Volume 45 - Article 11 | Pages 345–360

Using multiple cause of death information to eliminate garbage codes

By Agnieszka Fihel, Magdalena Muszyńska-Spielauer

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Date received:16 Nov 2020
Date published:28 Jul 2021
Word count:2493
Keywords:cardiovascular diseases, cause of death, garbage codes, International Statistical Classification of Diseases and Related Health Problems, mortality, multiple causes of death, Poland


Background: International comparisons of mortality largely depend on the quality of data. With more than 20% of deaths annually assigned to ill-defined cardiovascular conditions, the mortality level due to well-defined causes of death is under-registered in Poland.

Objective: We aim to reclassify cardiovascular garbage codes (GCs) into well-defined causes based on multiple causes of death (MCoD) data and to approximate mortality levels due to well-defined causes of death in Poland. We examine the usefulness of the MCoD approach for correcting low-quality data on causes of death.

Methods: Based on the unique MCoD dataset for Poland, death counts due to cardiovascular GCs were reassigned to well-defined underlying causes in two steps: (1) manually for death records that included MCoD information constituting a logical chain of conditions leading to death and (2) with coarsened exact matching for the remaining death records. Age-specific and age-standardised death rates for large groups of causes were calculated before and after redistribution and compared to those of other Eastern European countries with relatively good data quality.

Results: Of deaths originally assigned to cardiovascular GCs, 86,856 were reclassified, mostly to well-defined cardiovascular diseases, cancers, endocrine, nutritional and metabolic diseases, and respiratory diseases. The age-standardised death rate due to well-defined ischaemic heart diseases increased by 43%, and the rate due to cerebrovascular diseases by 22%. Cardiovascular mortality structure by large groups of causes became similar to the structure registered in other Eastern European countries characterised by a low prevalence of GCs.

Conclusions: Coarsened exact matching performs relatively well when abundant MCoD information is available and enhances the comparability of cause-of-death data between countries.

Contribution: Redistribution of GCs improves the quality of cause-of-death data and enhances their comparability between countries.

Author's Affiliation

Agnieszka Fihel - Uniwersytet Warszawski, Poland [Email]
Magdalena Muszyńska-Spielauer - Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Austria [Email]

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