Territorial gaps on quality of causes of death statistics over the last forty years in Spain

Abstract

Background/Objectives: The quality of the statistics on causes of death (CoD) do not present consolidated indicators in the bibliography, nor in official health or statistical publications, no further than the major coding group of symptoms, signs, and ill-defined conditions of the International Classification of Diseases. Our objective was to assess the territorial quality of CoD by reliability in the official mortality statistics over 1980-2019 years across Spain. Methods: A descriptive epidemiological design of decade unit (1980-, 1990-, 2000-, and 2010-2019) by (18) territories and sex, was implemented with the CoD cases and adjusted rates and ratios (to allcauses) were expert-assigned by reliability into unspecific and illdefined groups of medical certification. Data was obtained from the National Institute of Statistics. Territorial mortality rate was contrasted to the Spanish median in each decade and sex by the Comparative Mortality Ratio (CMR) in a Bayesian perspective. Statistical significance was considered when CMR did not contain the value 1 in the 95% credible intervals. Results: Unspecific, ill-defined and all-causes of death age-adjusted rates by sex and territory have decreased along 1980-2019 decades. The proportion of ill-defined CoD has decreased over decades, but was still prominent in women in the four decades (13, 10, 9, and 7%), especially in Andalusia and Ceuta & Melilla. In the last decade (2010-2019), CMR of ill-defined CoD exceed in women in 5/18 territories (Andalusia, Ceuta & Melilla, Extremadura, Madrid, and Valencia) (range of 2.11, 95%CI, 1.95-2.28, to 1.05, 1.04-1-06); while CMR of unspecific CoD exceed in women in 5/18 territories (Andalusia, Canary Islands, Galicia, Murcia, and Valencia) (range of 1.28, 1.26-1.31 to 1.05, 1.02-1.08). Conclusions/Recommendations: The reliability of the CoD in Spain has been improving in the last 40 years; however, territorial and gender gaps persisted. surveillance of unspecific and ill-defined CoD should be considered by the institutions involved, as well as a systematic medical post-grade training on death certification should be developed.