survey).

Data is collected on a monthly basis, no later than the 26^th of the next month after the occurrence of the death.

According to the laws and regulations in force in Romania, the Civil Status Services within the city halls of municipalities, cities and rural communes fill-in monthly the Death Statistical Bulletins for each death act regardless if the deceased whom the death act pertains is a Romanian citizen or a foreigner. The statistical bulletins of death data are transcribed from the civil status acts, from the medical certificate for ascertaining death that includes the causes of death and other information obtained based on the declaration made by a family member, the certifying doctor or anyone else aware of the death. The death statistical bulletins completed by the civil status offices are sent to the Territorial Statistics Directorates (DTS) until the 25th of the month L + 1 for the deaths registered in the month L. These death statistical bulletins are handed over on the basis of the address in which are included also information regarding the numerical interval for which the statistical bulletins were transmitted, according to the numbering from the civil status register. In order to ensure the confidentiality of the data, the handing over / receiving of the statistical bulletins is done according to strict procedures and only by the persons authorized to have access to the demographic statistical bulletins.

The physician (family doctor, doctor from hospitals, emergency services and forensic doctor) that certified the death issues the death ascertaining certificate, that lists the causes of death (primary and secondary ones) leading to the death, and hands it over to the next‑of‑kin. The next‑of‑kin then takes the death ascertaining certificate to the Civil Status Office within the City Hall where the death certificate is issued. The death certificate is used to fill the death statistical bulletin.

The physicians’ training on certifying causes of death begins in medical school and is provided in the „Higher educational program” of every medical and pharmacy school. Medical personnel also participate in periodic training.

Table on certification (Percentage)

There are different certificates for stillbirths and neonates.

The “death ascertaining certificate” - used for general deaths and neonatal deaths is a double-sided slip, one side stays with the certifier and the other is used by the Civil Status Officer for filling the Death Act.

The “Death ascertaining certificate” used for general and neonatal deaths contains the following data:

• Recording data (county, locality, data of recording, name of medical unit)
• Deceased identity (personal numerical code, first and last name, date of birth and date of death, marital status, nationality, educational level, activity status, permanent residence: county, locality, usual residence, place of death)
• Certifier’s credentials
• Causes of death (underlying cause of death, antecedent causes of death, initial morbid condition)
• Other morbid causes

The “Stillbirth ascertaining certificate” is similar in form with the above death ascertaining certificate, but contains the following data instead:

• Recording data (county, locality, data of recording, name of medical unit)
• Child’s identity (first and last name, sex, date of birth, antepartum/intrapartum stillbirth, place of birth, assistance at birth, gestational age, birth weight, birth parity
• Causes of death (underlying cause of death, other morbid causes)
• Data on both parents (two columns, one for each: first and last name, date of birth, activity status and educational level, nationality and religion, permanent and usual residence: county, locality, marital status of the mother and length of marriage, number of live born/prior stillbirths/multiple births, whether prenatal medical checks were made)

a) Stillbirths

Data on stillbirths are collected using a Statistical Bulletin for Stillbirth, different from the one for Death.

 b) Neonates

Data on neonatal deaths are codified using the regular Death Statistical Bulletin, the same as any other deaths.

The process of validating death data (including validation of causes of death) includes the following steps:

• Checking the integrity of the received data;
• Data codification, processing and validation at territorial level;
• Creating and validating the national database.

These phases are described in the following points.

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

The coding of the demographic data is performed at the level of the Territorial Statistical Directorates (for example the coding of the locality of the usual residence or of the permanent residence (domicile), of the country of birth, etc.). According to a unitary methodology at national level elaborated by INS, which also includes the nomenclatures, the codification is performed.

Well-trained doctors regarding the coding of the causes of death perform the coding of the causes of death at the Territorial Directorates of Public Health.

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 statistical bulletins that record deaths are validated in two steps: one at local level (Territorial Statistical Department) and the second at the central level (NIS).

The following processing occurs at local (Territorial Statistical Department) level:

• encoding the statistical bulletins (text data is encoded in numeric format);
• inputting the data within the statistical bulletins in a database;
• checking and data validation
• collaborating both with INS and the Public Community Services, to correct unclear data, inconsistencies and other errors;
• monthly transmission of the database files to the NIS using secure data channels.

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

 Assessing the coding of causes of death - resolving errors 

The validation of data collected from the Death Statistical Bulletin is performed through NIS’ own validation program. The causes of death errors (errors regarding the diagnostic, sex, age) are corrected by the National Institute of Public Health - National Center for Statistics and Informatics in Public Health (NIPH-NCSIPH) subordinated to the Ministry of Health according to the WHO regulations regarding filling and coding causes of death based on ICD‑10 classification.

At NIPH-NCSIPH level, there is a monthly reception of files from the NIS that contain anonymised data extracted from the Death Statistical Bulletins on infant deaths, deaths related to pregnancy, childbirth and the puerperium (O00‑O99), deaths of persons aged 1 to 4 years and stillbirths. These files are correlated with the death sheets (medical surveys) that are issued by the certifying unit. NIPH-NCSIPH verifies the variables pertaining to cause of death, residence, sex, place of death, weight etc.

The final validation of the summary table on deaths broken down by causes of deaths, sex and age groups for the previous year, received from the NIS, is made by the NIPH-NCPHSI (validating causes of death correlated to sex, age groups, WHO restrictions on certain diseases that cannot constitute a cause of death except in special cases). This is a last validation of the deaths database, in order to correct missed errors or errors that were made while correcting the monthly files which will not be listed again.

The following final processing occurs at the central (NIS) level:

• received counties' databases are imported in the main database;
• checking the data for missing bulletins;
• processing the data to identify errors and missing information;
• missing data or bulletins not inputted are requested to the Public Community Services via the Territorial Statistical Department. If the data is unavailable, it is inputted according to the instructions;
• inputting errors are corrected after consultation with the Public Community Services;
• microdata are checking for specific causes of deaths with the Public Health Directorate (e.g. the cause of death coded with R990 is verified if it is registered to a stillborn).

External registers are used (a survey on death sheets that is carried out by County Statistical Offices) for infant deaths, deaths related to pregnancy, childbirth and the puerperium (O00‑O99), deaths of persons aged 1 to 4 years and stillbirths 

Annual deaths data that are collected and validated at central level (NIS) contain individual records of deaths during a calendar year, considered by the date of occurrence and the date of registration of death.

As deaths from year Y could be registered later than December 31st, database records for statistical bulletins filled for late events are appended manually to the database of the reference year Y; while records of deaths occurring in the year before the reference year Y and registered in year Y are deleted (they had been appended to the data of the previous years and already processed).

Coding performed by a certifier:

The medical causes of death collected in the Death Statistical Bulletins are coded every month by the Public Health Directorates, according to the WHO instructions for coding causes of death, and according to other medical restrictions and correlations. Within the Public Health Directorate there is a medical commission composed of epidemiologists, pneumophtisiologists, oncologists, pediatricians and a representative of the biostatistics and medical informatics division. The commission members are consulted during the codification of the causes of death. After the transcription of the causes of death codes, the Death Statistical Bulletins are forwarded to the County Statistical Departments.

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.  

Not available

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

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

To insure the coverage of the registration of the entire number of deaths within Romania's official statistics the following steps occur:

 - The Death Statistical Bulletins are received by counties' statistical departments with a notice that includes the number of bulletin completed by the city halls of municipalities, cities and rural communes. The civil servant from the Territorial Statistical Department verifies the correspondence between the number of bulletins and the total number mentioned in the notice. Within the Death Statistical Bulletins there is a field that collects the number of the death act from the Civil Status Register.

-  The civil servant from the Territorial Statistical Department verifies if the numbers in the Death Statistical Bulletins are consecutive. If there are missing numbers, the situation is verified with the responsible person within the city halls of municipalities, cities and rural communes. Missing numbers might occur in case of transcribed or reconstructed death acts, which are not statistically registered.

Final data on deceased persons are produced 12 months after the reference year. From the database that includes definitive data on vital statistics, the following data are transmitted to Eurostat:

• a data file on deaths for the “Demography” domain;
• microdata files on cause of death for the “Health” domain.

In order to transmit the microdata file on causes of death to Eurostat, a data integrity is performed by checking the national statistics (the number of deceased persons having their usual residence in Romania) with the number of records of deceased persons having their usual residence in Romania included in the causes of deaths file and the number of deaths reported in Eurostat’s “Demography” domain. Simultaneously, a check is performed to ascertain if all non-residents that died in Romania are included, by comparing with the national database on deaths.

A verification of the perinatal deaths and stillbirths, both with the national database and with the data sent transmitted to Eurostat for the “Demography” domain, is also performed. Additionally, a verification is made to check if the files follow the structure specified by Eurostat and if all the variable are filled-in.

Not applicable.

The statistical survey on vital statistics (including death statistics) is an exhaustive survey, and thus, no adjustments are used.

Not applicable.