Improvement of the quality and comparability of causes-of-death statisticsinside the European Community

Background: Cause-of-death statistics are widely used for comparing health characteristics of European Community (EC) countries. Before attempting to interpret between-country differences, it is essential to assess the biases affecting the comparability of the data. EUROSTAT decided to address globa lly this problem with the objective to improve the quality and comparabilit y of cause-of-death data within the EC. Methods: The material is based on a review of results of international comp arative cause-of-death studies and on specific inquiries among EC. Both cau se-of-death certification and codification practices are analysed. Certific ation is studied comparing the models of death certificates, the type of in formation captured, certifiers training and querying practices. The differe nt coding systems are analysed (International classification of diseases (I CD) in use, interpretation of the ICD rules, implementation of automated co ding systems). Results: International studies on comparability of certification and coding practices between countries are rare. These studies are based on certifica tion of cases histories and recoding of samples of death certificates. Rece nt studies on respiratory diseases, cancers and diabetes outline difference s that influenced on the reported level of mortality. The specific EUROSTAT investigation (1997) outline general discrepancies: models of death certif icates, nature and amount of information entered, way to establish the diag nosis, degree of consistency of the certification process, autopsy practice s, certifiers practices, implementation of ICD-10 and implementation of aut omated coding systems. Conclusion: EUROSTAT studies are now focused on causes of death requiring s pecial attention for comparability (e.g. suicide, accidental deaths, drug a nd alcohol related deaths, unknown and ill-defined causes), on procedures t o improve the homogeneity of certifiers training and querying practices, on the effect of the transition to ICD-10. The international model of death c ertificate recommended by the World Health Organization should be adopted a s widely as possible. Uniform complementary information (e.g. surgery, preg nancy, autopsy, place of occurrence of accidental deaths, work accident) sh ould also be adopted. The EUROSTAT investigations must result in definition s of common recommendations and guidelines to EC.