Causes of death (hlth_cdeath)

National Reference Metadata in Single Integrated Metadata Structure (SIMS)

Compiling agency: Turkish Statistical Institute


Eurostat metadata
Reference metadata
1. Contact
2. Metadata update
3. Statistical presentation
4. Unit of measure
5. Reference Period
6. Institutional Mandate
7. Confidentiality
8. Release policy
9. Frequency of dissemination
10. Accessibility and clarity
11. Quality management
12. Relevance
13. Accuracy
14. Timeliness and punctuality
15. Coherence and comparability
16. Cost and Burden
17. Data revision
18. Statistical processing
19. Comment
Related Metadata
Annexes (including footnotes)
 



For any question on data and metadata, please contact: Eurostat user support

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1. Contact Top
1.1. Contact organisation

Turkish Statistical Institute

1.2. Contact organisation unit

Demographic Statistics Department / Vital, Social Structure and Gender Statistics Group

1.5. Contact mail address

Devlet Mah.Necatibey Cad. No:114 06420 Çankaya/ANKARA


2. Metadata update Top
2.1. Metadata last certified 05/03/2024
2.2. Metadata last posted 05/03/2024
2.3. Metadata last update 05/03/2024


3. Statistical presentation Top
3.1. Data description

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).

COD data are derived from death certificates. The medical certification of death is an obligation in Türkiye. The information provided in the medical certificate of cause of death into ICD codes according to the rules specified in the ICD.

Since 2020 (2019 ref. year) COD data are eventually linked and combined with death registers which are mainly derived from Central Civil Regisration System (MERNİS) and are broken down by sex, 5-year age groups, cause of death and by residential province of deceased person. For stillbirths and neonatal deaths additional breakdowns might include age of mother, which the data are derived directly from Minidtry of Health (MoH), Death Notification System (DNS), as done in the past, previously.

Since 2020, death and causes of death statistics have began to be disseminated in a single press release and kept together in one table. Annual national data are provided in absolute number which is equal with death statistics.

Coverage of deaths which is published according to civil registration uses also MoH data as a secondary source, but stillbirths came only from MoH data. So while GEN file was created according to the published data in the frame of death statistics, SBN file was created from MoH data just using the same roadmap/codes as previous years. Since 2020, the coverage has been changed for deaths but this is not possible for those stillbirths.

SBN file has been driven from the Death Notification System and GEN file from MERNIS (Central Civil Registration System). So, the former includes only cases occurred in Türkiye with also residents abroad, while the latter includes only residents of Türkiye with also cases occurred abroad. Since, the sources and their coverage are different, infants are not consistent in the two files which the discrepancies are not errors and are due to the different sources.

Adding a break in series flag to 2018 is appropriate because of changing coverage. Actually, it's taken (join by a unique ID) the ICD codes from MoH (Death Notification System), all other information are taken from civil registration (MERNIS) for deaths (not stillbirths). The coverage of civil registration is more comprehensive than MoH, since the deaths in the areas have been notified quickly in civil registration system by kin of the deceased but later in MoH where a physician was absent in such places. That’s why there are records (given “unknown-R99”)  in the statistics (comes from civil registration) as a deceased person which an underlying cause of death cannot be assigned since it’s not included in the Death Notification System  (MoH). Technically, it’s not possible to give different codes to the same record.

3.2. Classification system

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

 

Data year ICD classification used (ICD-9, ICD-10) (3 or 4 chars) For ICD-10: updates used
2011   ICD-10 
2012   ICD-10  
2013   ICD-10  
2014   ICD-10 
2015   ICD-10 
2016   ICD-10 
2017   ICD-10 
2018   ICD-10 
2019   ICD-10 
2020   ICD-10 
2021   ICD-10 

* The Turkish translation of ICD-10 is available only for 2006 edition, but for new/deleted diseases, we benefit from updates of ICD-10 English version.

3.3. Coverage - sector

Public Health - Demography

3.4. Statistical concepts and definitions

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

3.4.1. National definition used for usual residency

National Address Database (NAD) that covers all addresses within the boundaries of the country, to obtain the address information of Turkish citizens and foreigners living in Türkiye, to match the address information and the Central Civil Registration System-MERNIS by using the Turkish Republic identification numbers for Turkish citizens, to match the address information and passport numbers of foreigners and to keep this information in a separate database. Vital events including deaths are obtained from the central civil registration system-MERNIS database, which are kept and updated by the General Directorate of Civil Registration and Citizenship (GDCRC) of the Ministry of Interior. 

Main mortality indicators have been produced by NUTS-3 level since 2009. Causes of death data are produced in line with the same criteria used in producing death statistics since 2018.

3.4.2. Stillbirth definition and characteristics collected

a) National definition used for stillbirths

Stillbirth: The delivery of a fetus more than 500 gr or 22 weeks is accepted as stillbirth. Stillbirth is the death occurs freely from gestational age before complete expulsion or extraction of conception product from its mother; death is explained by the fact that fetus is not taking a breath or not showing any signs of life such as pounding of heart, pounding of unblical cordon or action of discretionary muscles after the delivery.

b) What are the characteristics that you collect (gestational age, weight, crown-heel)?

Gestational age, weight

3.5. Statistical unit

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

The statistical unit is the deceased person. The reporting unit is the certifier. This is in most cases a physician. In the case of non-natural deaths, the certification could be made by forensic physicians.

3.6. Statistical population

Mid-year population (of residents) which are estimated from Address Based Population Registration System (ABPRS).

3.6.1. Neonates of non-resident mothers

Neonatals of non-resident mothers are not considered residents.

3.6.2. Non-residents

Non-residents are not included in the national statistics.

3.6.3. Residents dying abroad

Residents dying abroad are included in the national statistics. 

Turkish citizens who reside in Türkiye and died abraod are included in the national data in line with Address Based Population Registration System (ABPRS).

3.7. Reference area

For the main source (Death Notification System) on causes of death; All death events occured in Türkiye are included in the national database except for death events not certified by physicians.

For the national death and causes of death statistics published since 2018; usual residents of Whole country including foreigners are covered. 

Data are available at national level and NUTS 1-2-3 level.

3.8. Coverage - Time

The data are available from 2009 according to ICD-10. For death and causes of death statistics, the reference date is calendar year. 

3.9. Base period

Not applicable.


4. Unit of measure Top

The data are published in absolute numbers which is collected at individual level. 


5. Reference Period Top

Data refer to the calendar year.


6. Institutional Mandate Top
6.1. Institutional Mandate - legal acts and other agreements

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.

Turkish Statistical Institute 

The compilation and dissemination of the data are governed by the Turkish Statistical Law No. 5429 of 10 November 2005.

The purpose of this law is to determine basic principles and standards concerning the production and organisation of official statistics; and to regulate the formation, duties, and authorities of the Turkish Statistical Institute (Turkstat) which is to compile and assess data and information, produce, publish, and disseminate statistics on the areas that country needs, and to ensure coordination among institutions and organizations that are involved in the statistics process prescribed in the Official Statistics Programme (Article 1).

The Official Statistics Programme establishes the framework for official statistics that shall be produced on subjects required at national and international level. Censuses and surveys are carried out within the framework of this Programme. Taking into account the existing resources, the burden on the respondents and the cost-benefit analysis, the Programme covers statistics needed to determine and monitor the situations of the country in the fields of economy, social issues, demography, culture, environment, science, technology and any other required areas (Article 3).

The Presidency, institutions and organisations taken part in the Programme shall take the measures to ensure the easy and equal access to the official statistics by all users.

Population 

Data on population and housing are compiled according to the responsibilities stated in Paragraph (a) of Article 29 of the Turkish Statistical Law on collecting the required statistical information on population, housing, education, culture, tourism, health, sports, justice, media, politics and other social subjects, analyzing them and calculating related indicators.

TurkStat carried out the field application in order to establish the Address Based Population Registration System (ABPRS) in 2007. The aim of this study was to develop existing administrative records based on addresses. Population Services Law No. 5490 dated 25 April 2006 was the legal base for the ABPRS. One of the purposes of the ABPRS were to establish National Address Database (NAD) that covers all addresses within the boundaries of the country, to obtain the address information of Turkish citizens and foreigners living in Türkiye, to match the address information and the Central Civil Registration System-MERNIS by using the Turkish Republic identification numbers for Turkish citizens, to match the address information and passport numbers of foreigners and to keep this information in a separate database. 

Vital Statistics

Vital events including births, deaths, marriages and divorces are obtained from the central civil registration system-MERNIS database, which is kept and updated by the General Directorate of Civil Registration and Citizenship of the Ministry of Interior, statistics are produced. MERNIS was converted to the online system in 2001. After that, birth statistics has been produced since 2001 from population registers. While birth statistics has been published according to the place of event (the place of birth occurred) in 2001-2008, it has been published according to the usual residence after 2009. Death statistics has been produced from MERNIS database since 2009. Death data taken from MERNIS database are matched with the causes of death data of TurkStat. So, death events not included in MERNIS database are added to the statistics. Main fertility and mortality indicators have been produced by NUTS-3 level since 2009.

6.2. Institutional Mandate - data sharing

According to the Turkish Statistical Law with Article 12, access to statistical results are given as follows:

Article 12 - The Presidency, institutions and organisations taken part in the Programme* shall take the measures to ensure the easy and equal access to the official statistics by all users by obeying the standards and release calendar specified in the Programme. The statistical information compiled by the TurkStat cannot be given to any person or authority before this information is made open to public.

*Programme: The Official Statistics Programme

Population

Population Services Law No. 5490 charged TurkStat for establishing the ABPRS, and Ministry of Interior, the General Directorate of Civil Registration and Citizenship (GDCRC) of the Ministry of Interior for developing and maintaining the system. Changes in usual residence addresses are entered to the system by the Provincial and District Directorates of Population of the GDCRC.

Updated information on population size and the basic characteristics of population is obtained from the system and announced by the TurkStat.Governmental organizations and establishments access the registers in the system for their administrative works by a protocol with GDCRC according to the Law. 


7. Confidentiality Top
7.1. Confidentiality - policy

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.

Confidential data

According to the Turkish Statistical Law:

Confidential data can be accessed only by those involved in the production of official statistics, to the extent that they need for performing their duties properly. If the number of the statistical unit in any cell of the data table formed by aggregating the individual data is less than three or one or two of the statistical units are dominant even if the number of units is three or more, the data in the concerned cell is considered confidential. The confidential data are compiled, processed and preserved for the production of official statistics cannot be delivered to any administrative, judiciary or military authority or person, can not be used for purposes other than statistics or as an instrument of proof. Civil servants and other staff in charge of compiling and processing these data are obliged to comply with this rule. This obligation continues after the related personnel leave their duties and positions. The rulers of the institutions and organizations producing official statistics shall take all measures to prevent any illicit access, use or revelation of the confidential data. Data or information obtained from sources that are open to all people shall not be deemed confidential (Article 13).

Data confidentiality ceases when a statistical unit gives written approval for the revelation of confidential data concerning itself.

Principles and procedures relating to data confidentiality and security shall be regulated through statutes to be issued in line with national and international principles and by soliciting the opinion of relevant institutions and organizations.

Use of individual data

Individual data may be given with the written permission of the Presidency after obscuring those parts which may lead to direct or indirect identification and on the condition that such data is used in scientific studies without any reference to distinct statistical units. People who are entitled to use individual data cannot give these data to third parties (Article 14).

7.2. Confidentiality - data treatment

All age groups showing a total mortality of less than 4 cases are considered as confidential. Therefore, any 'confidential' agegroup 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). 

For vital statistics this procedure is not applicable in general. If information on causes of deaths statistics in a cell are less then 3 (particularly in more than 2 breakdowns like age, sex and geographical level or including district) and this is wide-spread along the table, this table is not shared.


8. Release policy Top
8.1. Release calendar

Death and Causes of Death Statistics: 23 Febrauary 2023

8.2. Release calendar access

National Data Publishing Calendar: https://www.tuik.gov.tr/Kurumsal/Veri_Takvimi

8.3. Release policy - user access

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

Users can access release calendar from the following related link: https://www.tuik.gov.tr/Kurumsal/Veri_Takvimi


9. Frequency of dissemination Top

Annual.


10. Accessibility and clarity Top
10.1. Dissemination format - News release

Death and Causes of Death Statistics: https://data.tuik.gov.tr/Bulten/Index?p=Death-and-Causes-of-Death-Statistics-2021-45715

News releases on-line.

10.2. Dissemination format - Publications

Not applicable. 

10.3. Dissemination format - online database

Please consult free data on-line or refer to http://www.turkstat.gov.tr/PreTablo.do?alt_id=1083

Static statistical tables: https://data.tuik.gov.tr/Kategori/GetKategori?p=Population-and-Demography-109

Online dynamic database: https://biruni.tuik.gov.tr/medas/?kn=95&locale=en

10.3.1. Data tables - consultations

Not available.

10.4. Dissemination format - microdata access

Microdata is not disseminated.

10.5. Dissemination format - other

There is no other data disseminated.

10.5.1. Metadata - consultations

Not available.

10.6. Documentation on methodology

Documents for COD are available in CIRCABC, Causes of Death section.

Metadata on all indicators are given via TurkStat web page.

All other documents such as guidelines and technical documents are available only for internal use. They are not published or shared.

https://data.tuik.gov.tr/Kategori/GetKategori?p=Population-and-Demography-109

10.6.1. Metadata completeness - rate

100%

10.7. Quality management - documentation

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 (i.e. national certification and coding procedures). In general, all countries follow the standards and rules specified in the ICD, and the overall procedures for the collection of COD data are relatively homogenous between European countries (medical certification of cause of death, use of ICD).

However, national differences in interpretation and use of ICD rules exist and as a result important quality and comparability issues remain. Based on the report "Comparability and Quality Improvement of the European Causes of Death Statistics" countries work towards further improving certification and coding procedures.

Ongoing work is reported to Eurostat's Working Group "Public Health Statistics" (documents available in circabc).

In line with the TurkStat Quality Assurance Framework and the European Statistics Code of Practice, various quality assurance applications regarding the coverage, content and up-to-dateness and other quality aspects are carried out annually.

Besides, quality control measurements such as cross checks and validations are conducted, as well. 

Documentation on quality management and quality assessment are available for only internal use.

For vital statistics, institutional quality reports are published at website in 45 days after the press release published.


11. Quality management Top
11.1. Quality assurance

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

Vital Statistics are compliant with relevant regulations/definitions.  

All documents regarding quality assurance and control are available only for internal use, they are not published or shared.

See: https://www.tuik.gov.tr/Kurumsal/Tuik_Kalite_Guvence_Cercevesi_Belgesi

11.2. Quality management - assessment

A quality assessment of Eurostat's COD statistics was organised in May and June 2008. In that framework, a questionnaire was sent to Eurostat's partners (data providers) for COD statistics and a user survey was set up on Eurostat's website, for which 25 partners and 34 users answered. A questionnaire was also filled in by responsible people of COD statistics in Eurostat.

For Türkiye;

Country Assessments and Strategies, 2020

Turkey CRVS Decade (2015-2024) Midterm Questionnaire - https://getinthepicture.org/resource/turkey-crvs-decade-2015-2024-midterm-questionnaire


12. Relevance Top
12.1. Relevance - User Needs

Based on the 34 answers received from the web survey, the main users are Research Institutes,  Universities, Public Government agencies, Private, Commission services and Business companies. On these 34 answers, Eurostat data on Causes of Death are "essential", "important", or "used for background information" for 25 respondents.
Asking about the availability of needed data in the Eurostat production, users are divided in two equivalent part: 12 answered that they do not need statistics on the field not currently available from Eurostat and 13 answered that they need, giving information about defects and lacks of the Eurostat data.

TurkStat produces official statistics according to the Official Statistics Programme which is prepared for 5-year period. In the preparation process of this programme, the needs of users, academia, organizations and institutions are taken into consideration.

12.2. Relevance - User Satisfaction

Not available.

12.3. Completeness

Ideally, all deaths are subject to a legal procedure of filling the death certificate for burial and other legal process and death event is notified to the General Directorate Civil Registration and Citizenship (GDCRC) by Ministry of Health (MoH), in 10 days.

12.3.1. Data completeness - rate

1. For mandatory variables:

 100%

2. For voluntary variables:

 100%

3. For additional variables:

  • External CoD

 Available.

  • Place of occurrence for external CoD

 Available.

  • Activity for external CoD

Not available.

Death statistics in total 95%-100%

Death statistics with an assigned underlying cause of death: 90%-100%


13. Accuracy Top
13.1. Accuracy - overall

Death events of foreigners are included. They are included in line with the criteria used for determination of foreign population in Address Based Population Registration System (ABPRS).

For deaths which covered in the Central Civil Registration System, but not covered in Death Notification System (yet or will never be transferred to the TurkStat) are published as ‘Unknown’, but not ill-defined, in terms of causes of death. The coverage and timeliness of civil registration is more comprehensive than MoH. That’s why there are records (given “unknown”) in the statistics (comes from civil registration) as a deceased person which they cannot be assigned an underlying cause of death since it’s not included in the Death Notification System (MoH).

13.2. Sampling error

Not applicable. Data collection is from administrative sources.

13.2.1. Sampling error - indicators

Not applicable.

13.3. Non-sampling error

Not applicable.

13.3.1. Coverage error

Not applicable.

13.3.1.1. Over-coverage - rate

Not applicable.

13.3.1.2. Common units - proportion

Not applicable. Data collection is from administrative sources.

13.3.2. Measurement error

Not applicable.

13.3.3. Non response error

Not applicable.

13.3.3.1. Unit non-response - rate

Not applicable.

13.3.3.2. Item non-response - rate

Not applicable.

13.3.4. Processing error

Not applicable.

13.3.5. Model assumption error

Not applicable.


14. Timeliness and punctuality Top
14.1. Timeliness
Year Number of months between the end of the reference year and the publication at national level
2011  4 months
2012  4 months
2013  3 months
2014  3 months
2015  3 months
2016  4 months
2017  4 months
2018  4 months
2019  6 months
2020  6 months
2021  6 months

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

14.1.1. Time lag - first result

Death and Causes of Death statistics are disseminated within 6 months (t+180) after the end of the reference year.

14.1.2. Time lag - final result

18 months - revision after the first results of the reference year 

14.2. Punctuality

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.

The results are disseminated as press release according to national press release calendar.

All official statistics under the responsibility of TurkStat are disseminated on the predetermined date and time specified in the National Data Publishing Calendar.

National Data Publishing Calendar: https://www.tuik.gov.tr/Kurumsal/Veri_Takvimi

14.2.1. Punctuality - delivery and publication
Reference year Time between the end of the reference year and the delivery of final data to Eurostat
2011  
2012  
2013  
2014  
2015  
2016  
2017  
2018 24 months 
2019 24 months
2020 36 months
2021 24 months

2021 press release had been postponed due to ongoing studies on administrative registers of related institutions. 

Instead of June, 2022 it have been announced on February, 2023. The number of days between delivery and schedule are 8 months.


15. Coherence and comparability Top
15.1. Comparability - geographical

The comparability of the data across different countries is limited by the fact that the revision of classification used to collect information on underlying causes of death may be different. However, only one country (Greece) is currently still using the ninth revision of the ICD. Furthermore, not all countries apply the recommended WHO's updates.
The coverage of residents dying abroad or non-residents dying in the reporting country can also affect the comparability among countries.
On-going work to increase quality, comparability and coverage done by the Technical group on Causes of Death or by ad-hoc Task Forces, or other means (e.g. ad-hoc workshops), is reported to Eurostat's Working Group "Public Health Statistics".

Comparability processes are performed between geographical areas (only provinces and districts) for death and causes of death statistics.

15.1.1. Asymmetry for mirror flow statistics - coefficient

Not applicable.

15.2. Comparability - over time

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

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

Beginning from the year 2018, causes of death data are given by usual residence of deceased person covering only residents including foreigners as time-series. Between 2009-2017 causes of death data had been published by usual residence of death events which occured in Türkiye including non-residents.

15.2.1. Length of comparable time series

2009-2017 (9 years) - Causes of death statistics for all deaths occured in Türkiye including non-residents.

2018-2022 (5 years) - Causes of death statistics for all deaths of residents in Türkiye including residents of dying abraod.

15.3. Coherence - cross domain

Is there any missing information (uncomplete geographical coverage, missing certificates, …)? If yes, please indicate also the %.

Yes (2009=24%, 2010=20%, 2011=17%, 2012=15%, 2013=5%, 2014=2%, 2015=2%, 2016=1%, 2017=1%)

Death and causes of death statistics: Performing coherence with causes of death data (Death Notification System) and Ministry of Health infant death records.

15.3.1. Coherence - sub annual and annual statistics

The smallest comparable geographical units are districts. The published statistics include NUTS 1 (12 regions) , 2 (26 sub-regions) and 3 (81 provinces). District level data provide and assessment are subject to statistical informaton requests.

15.3.2. Coherence - National Accounts

Not applicable.

15.4. Coherence - internal

The disease groups are consistent between years.

Death and Causes of Death Statistics: Cross validations are carried out to check consistency among the different tables for each domain.


16. Cost and Burden Top

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


17. Data revision Top
17.1. Data revision - policy

Death and Causes of Death Statistics: Information form on revisions for the death statistics can be accessed from the link below:

https://www.tuik.gov.tr/indir/revizyon/2020_RBF_EN_DIDB_HIG_OONI.pdf

17.2. Data revision - practice

Death and Causes of Death Statistics: Death data were revised 3 years retrospectively, causes of death and suicide data were revised 1 (one) year retrospectively due to delayed registrations in the administrative records.

17.2.1. Data revision - average size

Forensic cases etc. due to late registration or judicial process are revised which are about max 2% of all deaths.  


18. Statistical processing Top
18.1. Source data

Ministry of Health (MoH), Death Notification System (DNS); Medical and non-medical information of deceased person are collected.

18.2. Frequency of data collection

Continuously.

18.3. Data collection

Definition: These statistics are based on underlying causes of death.

Classification: International Classification of Disease (ICD-10) is used for the evaluation of cause of death statistics.

Geographical coverage: All deaths that occured in Turkey and their death certificates are filled out by physicians are covered, whether their residences are in Turkey or not.

Time coverage: Data are available since 2009.

Data Sources: Hospitals, family health centers, institutions of municipal medicine, institutions of forensic medicine and other health institutions.

Variables collected: Causes of death, usual residence, gender and age group.

Data collection system: Death certificate is filled out by the physicians in the hospitals, family health centers, institutions of municipal medicine, institutions of forensic medicine and other health institutions via Death Notification System (DNS)

Data entry: Coding the diseases at the sections for the determination of causes of death are done according to International Classification of Diseases (ICD-10) and underlining causes of death are determined in 
TurkStat Regional Offices
 
Revision: Causes of death statistics are revised one year retrospectively due to late incoming reports. 
 
Geographic detail: Data are available for whole of Türkiye in 2009. Data are available for whole of Türkiye and all provinces since 2010.  
 
Coding: 
• Diagnosis coding is done at regional level in each of the 26 regions of Turkey. There are between 2 and 10 coders in each region according to its size.
• At central level, 2 coders are in charge of quality control and training.
• All coders use a specific data entry program to access the MoH database fed with DNS to code causes of death and enter the underlying cause of death.
18.3.1. Certification

Table on certification (Percentage)

Year

All doctors (certifiers) trained in the certification All doctors (certifiers - pathologists or others doctors) trained in the post-mortem examination (autopsies) Certificates filled by persons who attended a course on certification or post-mortem examination Death certificates that are queried (only queries related to medical part of the death certificate should be included) Replies received for queries sent Deaths where the underlying cause is changed as a result of the query Death certificates with incorrect sequence
2011  -  -  - -  -  -  - 
2012  -  -   -  -  -  -  - 
2013  -  -  - -  -  - - 
2014  - -   - -  -
2015 -  - 
2016 -  - 
2017 - 
2018 - 
2019  -
2020  -
2021  -

All deaths occured in Türkiye are covered and certificates of these deaths are filled out by physicians whether their residences are in Türkiye or not. 

• Laws gives the main responsibility to the health institutions for the identification of death events
• For suspicious case, responsibility is shared by prosecuters and judicial physicians
 
• Role of MoH and health institutions is critical in the level of certification and coverage in terms of quality
– Only the diagnoses made by physicians are accepted because of medical part
– The efforts made by MoH such as duty physician and family physician systems are useful for the coverage improvement
– Trainings on certification are necessary for quality improvement
– Since 2013 with the enforcement of DNS by MoH, there has been a visible improvement in coverage and timeliness in the dissemination of results
 
• Role of NSO (TurkStat) is critical in the level of coding
–Easy interaction between regional coders and central coders
–Reminder trainings periodically
18.3.2. Automated Coding
Data year Use of any form of automated coding System used (IRIS, MICAR, ACME, STYX, MIKADO, others)
2011  Yes  IRIS
2012  No  
2013  No  
2014  No  
2015  No  
2016  No  
2017  No  
2018  No  
2019  No  
2020  No  
2021  No  

There is not any programme for automated coding used, currently.

18.3.3. Underlying cause of death
Data year Only manual selection of underlying cause Manual with ACME decision tables (if yes, version of ACME) ACS utilising ACME decision tables (if yes, version of ACME) Own system (ACS without ACME) Comments
2011   Yes - 2008      
2012   Yes - 2011       
2013   Yes - 2011       
2014   Yes - 2011        
2015   Yes - 2011        
2016   Yes - 2011        
2017   Yes - 2011        
2018   Yes - 2011        
2019   Yes - 2011        
2020   Yes - 2011        
2021   Yes - 2011       

The Central  Civil Registration  System (MERNIS): It is a database within the Ministry of Interior, General Directorate of Civil Registration and Citizenship (GDCRC) which includes population registers in the form of family ledgers. Birth, death, marriage and divorce events, citizenship and other vital events are registered by local population directorates of the GDCRC. Population registers are kept in the form of family ledgers which is arranged according to the father for each family.

Causes of death data: Death certificate is filled out by the physicians in the hospitals, family health centers, institutions of municipal medicine, institutions of forensic medicine and other health institutions via Death Notification System (DNS). Coding the diseases at the sections for the determination of causes of death are done according to International Classification of Diseases (ICD-10) and underlining causes of death are determined in TurkStat Regional Offices. 

Death statistics has been produced from MERNIS database since 2009. Death data taken from MERNIS database are matched with the causes of death data of TurkStat.  For deaths which covered in the Central Civil Registration System, but not covered in Death Notification System (yet or will never be transferred to the TurkStat) are published as ‘Unknown’, but not ill-defined, in terms of causes of death. The coverage and timeliness of civil registration is more comprehensive than MoH. That’s why there are records (given “unknown”) in the statistics (comes from civil registration) as a deceased person which they cannot be assigned an underlying cause of death since it’s not included in the Death Notification System (MoH).

18.3.4. Availability of multiple cause
Data year Information stored in the national CoD database, UC (Underlying cause) or MC (Multiple cause)
2011 MC
2012 MC
2013 MC 
2014 MC 
2015 MC 
2016 MC 
2017 MC 
2018 MC 
2019 MC 
2020 MC 
2021 MC 

Multiple causes and underlying cause of death are included together in the national database.

18.3.5. Stillbirths and Neonatal certificates

There is not any separate certificate for stillbirths and neonatal deaths. All deaths are subject to one standart certificate.

18.4. Data validation

What are the criteria (external source, local registers, …) used for the validation of the coverage?

Results of Population and Demography Statistics and Population Registers

Death and Causes of Death Statistics: Cross validations are carried out to check consistency among the different tables for each domain. Time series analysis are conducted by tables.

18.4.1. Coding

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

Distributed among regional offices and analyzed in the regional-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):

Analyzes in the Harzemli Analysis Programme (HAP) in electronical and dynamic base between regional and central level. 

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

More than 200 queries under HAP based on correcting / approving the detected soft/hard errrors. Last approve belongs to Central Office.  

Coding performed by a certifier:

Physician is authorized to code only list of diseases causing to the death directly or indirectly, from a selection of ICD-10 disease list. 

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:

 -

Many (more than 200) queries (hard or soft) had been done manually (calling attention of Regional Offices via e-mail) before reference year 2022.

Causes of Death Statistics are coded by Regional Offices to ICD-10. In coding, the underlying or external (injury) underlying cause is assigned by trained expert coders within the framework of the ACME rules of the World Health Organization. Data entries are made through the Harzemli Web – Cause of Death Statistics application which is a specific application platform used in TurkStat. With the Harzemli Analysis program, underlying or external underlying causes such as age, gender, birth weight, gestation period, etc. possible inconsistencies are checked for validation and corrected since 2022 reference year.

18.4.2. Unspecified CoD code

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

Year Unspecified CoD (for ICD10: R00-R99 codes, for ICD9: 780-790 codes) Unknown CoD (for ICD10: R98-R99 codes, for ICD9: 799.9, 798.9, 798.2 codes) Deaths due to senility (for ICD10: R54 code, for ICD9: 797 code) Deaths due to exposure to unspecified factor (for ICD10: X59 code, ICD9: 928.9 code)
2011  4.0   2.1  0.9  0.4
2012  4.7   2.2  1.2 0.6
2013  2.3   1.1   0.4   0.4 
2014  2.4  1.1   0.4  0.4
2015  2.0  1.0  0.2  0.3 
2016  2.2  1.1  0.1  0.4 
2017 2.2 1.0  0.1  0.4
2018 2.5 1.3  0.1 0.4
2019 1.7 0.6  0.1   0.3 
2020 1.5 0.5  0.1   0.3 
2021 1.3 0.5  0.1   0.3 

Death statistics has been produced from MERNIS database since 2009. Death data taken from MERNIS database are matched with the causes of death data of TurkStat.  For deaths which covered in the Central Civil Registration System, but not covered in Death Notification System (yet or will never be transferred to the TurkStat) are published as ‘Unknown’, but not ill-defined, in terms of causes of death. The coverage and timeliness of civil registration is more comprehensive than MoH. That’s why there are records (given “unknown”) in the statistics (comes from civil registration) as a deceased person which they cannot be assigned an underlying cause of death since it’s not included in the Death Notification System (MoH). For example; Unknown or unspecified cases in 2021 can about 5% added to the other unspecified cases given in the table.

18.4.3. Unknown country or region

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

 

Year Residents Non-residents
Unknown residency (NUTS2) Unknown occurrence (NUTS2) Unknown residency (country) Unknown residency (NUTS2) Unknown occurrence (NUTS2)
2011  -  - 0.4 0.4   -
2012  -  0.5  0.5 
2013  1.4 1.4 
2014  1.8  1.8 
2015  2.0 2.0 
2016  2.4 2.4 
2017 -  2.9 2.9 
2018 Not applicable Not applicable Not applicable
2019 Not applicable Not applicable Not applicable
2020  - Not applicable  Not applicable  Not applicable 
2021  -  - Not applicable  Not applicable  Not applicable 

The non-residents are not included even they died in Türkiye, since 2018. Before 2018, information on residence of country and NUTS2 of non-residents are unknown. 

The information of citizenship by country is available.

18.4.4. Validation of the coverage

Checked with the Central Civil Registration System (MERNİS).

18.5. Data compilation

Diagnoses are coded according to ICD 10 and underlying causes are found by means of ACME decision tables and rules.

18.5.1. Imputation - rate

Not applicable.

18.6. Adjustment

The first results are disseminated in 6 months after reference year. The first reference year results are revised 1 year retrospectively in the second year after reference year with the addition of cases not covered in first results.

18.6.1. Seasonal adjustment

Not applicable.


19. Comment Top

None.


Related metadata Top


Annexes Top