Turkish Statistical Institute

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

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

Definiton of data: Death certificate which 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) include information on causes of death  which coding process of the diseases at the sections for the determination of causes of death are done according to International Classification of Diseases (ICD-10) and underlying causes of death are determined in TurkStat Regional Offices. 

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. 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".

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 until 2021. 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. Since reference year 2022 non-residents derived from Death Notification System has been included in the aggreagated GEN file with residents of Türkiye. 

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.

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

Classification and updates applied by years

* 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.

Public Health - Demography.

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

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

Coding the diseases at the sections for the determination of causes of death are done according to International Classification of Diseases (ICD-10) and underlying causes of death are determined according to same classification. Then, data are disseminated by grouping. 

"O00-O99" code known as "Complications of pregnancy, childbirth and puerperium" covers following categories: "Death occured at the pregnancy period", "Death occured at the childbirth process", "Death occured within 42 days after the birth" and also "Death occured between 42 days and 365 days after the birth".

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.

• 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.

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

Gestational age, weight.

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.

Deaths occured in Türkiye and which their death certificates have been filled out by physicians are covered who were residing in Türkiye in the reference year.

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

In national population which is called Address Based Population Registration System (ABPRS) and in national vital statistics, Turkish Republic citizens and foreign nationals residing within the boundaries of the country are covered.

Foreign population covers individuals who are holding a valid residence/work permit at the reference day and individuals who have a valid address declaration at the reference day while holding an identity document equivalent to residence permit such as international protection identity document and the individuals who have already renounced his/her Turkish Republic citizenship and who have a valid address declaration at the reference day. In addition to Syrians under temporary protection, foreigners holding visas or residence permits shorter than 3 months with the purpose of training, tourism, scientific research, etc. are not covered.

Neonatals of non-resident mothers are not considered residents.

Non-residents are not included in the national statistics.

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).

Before 2008 and previous It was used the International Classification of Disease (ICD-8) containing 50 and 150 diseases as required by the World Health Organization which only covered province and district centers. Since 2009 geographical coverage is Whole Türkiye, while data of 2009-2017 years covers deaths occured in Türkiye and their death certificates are filled out by physicians published by residing provinces, data since 2018 covered deaths who residing in Türkiye before dying in a certain year published by Statistical Regions Classification.

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. 

Causes of death data;

From 2018 onwards, are available for the province and districts according to the usual residence of deceased person.

Geographical coverage: Between 2009 and 2017 deaths occured in Türkiye and their death certificates are filled out by physicians are covered while 2018 onwards deaths are covered who residing in Türkiye before dying in a certain year.

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

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

Not applicable.

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

Deaths transferred from the Ministry of Health (MoH) Death Notification System (DNS) within the reference year (between January 1 and December 31) are covered, and in order to capture the scope, deaths from the previous year transferred within the first 3 months (January, February, March) following the reference year are also included in the publication period. In addition, cause of death data were revised 1 year retrospectively due to delayed registrations originated from judicial process etc. to the administrative records and registers added/updated later for the revised ones are also included in the publication period. The 2023 press release has been published including 2023 reference year and revised 2022 reference year in CoD Statistics.

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.

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. 

Causes of death data:

Cause of death data is created by coding the underlying cause of death according to the World Health Organization (WHO) International Classification of Diseases (ICD-10). The "Death Notification Form", which was compiled on paper between 2009-2012 within the framework of cooperation with the Ministry of Health, began to be compiled electronically with the "Death Notification System" as a result of the cooperation carried out with the Ministry of Health in 2013. In this way, both the scope and quality of the data were increased. Cause of death data is revised retrospectively for 1 year due to new records reflected in administrative records with a delay, and is published under the same press release combined with death statistics since 2018 and presented to the users.

Vital Statistics obtained from the MERNIS database;

The protocol for data sharing, exchange and coordination is below:

Protocol on Data Exchange between Republic of Türkiye The Ministry of Interior, General Directorate of Civil Registration and Citizenship Affairs and the Presidency of the Turkish Statistical Institute-(07 February 2006)

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

Data privacy and confidential data security regarding the statistics produced by Turkish Statistical Institute are guaranteed with the Turkish Statistical Law No. 5429 and the Regulation about Procedures and Principles of Data Privacy and Confidential Data Security of Official Statistics. Statistics are also prepared in accordance with the regulation published by the European Statistical Office (Eurostat) on March 11, 2009 with the number 223/2009 and the European Statistics Code of Practice, within the scope of harmonization with the European Union.The collection of data solely for statistical purposes and the confidentiality of the individual responses are guaranteed with the related legislation and regulations.

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).

For vital statistics this procedure is not applicable in general. If information on causes of deaths statistics in any cell of the data table created by aggregating individual data is less than three (particularly in more than 2 breakdowns like age, sex and geographical level or including district) and this is wide-spread along the table, the data in the relevant cell or whole table cannot be provided as it is considered confidential (According to Article 13 of Law No. 5429).

The data release calendar for statistical outputs is prepared on an annual basis and it is publicly announced on the National Data Release Calendar section of the website.

Death and Causes of Death Statistics: 14 June 2024.

Publication dates and times of the press releases published by the Turkish Statistical Institute are available at National Data Release Calendar.

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.

The principles, standards and procedures regarding the publication and dissemination of statistics produced by Turkish Statistical Institute are determined by the Publication and Dissemination Board. In order to ensure that statistics are delivered to users in accordance with the principles of confidentiality and equal access, and in an accurate, reliable, consistent, timely, and transparent way, the publishing dates of the press releases are determined within the framework of the Directive on the Procedures and Principles Regarding the Working Calendars of the Presidency of the Turkish Statistical Institute and announced to the public via the institutional website at the beginning of each year.

Users can access release calendar from the following website Tuik Kurumsal.

Annual.

Death and Causes of Death Statistics:

• Data Kategori.
• Data Death and Causes of Death Statistics 2023.

News releases on-line.

Not applicable. 

Please consult free data on-line or refer to Turkstat gov.

Static statistical tables: Data Population and Demography.

Online dynamic database: Biruni tuik.

Not available.

Microdata is not disseminated.

Information requests are given at national and international level. In addition, the information requested by organizations such as Eurostat, WHO and OECD is provided.

Not available.

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

Metadata on all indicators are given via TurkStat web page.

For causes of death statistics, aggregated COD_SBN and COD_GEN questionnaires of Eurostat are filled in and sent via EDAMIS, according to Commission Regulation (EU) No 328/2011 as regards statistics on causes of death. 

Coding Process of Underlying Causes of Death (UCOD)

Coding underlying causes of death is subject to a sequence of principles and rules in accordance of classification of International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10).

The ICD-10 consists of three volumes (Data for Health Initiative, 2022):

• Volume 1 – Tabular list
• Volume 2 – Instructions and guidelines manual
• Volume 3 – Alphabetical index (WHO, 2016).

World Health Organization. (2016). International Statistical Classification of Diseases and Related Health Problems, 10th revision, vol. 3, 5th edition. Geneva, World Health Organization. Apps

Basic documents within the scope of Civil Registration and Vital Statistics (CRVS):

• Principles and Recommendations for a Vital Statistics System

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

Data Population and Demography.

100%.

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).

European Statistics Code of Practice (CoP)

European Statistics Code of Practice (CoP) are the quality principles and standards established by the European Union. CoP; It consists of 3 main sections: institutional environment, statistical processes and statistical outputs. There are 16 quality principles and 84 quality indicators under these principles. TurkStat carries out its activities in accordance with the CoP's quality principles and indicators. The CoP is available on the Eurostat's website.

Institutional Quality Reports

Institutional quality reports are prepared for annual studies. The relevant quality report can be accessed under the Metadata tab on the Statistics Data Portal.

ISO 9001:2015 Quality Management Documentation

Quality-related documents were created within the scope of the ISO 9001:2015 Quality Management standard. Procedures, guides, instructions, plans, lists, and forms are included in the quality management system along with the standard coding system. There is a "Document Control Procedure" for the creation and updating of the documents. In addition, all studies are detailed on the basis of the articles of the standard in the "Quality Handbook", prepared within the scope of the ISO 9001:2015 Quality Management standard.

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.

TurkStat Quality Policy

TurkStat is committed to implementing a quality policy based on the European Statistics Code of Practice (ES-CoP), the European Statistical System Quality Assurance Framework (ESS-QAF), and other internationally recognized best practices determined by the European Statistical Office (Eurostat). In this context, TurkStat strictly adheres to and implements quality standards in statistical production processes by adopting the principle of continuous improvement and excellence in accordance with the ISO 9001:2015 Quality Management System Standard.

TurkStat Quality Policy is avaliable on the TurkStat website.

Quality Assurance Framework

The Quality Assurance Framework of the European Statistical System (ESS QAF) is a supporting document that aims to assist in the implementation of the European Statistics Code of Practice (CoP). It identifies possible activities, methods and tools that can provide guidance and evidence for the implementation of the CoP's indicators. TurkStat has determined its own quality assurance framework according to the QAF and shares it with all users on the TurkStat website. In line with the principles of the CoP, TurkStat quality assurance framework includes the studies, tools and legal regulations. 

ISO 9001:2015 Quality Management System

TurkStat is certified by the “ISO 9001:2015 Quality Management System” standard. TurkStat implements a holistic quality management system by fulfilling all the necessary requirements of the standard.

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.

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.

Quality Monitoring and Assessment Tool (QMAT)

TurkStat aims to increase the quality of statistics by evaluating the compliance of official statistics produced with quality principles and standards based on European Statistics Practice Principles (Code of Practice-CoP). As a result of the quality assessment carried out with QMAT, areas open to improvement are determined and improvement action plans are created. The actions scheduled in the improvement action plan are regularly monitored to ensure continuous improvement in the quality of official statistics.

For Türkiye;

Country Assessments and Strategies, 2020

Turkey CRVS Decade (2015-2024) Midterm Questionnaire - Turkey crvs decade 2015-2024.

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.

There are sections on the website of our institution for users who want to access both general and detailed information. After selecting the topic interested in from the "Subcategories" part of the "Statistics" section and clicking on the "Search" button,  "Press Release", "Statistical Tables", "Databases", "Reports" and "Metadata" contents can be reached.

Data at international and regional level can be accessed through the "Regional Statistics", "Provincial Indicators", "International Selected Indicators",  and "Turkstat Library" applications in the "E-Services" section.

Data requests which cannot be replied are compiled regularly and data production process are addressed in the light of this information.

If the requested data cannot be accessed from the website; it is possible to make a data request via this website.

Statistics produced by the Turkish Statistical Institute are presented to users through various channels, and a number of studies are carried out to increase service quality and meet user needs. The user satisfaction survey, which is one of these studies, is conducted through the corporate website in order to determine the profile, needs, and expectations of the users. The results of the survey are reported annually.

User Satisfaction Survey

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.

For causes of death data, all the variables requested by Eurostat are met however, since the coverage (Türkiye residents-deaths occured in the country/abroad) has changed after the statistics on death and causes of death were combined and announced beginning from the 2018 reference year, deaths of abroad residences are not included in the tables because of they are not included in the data, and records with a place of death abroad are included according to their country in the new data submission (COD_SBNAGG, COD_GENAGG). Also, in the Death and Causes of Death Statistics, the proportion of forms which have a medical cause assigned by a physician is over 90%.

Cause of Death Statistics are revised 1 year retrospectively because of delayed reflection or updated forms in administrative records originated from judicial etc. processes.

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%

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).

Causes of Death data are checked with administrative data sources such as Address Based Population Registration System (ABPRS), Ministry of Health (MoH) Death Notification System and Birth Notification System (for infant deaths which has not been registered in death records yet) and Central Civil Registration System (MERNIS).   

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

Cause of death statistics have been compiled and coded in accordance with International Classification of Diseases (ICD-10) of the World Health Organization (WHO). The "Death Notification Form". For accuracy and checks in this regard, ACME (Automatic Classification of Medical Entry) documents in accordance with international methodology are used.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

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

Death and Causes of Death statistics are disseminated within 6 months (t+165) after the end of the reference year.

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

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:

The pre-announced date and time to the users are complied with.

For the causes of death statistics between 2009 and 2017  deaths occured in Türkiye and their death certificates are filled out by physicians are covered while 2018 onwards deaths are covered who residing in Türkiye before dying in a certain year. In this context, the causes of death statistics have been internationally comparable according to provinces of residence since 2009, and have been differentiated in terms of coverage in 2018 and later. Deaths and causes of death of deceased persons who are not residents of Türkiye since 2018 are not included in the statistics. 

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

Not applicable.

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.

Since 2009, the causes of death statistics compiled from the Ministry of Health Death Certificates and since 2013 from the Death Notification System (DNS) have been comparable. Before 2009, causes of death statistics were not internationally comparable in terms of disease classification and geographical coverage.

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

2018-2023 (6 years) - Causes of death statistics for all deaths of residents in Türkiye including residents of dying abraod.

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:  Causes of Death statistics are compatible with the Address Based Population Registration System (ABPRS), the Ministry of Health Death Notification System and Birth Notification System, and the MERNIS data.

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.

Not applicable.

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. The data is self-consistent.

There is no statistically specific cost calculation or respondent burden analysis.

Revision Policy <

For reliable, comparable, compatible and consistent production of the current statistics by ensuring data integration; strategies have been specified in "Directive on Methods and Principles Regarding Revisions on Statistical Data Produced by Turkish Statistical Institute" . In this context, the general framework with regard to which statistics are to be revised, why, how long and how deep is available via the website.

Current Revision Plan

Information about routine/major revisions to be implemented in the current period is crucial for statistics users in the sense of determining the validity of data. In this context, TurkStat has adopted the principle of releasing the routine and/or major revision status of all statistical topics to be published in the beginning of each calendar year via the website.

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.

Detailed information on the revision policy of the data published in the press release can be found here (Turkish Statistical Institute Revision Information Form).

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

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

Causes of death data are collected from; Hospitals, family health centers, institutions of municipal medicine, institutions of forensic medicine and other health institutions. 

The collected data is transferred to TurkStat through the Ministry of Health Death Notification System.

Continuously.

The Death Notification System (DNS) data is the main data source and is transferred daily via web services, but the data transferred to Harzemli on a monthly basis for coding of underlying causes of death through Regional Offices are published annually together with death statistics after Regional data entry and Central analysis processes are harmonized and integrated with other relevant data.

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.

Table on certification (Percentage)

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 result;
• Role of NSO (TurkStat) is critical in the level of coding;
• Easy interaction between regional coders and central coders;
• Reminder trainings periodically.

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

*For final analysis and correction due to validations ICD-10 Version:2019 has been checked: https://icd.who.int/browse10/2019/en

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).

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

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

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.

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.

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

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 2022 can about 5.7 % added to the other unspecified cases given in the table.

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

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.

For only 2022 data transmission of non-residents, data has been deriven from Death Notification System by the information of abroad country, instead of citizenship.

Checked with the Central Civil Registration System (MERNİS).

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

Not applicable.

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.

Not applicable.

None.