Causes of death (hlth_cdeath)

1.1. Contact organisation

[EE1] Statistics Estonia, National Institute for Health Development

1.2. Contact organisation unit

Estonian Causes of Death Registry

1.3. Contact name

Confidential because of GDPR

1.4. Contact person function

Confidential because of GDPR

1.5. Contact mail address

Paldiski road 80, 10617, Tallinn

1.6. Contact email address

Confidential because of GDPR

1.7. Contact phone number

Confidential because of GDPR

1.8. Contact fax number

Confidential because of GDPR

2.1. Metadata last certified

8 October 2025

2.2. Metadata last posted

8 October 2025

2.3. Metadata last update

8 October 2025

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).

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 revision used (ICD-8, ICD-9, ICD-10)	For ICD-10: updates used
1990	ICD-9 (Soviet)
1991	ICD-9 (Soviet)
1992	ICD-9 (Soviet)
1993	ICD-9 (Soviet)
1994	ICD-9 (Full)
1995	ICD-9 (Full)
1996	ICD-9 (Full)
1997	ICD-10	1996
1998	ICD-10	1996
1999	ICD-10	1996
2000	ICD-10	1996
2001	ICD-10	1996
2002	ICD-10	2002
2003	ICD-10	2002
2004	ICD-10	2002
2005	ICD-10	2002
2006	ICD-10	2002
2007	ICD-10	2004
2008	ICD-10	2004
2009	ICD-10	2004
2010	ICD-10	2010
2011	ICD-10	2010
2012	ICD-10	2010
2013	ICD-10	2010
2014	ICD-10	2010
2015	ICD-10	2010
2016	ICD-10	2010
2017	ICD-10	2016
2018	ICD-10	2016
2019	ICD-10	2019
2020	ICD-10	2019
2021	ICD-10	2019
2022	ICD-10	2019
2023	ICD-10	2019

3.3. Coverage - sector

Public Health.

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

Reported by certifier with death certificate (de facto).

3.4.2. Stillbirth definition and characteristics collected

>500g.

3.5. Statistical unit

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

3.6. Statistical population

The deceased.

3.6.1. Neonates of non-resident mothers

No, place of residence of neonates = place of residents of their mothers.

3.6.2. Non-residents

Data on non-residents are collected, but not published in national statistics.

3.6.3. Residents dying abroad

Partly available, as they are registered at Estonian foreign missions. Date of death may be available through Estonian Population Registry.

3.7. Reference area

Estonia, whole country.

3.8. Coverage - Time

Electronic database since 1989 data year.

3.9. Base period

Not applicable.

The unit is number.

2023 last provided to Eurostat.

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.

6.2. Institutional Mandate - data sharing

According to Estonian Data Protection Act.

7.1. Confidentiality - policy

GDPR, Estonia Data Protection Act.

7.2. Confidentiality - data treatment

Authorization by data protection officer and hierarhy including Director required to every dislosure of personal data.

8.1. Release calendar

End of May next year, preliminary data montly, +1 month and a few days.

8.2. Release calendar access

Please find information at this website Statistika Andmebaas.

8.3. Release policy - user access

Publication of annual data are accompanied with press relaese containing short analysis sent to the media, preliminary data monthly.

Annual, preliminary data monthly.

10.1. Dissemination format - News release

Please find information at this website (tai-statistika-alkoholist-ja-narkootikumide-uledoosist-pohjustatud-surmajuhtude-arv).

10.2. Dissemination format - Publications

Please find information at this website (Andmebaas).

10.3. Dissemination format - online database

• NIHD website.
• Statistics Estonia website.

10.3.1. Data tables - consultations

NIHD website

Year	Pageviews
2017	17 842
2018	23 854
2019	19 442
2020	34 160
2021	38 677

Not available later.

10.4. Dissemination format - microdata access

Data may be disclosed on signed data request according to data protection legislation.

10.5. Dissemination format - other

Data are transferred annually to Statistics Estonia, Eurostat and World Health Organization.

10.5.1. Metadata - consultations

Not available.

10.6. Documentation on methodology

Please find information at this website (Statistika Databases Andmebaas).

10.6.1. Metadata completeness - rate

All concepts provided.

10.7. Quality management - documentation

1. Denissov, Gleb (2016). Sharp decrease in observed cerebrovascular mortality may be due to certification and coding. Scandinavian Journal of Public Health, 44, 335−337.
2. Innos, Kaire; Paapsi, Keiu; Alas, Indrek; Baum, Peep; Kivi, Martin; Kovtun, Mihhail; Okas, Rauno; Pokker, Helis; Rajevskaja, Olga; Rautio, Aleksandra; Saretok, Mikk; Valk, Elari; Žarkovski, Mihhail; Denissov, Gleb; Lang, Katrin (2022). Evidence of overestimating prostate cancer mortality in Estonia: a population-based study. Scandinavian Journal of Urology, 56 (5-6), 359−364. DOI: 10.1080/21681805.2022.2119274.

11.1. Quality assurance

Regular training courses to certifiers are provided in the premises of Institute for Heatlh Development, some hospitals and elsewhere as a part of training for data providers. All death certificates are reviewed by coders, who use IRIS software as data control tool. Coders partisipate to international activities for mortality coders. Logical checks on database are regularly applied.

11.2. Quality management - assessment

Usabilty 91-95% according to " WHO methods and data sources for country‐level causes of death 2000‐2019" WHO, Geneva, 2020: pg 11. Please find information at this website (Data-quality).

12.1. Relevance - User Needs

Policy makers, academic science, practicing doctors, relatives of the deceased, media and general public.

12.2. Relevance - User Satisfaction

Not available.

12.3. Completeness

Cause of death is provided in all cases, however there are unknown and ill-defined causes of death provided in ICD-10 classification.

12.3.1. Data completeness - rate

1. For mandatory variables:

100% 

2. For voluntary variables:

 100%

3. For additional variables:

• External CoD

 Yes

• Place of occurrence for external CoD

 Yes

• Activity for external CoD

 Yes

13.1. Accuracy - overall

Accuracy is very high.

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

Possible delays in certification, especially fornsic cases, delivery of medical death certificate to the causes of death registry, coding rules are not always clear.

13.3.1. Coverage error

Definition of usual place of residents may differ from definitions used elsewhere, dterefore published data may differ because of coverage.

13.3.1.1. Over-coverage - rate

Not applicable.

13.3.1.2. Common units - proportion

Not applicable. Data are collected from administrative sources.

13.3.2. Measurement error

Not applicable.

13.3.3. Non response error

Not applicable, death certification is strictly mandatory.

13.3.3.1. Unit non-response - rate

Not applicable.

13.3.3.2. Item non-response - rate

If death is regirested abroad, medical death certificate may be missing. Large number of Finnish death certificate are delivered through Estonian embassy in Helsinki, which may be a substantial part of Estonian residents dying abroad.

13.3.4. Processing error

Rules for selection of underlying cause of death are not always clear. Nordic-Baltic international seminar on this issue is held annually.

13.3.5. Model assumption error

Not applicable.

14.1. Timeliness

Year	Number of months between the end of the reference year and the publication at national level
2011	5
2012	5
2013	5
2014	5
2015	5
2016	5
2017	5
2018	5
2019	5
2020	5
2021	5
2022	5

14.1.1. Time lag - first result

Not applicable.

14.1.2. Time lag - final result

Not applicable.

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.

2022's data vere submitted in June 2024, +18months.

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	19 months
2019	17 months
2020	21 months
2021	21 month
2022	18 month
2023	19 month

15.1. Comparability - geographical

Estonia doesn’t have regions at NUTS level 2 and the geographical comparability is ensured.

15.1.1. Asymmetry for mirror flow statistics - coefficient

Not applicable.

15.2. Comparability - over time

ICD-10 updates have impact on data comparabilty.

15.2.1. Length of comparable time series

Data series are comparable since introduction of ICD-10 with 1997 data year.

15.3. Coherence - cross domain

Data are validated with population register. Death counts are sligtly differnt form demographic statistics because of different definitions of place of usual residence.

15.3.1. Coherence - sub annual and annual statistics

Not applicable, only annual data are available.

15.3.2. Coherence - National Accounts

Not applicable.

15.4. Coherence - internal

There are no inconsistencies between the neonates information provided in the General mortality dataset and in the Stillbirths and neonates dataset as both datasets are extracted from the same database.

Since 1st July 2019 data are collected electronically, more cost effective.

17.1. Data revision - policy

There is no data revision policy.

17.2. Data revision - practice

Not applicable.

17.2.1. Data revision - average size

Not applicable.

18.1. Source data

Medical death certificate is issued by physicians and forensic examiners (only MD-s). Since July 2019. it is an electronic document uploaded to E-Healt. Causes of Death Registry downloads data from E-Health every working day. Causes of death data are processed according to the WHO methodology. Additional information may be sought from certifier, usually by phone or e-mail.

All the future MD-s in Estonia are instructed to fill out medical death certificate in a mandatory course of pathological anatomy and legal medicine.

18.2. Frequency of data collection

Annual.

18.3. Data collection

All the death certificated are reviewed centrally by mortality coders, underlying cause of death selected.

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	100%	100%		1%	100%	1%
2019	100%	100%		1%	100%	1%
2020	100%	100%		1%	100%	1%
2021	100%	100%		1%	100%	1%
2022	100%	100%		1%	100%	1%
2023	100%	100%		1%	100%	1%

18.3.2. Automated Coding

Data year	Use of any form of automated coding	System used (IRIS, MICAR, ACME, STYX, MIKADO, others)
2011		IRIS
2012		IRIS
2013		IRIS
2014		IRIS
2015		IRIS
2016		IRIS
2017		IRIS
2018		IRIS
2019		IRIS
2020		IRIS
2021		IRIS
2022		IRIS
2023		IRIS

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					Manual, IRIS used as a quality control tool
2012					Manual, IRIS used as a quality control tool
2013					Manual, IRIS used as a quality control tool
2014					Manual, IRIS used as a quality control tool
2015					Manual, IRIS used as a quality control tool
2016					Manual, IRIS used as a quality control tool
2017					Manual, IRIS used as a quality control tool
2018					Manual, IRIS used as a quality control tool
2019					Automatic, reviewed by coder
2020					Automatic, reviewed by coder
2021					Automatic, reviewed by coder
2022					Automatic, reviewed by coder
2023					Automatic, reviewed by coder

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
2022	MC
2023	MC

18.3.5. Stillbirths and Neonatal certificates

Perinatal death certificate with conditions of mother and child for perinatal period (stillbirths+deaths on the 1-st week of life).

18.4. Data validation

Data on date of death are transferred electronically from Estonian Population Registry. Logical checks applied on database to identify missing and impossible values.

18.4.1. Coding

• Description of coding procedure (central level, distributed among other bodies, etc.): Central, one medical coders.

• 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): Extraction from databased processed by IRIS, disagreements with manualluy selected UC reviewed by coders.

• Description of the measures taken in order to solve detected errors: Changes to database.

• Coding performed by a certifier: Voluntary, reviwed by coders.

• Estimation of the percentage of autopsy from which information is available for coding: 100% In case of autopsy death certificates are filled by pathologist.
• Description of double coding exercises and rate of codification errors for underlying cause of death: A random sample of death certificate is annualy coded by particpants of Nordic-Baltic mortality group and results discussed on face-to-face meeting.

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	2%	1%	1%	0%
2012	2%	1%	1%	0%
2013	2%	1%	1%	0%
2014	2%	1%	1%	0%
2015	2%	1%	1%	0%
2016	2%	1%	1%	0%
2017	2%	1%	1%	0%
2018	2%	1%	1%	0%
2019	2%	1%	1%	0%
2020	1.5%	1,15%	0.35%	0%
2021	1.39%	1.09%	0.27%	0%
2022	1.41%	1.14%	0.22%	0%
2023	1.34%	1.10%	0.18%	0%

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%	0%	0%	100%	0%
2012	0%	0%	0%	100%	0%
2013	0%	0%	0%	100%	0%
2014	0%	0%	0%	100%	0%
2015	0%	0%	0%	100%	0%
2016	0%	0%	0%	100%	0%
2017	0%	0%	0%	100%	0%
2018	0%	0%	0%	100%	0%
2019	0%	0%	0%	100%	0%
2020	0%	0%	0%	100%	0%
2021	0%	0%	0%	100%	0%
2022	0%	0%	0%	100%	0%
2023	0%	0%	0%	100%	0%

18.4.4. Validation of the coverage

Data on date of death and place of registration (Civil Registration Office or embassy) transferred electroniacally from Estonian Population Registry as well as names and personal ID of the deceased.

18.5. Data compilation

Not applicable.

18.5.1. Imputation - rate

Not applicable.

18.6. Adjustment

There is no adjustment.

18.6.1. Seasonal adjustment

Not applicable.

Electronic death certification introduced on 1st July 2019.

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).

8 October 2025

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

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

The deceased.

Estonia, whole country.

2023 last provided to Eurostat.

Accuracy is very high.

The unit is number.

Not applicable.

Medical death certificate is issued by physicians and forensic examiners (only MD-s). Since July 2019. it is an electronic document uploaded to E-Healt. Causes of Death Registry downloads data from E-Health every working day. Causes of death data are processed according to the WHO methodology. Additional information may be sought from certifier, usually by phone or e-mail.

All the future MD-s in Estonia are instructed to fill out medical death certificate in a mandatory course of pathological anatomy and legal medicine.

Annual, preliminary data monthly.

Year	Number of months between the end of the reference year and the publication at national level
2011	5
2012	5
2013	5
2014	5
2015	5
2016	5
2017	5
2018	5
2019	5
2020	5
2021	5
2022	5

Estonia doesn’t have regions at NUTS level 2 and the geographical comparability is ensured.

ICD-10 updates have impact on data comparabilty.