National Institute for Health Development (NIHD)

Estonian Causes of Death Registry

Hiiu 42
11619 Tallinn

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.

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

Reported by certifier with death certificate (de facto).

>500g.

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

The deceased.

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

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

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

Estonia, whole country.

Electronic database since 1989 data year.

Not applicable.

The unit is number.

2021 last provided to Eurostat.

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.

According to Estonian Data Protection Act.

GDPR, Estonia Data Protection Act.

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

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

https://statistika.tai.ee/pxweb/en/Andmebaas/Andmebaas__01Rahvastik__04Surmad/?tablelist=true

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

Annual, preliminary data monthly.

https://www.tai.ee/et/uudised/tai-statistika-alkoholist-ja-narkootikumide-uledoosist-pohjustatud-surmajuhtude-arv

https://statistika.tai.ee/pxweb/en/Andmebaas/Andmebaas__01Rahvastik__04Surmad/?tablelist=true

NIHD website:

https://statistika.tai.ee/pxweb/en/Andmebaas/Andmebaas__01Rahvastik__04Surmad/?tablelist=true

Statistics Estonia website

https://andmed.stat.ee/en/stat

NIHD website

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

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

Not available.

https://statistika.tai.ee/Resources/PX/Databases/Andmebaas/01Rahvastik/04Surmad/SDinfo_en.htm

All concepts provided.

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.

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 fr mortality coders. Logical checks on database are regularly applied.

Usabilty 91-95% according to " WHO methods and data sources for country‐level causes of death 2000‐2019" WHO, Geneva, 2020: pg 11.

https://platform.who.int/mortality/about/data-quality

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

Not available.

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

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

Accuracy is very high,

Not applicable. Data collection is from administrative sources.

Not applicable.

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

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

Not applicable

Not applicable. Data collection is from administrative sources.

Not applicable

Not applicable, death certification is strictly mandatory.

Not applicable.

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.

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

Not applicable.

Not applicable.

Not applicable.

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.

2020's data vere submitted in September 2022, +21 months.

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

Not applicable.

ICD-10 updates have impact on data comparabilty.

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

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

Not applicable, only annual data are available.

Not applicable.

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.

N/A

Not applicable.

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 deth 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.

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

Table on certification (Percentage)

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

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

Description of coding procedure (central level, distributed among other bodies, etc.): Central, two medical coders working part time

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. Since 1st July 2019 first processed by IRIS then reviewed by coders.

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

Coding performed by a certifier: Voluntary, revied 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.

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

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

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.

Not applicable.

Not applicable.

N/A

Not applicable.

Electronic death certification introduced on 1st July 2019