international comparisons of proportion of unspecified external causes of death tsung-hsueh (robert)...
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International International Comparisons of Comparisons of Proportion of Proportion of Unspecified External Unspecified External Causes of Death Causes of Death Tsung-Hsueh (Robert) Lu, MD, MPH
Institute of Public Health, College of MedicineNational Cheng Kung University, Tainan, Taiwan
IntroductionIntroduction
IDEALLY, external causes of death (ECD) provide information of circumstances related to the occurrence of injury events, which provide important information for injury prevention. (Users)
REALISTICALLY, certifiers (medical examiners and coroners) did not provide sufficient information for ideal external causes coding. (Producers)
V243
Transport accidentsTransport accidents
Transport accidents
Mode of transport of the victim Mode of transport
of counterpart
Circumstances of the event and
the role of the victim
ECD: X59 exposure to ECD: X59 exposure to unspecified factorunspecified factor
Accidental head injury
Example OneExample One
ECD: V99 unspecified transport ECD: V99 unspecified transport accidentaccident
Head injury
Example TwoExample Two
Transport accident
ECD: V244 motorcycle rider ECD: V244 motorcycle rider injured in collision with heavy injured in collision with heavy transport vehicle or bustransport vehicle or bus
Head injury
Example ThreeExample Three
Motorcyclist in collision with bus
Research QuestionsResearch Questions
What’s the proportion of injury deaths of which the information reported could only be coded as “unspecified”? ---- an indicator of insufficiency of specific information the certifiers reported on the death certificates
Did this proportion differ by country? Did this proportion differ by ECD?
Materials & MethodsMaterials & Methods The number of deaths registered in
the year 2001 for each three-character code in Chapter XX (External causes of morbidity and mortality) of the ICD-10 were provided by four countries participating in the ICE (International Collaborate Efforts on Automating Mortality Statistics), i.e., Australia, Sweden, Taiwan and the United States.
Materials & Methods Materials & Methods (cont.)(cont.)External Causes of Injuries ICD-10 Code, U/B
All unintentional injuries X59/V01-X59
Transport accidents V89&V99/V01-V99
Falls W19/W00-W19
Accidental drowning and submersion W74/W65-W74
Other accidental threats to breathing W84/W75-W84
Exposure to smoke, fire and flames X09/X00-X09
Intentional self-harm X84/X60-X84
Assault Y09/X85-Y09
Event of undetermined intent Y34/Y10-Y34
ResultsResults Sweden (32.5%) had the highest
proportion of unspecified code (ICD-10 code X59), followed by Australia (16.6%), Taiwan (13.2%) and the USA (7.2%).
The percentage of unspecified code was relatively high in falls and unintentional drowning and was relatively low in accidental poisoning, intentional self-harm and event of undetermined intent.
Results (cont.)Results (cont.) Sweden had highest unspecified
percentage (63.7%) of deaths from falls, followed by Australia with 55.5%, the USA (50.9%) and Taiwan (49.1%) . The proportion increased with age in each country (Table 2).
Taiwan had an extremely high percentage of unspecified codes in transport accidents (86.5%), accidental drowning (98.7%) and fire and flame (98.7%).
Swe
USASwe
USA
Aus
Swe
USA
AusTwn
Aus
Twn
Twn
0
20
40
60
80
100
0All unintentional injuries Transport accidents Falls
Per
cent
age
of u
nspe
cifie
d co
ding
,%
Why the % in Aus & Swe are relatively high compared with US?
Why all countries had relatively high % in falls?
Why the % in Aus & Swe are relatively low compared with US?
Persons?
Explaining the variations
Differences in the system of medical examiners and coroners?
Differences in the training of medical examiners and coroners?
Differences in the format of death certificate?
Differences in the query system?
Taiwan’s attempts to improve Communicating with the medical
examiners, coroners, and prosecutors. Querying the certifiers for more specific
information for coding. Revising the format of death certificate. Interviewing the families of the deceased
to collect detail information. Building the National Coroners
Information System like those in Australia
ConclusionsConclusions
According to our findings, there were certain gaps between the ‘ideal’ and the ‘reality’ in classifying injury deaths among the four ICE participating countries.
Should the ‘users’ slow down the pace a little bit and spend more time with the ‘producers’ to improve the quality of data entry?
Swe
USASwe
USA
Aus
Swe
USA
AusTwn
Aus
Twn
Twn
0
20
40
60
80
100
0All unintentional injuries Transport accidents Falls
Per
cent
age
of u
nspe
cifie
d co
ding
,%
Why the % in Aus & Swe are relatively high compared with US?
Why all countries had relatively high % in falls?
Why the % in Aus & Swe are relatively low compared with US?
CommentComments are s are
needed!needed!
Persons?