Statistical Service of Cyprus (CYSTAT)

Demography, Social statistics and Tourism

Statistical Service of Cyprus

CY - 1444

Nicosia

CYPRUS

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).

Eurostat's CoD statistics build on standards set out by the World Health Organisation (WHO) in the International Statistical Classification of Diseases and Related Health Problems (ICD).

The regional breakdown is based on the Nomenclature of Territorial Units for Statistics (NUTS 2).

Classification and updates applied by years

Public Health, covering all the deaths occuring in the Government Controlled Area including the deaths of Residents and non-residents (i.e. visitors), as well as deaths of permanent residents occuring abroad. 

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

Usual resident is a person having resided or having the intention to reside in Cyprus for a period of at least 12 months.

According to the national Legislation "Law 168(I) / 2017 LAW AMENDING THE LAW OF POPULATION OF 2002 TO (NUMBER 4) OF 2015", based on the COMMISSION REGULATION (EU) No 328/2011, the definition of stillbirth has been adjusted to the following:

"Stillbirth" means embryo death which is born with a weight of at least five hundred (500) grams or a gestational age of at least twenty-two (22) completed weeks or a body length from the top of the head to the heel of at least twenty-five (25) centimeters. 

Up to 2013, the characteristics collected included the weight and the gestational age; from 2014 onwards, the crown-heel length is also available for a few cases.  

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

Detailed information is given in the following points.

Neonates of non-resident mothers are considered as non-residents.

Non-residents dying in Cyprus are included in the national death statitics, but they are excluded from the calculations of SMR and crude rates.

Residents dying abroad are included in the national death statistics. Residents dying abroad are usually burried in Cyprus. In order to proceed with the funeral, it is obligatory to provide the church with the medical death certificate, issued from the country where the death occured. This medical death certificate includes information on the cause of death, external cause of death, sex, age and date of death.

The data covers all the deaths of residents and non-residents occuring in the Government Controlled Area of Cyprus, as well as the deaths of residents dying abroad.

Generally, comparable data for cause of death data is available from the implementation of the EU Regulation, i.e. 2011 onwards. For previous years there is available data, but it is not always comparable, due to the different groupings of causes of death.

Moreover, the time series for data on stillbirths starts in 2011 since no information for previous years is available.

Not applicable.

The unit is an absolute number.

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

The last reference year is 2021.

CoD data was submitted to Eurostat up to data referring to year 2010 on the basis of a gentleman's agreement established in the framework Eurostat's Working Group on "Public Health Statistics".

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.

The data is being compiled by the Health Monitoring Unit of the Ministry of Health and is sent to the Statistical Service of Cyprus (CYSTAT) for the dissemination to Eurostat. CYSTAT disseminates aggregated data in its website, under the electronic publication "Health and Hospital Statistics".

The Health Monitoring Unit of the Ministry of Health is responsible for data sharing CoD. Data are sent uppon request to European and International Organizations, Universities (in Cyprus and abroad), as well to researchers. In order to provide micro data to an applicant, an aggrement for access to non-confidential data must be signed between HMU and the applicant. 

No confidentiality issues apply, since the characteristics of the deceased do not fall under the provisions of the national Law for the Protection of Natural Persons. Hence, the prevention for unauthorised disclosure of data that identify a person or economic entity either directly or indirectly does not apply. 

Reference: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32016R0679 , article (27), This General Data Protection Regulation, does not apply to the personal data of deceased persons. Member States may provide for rules regarding the processing of personal data of deceased persons

General Data Protection Regulation does not apply to the personal data of deceased persons, thus age groups showing a total mortality of less than 4 cases is not considered as confidential. 

HMU: November n for reference year n-1

CYSTAT: May n for reference year n-2 (for 2021, it is expected to publish the data in july 2023)

CYSTAT: Each interested party could fill in a registration form online in order to become a registered user and use the online services offered by the Statistical Service’s website. The registration form could be viewed on the following link (the deaths are listed under the subtheme "health"):

https://www.cystat.gov.cy/en/UserRegister

Through this process the interested party could enable the alert service in order to be informed about the release calendar; also the user can select the domains of interest for which he/she will be informed for any data release.

Upon the submission of the registration form, the interested party will receive an e-mail with a username and a password which should be used to Login.

Each registered user, could enable the alert service in order to be informed about the release calendar; also the user can select the domains of interest for which he/she will be informed for any data release.

Annual

CYSTAT: The data on causes of death are disseminated through the annual electronic publication "Health and Hospital Statistics". The dissemination of this publication is anounced in advance through the release calendar in CYSTAT's website and a press release presents the main figures included in the publication. The press release for the latest publication can be viewed on the following link: https://www.cystat.gov.cy/en/PressRelease?id=67627

Up to the date of the submission of this report, the latest published data refers to year 2020. 

HMU: The data on causes of death are disseminated through an annual puplication (year n) of main figures for reference year (n-1). The puplication can be viewed on the following link: Causes of Death in Cyprus in 2021.pdf (moh.gov.cy) 

CYSTAT

Up to the date of the submission of this report, the latest published data refer to year 2020. 

Annual publication:

"Health and hospital statistics", https://library.cystat.gov.cy/NEW/HEALTH_HOSPITAL_STATS-2020-EN-120123.pdf

Electronic publication in pdf format and aggregated figures in excel format

Data in the form of a database, https://cystatdb.cystat.gov.cy/pxweb/en/8.CYSTAT-DB/8.CYSTAT-DB__Health__7.Deaths%20by%20Cause%20of%20Death/2170010E.px/

HMU

Annual publication:

"Report on mortality Statistics in Cyprus",   Causes of Death in Cyprus in 2021.pdf (moh.gov.cy) 

CYSTAT

Up to the date of the submission of this report, the latest published data refer to year 2020. 

Disseminated are aggregated figures and micro data in the form of a database

https://www.cystat.gov.cy/en/PublicationList?s=38

https://cystatdb.cystat.gov.cy/pxweb/en/8.CYSTAT-DB/8.CYSTAT-DB__Health__7.Deaths%20by%20Cause%20of%20Death/2170010E.px/

HMU

Disseminated are only aggregated figures, no micro data in the form of a database

CYSTAT:

Not applicable

HMU

Not applicable since no data is disseminated in online tables.

CYSTAT

Statistical micro-data from CYSTAT’s surveys are accessible for research purposes only and under strict provisions as described below:

Under the provisions of the Statistics Law, CYSTAT may release microdata for the sole use of scientific research. Applicants have to submit the request form "APPLICATION FOR DATA FOR RESEARCH PURPOSES" giving thorough information on the project for which micro-data are needed.

The application is evaluated by CYSTAT’s Confidentiality Committee and if the application is approved, a charge is fixed according to the volume and time consumed for preparation of the data. Micro-data may then be released after an anonymisation process which ensures no direct identification of the statistical units but, at the same time, ensures usability of the data. The link for the application is attached below.

• Link to the application for access to microdata on CYSTAT's website: https://www.cystat.gov.cy/en/DataRequestContactForm?fid=7

HMU

Microdata access only by special request and after the aggreement for access to non-confidential data of the Helth Monitoring Unit.

CYSTAT

Causes of death data are disseminated in aggregated tables. The table is presented only in the annual electronic publication "Health and hospital statistics" (excel file: worksheet "H1")

Link: https://www.cystat.gov.cy/en/PublicationList?s=38

HMU

Causes of death data are disseminated in aggregated tables and only after special request in microdata

CYSTAT:

Not applicable since no metadata are disseminated in CYSTAT's website. However a link to Eurostat's website is placed on the website.

HMU:

Not applicable since no metadata are disseminated in HMU's website.

CYSTAT:

Not applicable since no methodological documents are disseminated in CYSTAT's website.

HMU:

Microsoft Word - English 2.doc (moh.gov.cy) 

MINISTRY OF HEALTH - Statistics (moh.gov.cy)

Almost complete.

HMU

The quality of CoD data is subject to the standards and rules specified in ICD10. Medical death certificate of causes of death follows WHO death certificate, thus the collection of CoD  data is homogenous between European Countries.

HMU

The causes of death data are compiled according to the Commission Regulation No. 328/2011. All the requirements defined from the Regulation regarding the scope, the definitions and the variables to be included in the dataset, as well as the quality of the data submitted are met. 

A qualified nursing officer performs the coding of the causes of death. The officer participates on an annual basis IRIS training courses. Also the statistical officer who is responsible for mortality statistics participates the IRIS training on an annual basis. IRIS Institution provides techical support when requested by the Health Monitoring Unit during the causes of death coding procedure. 

HMU

Quality standards (documents that provide requirements, specifications, guidelines, or characteristics) are used consistently to ensure the quality of CoD data. 

Not available.

Since 2008 (with the exception of 2010, 2013 and 2020) CYSTAT carries out an annual online “Users Satisfaction Survey”. The results of the surveys are available on CYSTAT’s website at the link attached below.

Overall, there is a high level of satisfaction of the users of statistical data published by CYSTAT.

• Results of CYSTAT’s User Satisfaction Surveys: https://www.cystat.gov.cy/en/StaticPage?id=1144

The data is sent to Eurostat timely, i.e. 18 months after the end of the reference period. The coverage of the dataset is full as regards the Government Controlled Area. 

For the case of Cyprus, the ratio of the number of data cells provided to the number of data cells required cannot be computed because the CoD data is provided in microdata format and the number of data cells required is unknown.

Below, information on completeness for mandatory variables, voluntary variables as well as for additional variables, is provided:

1. For mandatory variables: 100% 

2. For voluntary variables: 100%

3. For additional variables:

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

HMU

The accuracy of CoD data is almost 100%, since besides the medical death certificate which is the main data source, various other sources are also used.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable

Full coverage is achieved. National figures are revised on a continuous basis; any updated figures are sent to Eurostat be the end of the year of dissemination, i.e. any updates for the data sent in June year n are sent to Eurostat by the end of year n (reference year n-2).

For the calculation of standardized death rates, the deaths of non-residents occurring in Cyprus are excluded.  

Not applicable. Data collection is from administrative sources.

A small number of deaths (10-15 deaths occurred in reference year (n)) are not registered at the Administrative Offices within the reference year n,  but eventually, those deaths are also included in the national mortality file since the information are being captured from the other sources (multiple sources are used for the causes of death statisics). 

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable.

As regards the HMU, the first results are usually published in November year N for reference year N-1.

As regards CYSTAT, the first results are usually published in May year N for reference year N-2. 

The same as in 14.1.2.

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.

In general, at the first time of data submission to Eurostat, final data are submitted. However, if any updates occur the revised datafile is sent during next year's submission.

In the table below, the figures present the first and the latest data submissions. 

For the case of Cyprus the geographical comparability between regions does not apply.

Not applicable.

The data is considered to be comparable from 2011 onwards. The same methodology is applied for the implementation of the EU Regulation onwards.

The time series is comparable from 2011 onwards.

The death data provided to Eurostat according to Commission Regulation No. 328/2011 has several discrepancies compared to the data provided for the needs of Demographic Statistics. However, this is acceptable due to the fact that different data sources are used for each dataset and different reference population is applied for each data collection. Moreover, each dataset is submitted to Eurostat in different points in time; the CoD dataset is submitted at a later stage compared to the dataset submitted for demographic statistics, hence the information included are updated.

Not applicable, only annual data are available.

Not applicable.

No inconsistencies between the two datasets provided (General mortality dataset and stillbirths and neonates dataset).

HMU

Due to the lack of an electronic death certificate a lot of person-hours are spent in order to scan the paper based medical death certificates, transform then into an electronic form, data entry procedure to an access based database, coding procedure using IRIS software. Almost every year, HMU clercks attend IRIS tarining in order to be able to code causes of death with the latest version of IRIS software. 

We are in the process of reducing cost and burden of the data collection by developing the electronic death certificate.

Not applicable since no preliminary data are disseminated.

There is no systematic revision of previous years data. Data are occasionally revised in case that the Health Monitoring Unit receives additional infromation about a death.

Not applicable.

The main data source is the Medical Death Certificate completed by the physician who certifies the death, including information on the demographic characteristics of the deceased, as well as the cause of death. Secondary data sources are used in order to capture more detailed information if needed, i.e. autopsy repotrs, coroners reports, population register of the Ministry of Interior, EMCDDA of Cyprus, police records, accidents at work from the Ministry of labour, Monistry of Foreign Affairs as regards the deaths occuring abroad. Even press reports are used to cooroborate data.

The data collection is continuous throughout the year.

The data collection is continuous and ongoing throughout the year. It should be stated that according to the National Law there is a time period of 12 months from the time of the death, in order to register the event.

Table on certification (Percentage): Please see notes from the Health Monitoring Unit after the table.

HMU:

All doctors (certifiers) trained in the certification: Only during their graduate studies, no additional training provided from the Health Monitoring Unit.

All doctors (certifiers - pathologists or others doctors) trained in the post-mortem examination (autopsies): Only forensic are trained in the post-mortem examination, during thei medical studies. No additional training provided from the Health Monitoring Unit.

Certificates filled by persons who attended a course on certification or post-mortem examination: Provided that the persons filling the certificates are physicians who attended training on death certification during their studies, this percentage has been estimated to reach 100%.

Death certificates that are queried (only queries related to medical part of the death certificate should be included): Estimated percentage.

Deaths where the underlying cause is changed as a result of the query: Estimated percentage.

Death certificates with incorrect sequence: Estimated percentage.

The information on stillbirths is collected through the regular medical death certificate. However, additional information received through the Medical Birth Registry (regarding parity, birthweight, gestational age, age of mother, sex). 

As regards the neonatal deaths, the regular medical death certificate is used. Included in the certificate are specific parts addressed to perinatel deaths (both neonatal and stillbirths). Early neonatal deaths (0-6 days) are coded manually. Late (7-27 days) and post-neonatal (28-365 days) deaths are included in the national register and the coding is performed automatically by the IRIS software. Addiotional information is received from the Medical Birth Registry (regarding parity, birthweight, gestational age, age of mother, sex). 

See point below:

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

The main data source is the medical death certificate which is sent to the Health Monitoring Unit in paper form. The data entry and coding are done centrally from HMU's personnel.  Coding is done by using the IRIS software.

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):

Standard quality checks for causes of death data are performed on a continuous basis throughout the year. A number of quality checks are done automatically through the data entry procedure via the data entry tool, as well as during the coding procedure via the IRIS automated coding program. The validation checks include the undelying causes that are impossible or highly unlikely according to sex and age limits.

Moreover, the following consistency checks are applied to the data, in order to ensure the quality:

• Checks for duplicates (two death certificates for one person with two different identity card numbers
• Checks for the permanent residence of the deceased (for residents and non-residents)
• Matching of external causes of death with:
  • Police records (suicides, transport accidents, homicides, drowning)
  • Department of Labour Inspections records (deaths due to accidents at work)
  • Cyprus EMCDDA (drug related deaths)
  • Calls to certifiers for clarifications in case of an illegible or dubious certificate
  • Check time trend of the main causes of death to check for unlikely yearly variations 

Quality control checks are also perfomed before the dissemination phase via EDamis regarding both the structure and the content of the datafile to be submitted. 

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

Measures will be taken after the adobtion of the electronic death certificate. Duplicates will be detected directly, illegible or dubious certificates will be eliminate

Coding performed by a certifier:

Coding perform by a coder and not by the certifier

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

5.4%

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

Double coding is done only for cases that the underlying cause of death is "maybe" (after the automatic coding through IRIS). In that cases a manual coding should be done in order to retrieve the underlying cause of death. The rate of codification errors for underlying cause of death is extremely low, almost 0%.

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

The following figures refer to the General Mortality Datafile:

Note: since 2019 codes I46.0 and I46.9 are automatically converted into R99, thus the percentage had been increased rapidly from 2018 to 2019. However since 2019 all the certifiers have been informed that they should avoid reporting the cardiac arrest as a cause of death and use other causes instead.

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

For the case of Cyprus, NUTS2 is CY00.

 ^{* for the majority of non-residents the country of residence id known but the NUTS2 is unknown}

From 2011 onwards the coverage is considered to be complete.

Not applicable.

Not applicable.

Not applicable.

Not applicable.