Mortality Statistics SEPHIG – 16/09/2015 Claudia Wells Head of Mortality Analysis Office for...
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Transcript of Mortality Statistics SEPHIG – 16/09/2015 Claudia Wells Head of Mortality Analysis Office for...
Mortality Statistics SEPHIG – 16/09/2015
Claudia Wells
Head of Mortality Analysis
Office for National Statistics
Impact on Mortality Statistics
• IRIS for cause of death coding
• Death certification reform
What is IRIS?
What is IRIS?• Software used to code cause of death to a package called IRIS (version
2013).
• The development of IRIS was supported by Eurostat (the statistical office of the European Union) and managed by the IRIS Institute hosted by the German Institute of Medical Documentation and Information in Cologne.
• Provide a common mortality coding system that can be used for coding death certificates, written in any language, according to ICD mortality coding rules and instructions.
• The use of the IRIS software will help to improve the international comparability of mortality statistics.
• Currently IRIS uses components of the NCHS Mortality Medical Data System (MMDS) to code the causes of death
Main changes introduced with IRIS
• IRIS includes major updates to the ICD-10 approved by WHO - including significant changes to the use of codes within the neoplasms chapter.
• Control of the English IRIS data dictionary
• Changes to the way drug mentions are coded
• For stillbirths and neonatal deaths, any maternal condition mentioned on the death certificate will be coded to chapter XVI (certain conditions originating in the perinatal period).
Dual coding
• 2012 registrations, (excluding neonates)
• Records were selected from each quarter to avoid seasonal influences
• Weeks around public holidays were excluded
• 38,718 records (7.8 per cent) selected for dual coding
Percentage changes by ICD Chapter
Chest Infections
v2010: J98Other respiratory disorders
IRIS: J22Unspecified lower respiratory infection
Respiratory disease
Mental and behaviour disorders
2.5% 7.0%
Dementia
Chest Infections
Aspiration pneumonia
7.1% increase in allocation to underlying cause of
death
Other significant changes
• Certain infectious and parasitic diseases
• Up 4.9 %• Movement of deaths involving sepsis/septicaemia
Other significant changes
• Endocrine, nutritional and metabolic diseases
increased by 5.7%
• Diabetes
increased by 6.8%
Where to get more information
• Statistical Bulletin and underlying data:www.ons.gov.uk/ons/rel/subnational-health3/impact-of-the-implementation-of-iris-software-for-icd-10-cause-of-death-coding-on-mortality-statistics/england-and-wales/index.html
• Information Note:www.ons.gov.uk/ons/guide-method/user-guidance/health-and-life-events/Changes-to-cause-of-death-coding-in-England-and-Wales/index.html
What about stillbirths and neonatal deaths
• An English dictionary of terms specifically for stillbirths and neonatal deaths
• Automatic coding using the same system as deaths >28days
• Requires a change in coding for stillbirths and neonatal deaths
• Assigns an underlying cause of death
Neonatal and stillbirth death certificate Duration
a. Main diseases or conditions in infant/fetus ...................................................................
b. Other diseases or conditions in infant/fetus .........................................................................
c. Main maternal diseases or conditions affecting infant/ fetus ..........................................................................
d. Other maternal diseases or conditions affecting infant/ fetus..........................................................................
e. Other relevant causes ................................................................................
Example of current coding Duration
a. Main diseases or conditions in infant/fetus Necrotising Enterocolitis – P77
b. Other diseases or conditions in infant/fetusPreterm 28 weeks gestation– P073
c. Main maternal diseases or conditions affecting infant/ fetus Maternal HIV infection – B24
d. Other maternal diseases or conditions affecting infant/ fetusMaternal Hepatitis B Infection – O984
e. Other relevant causes ................................................................................
ONS hierarchical cause groups
Neonatal Classification
Before the onset of labour
• 1 Congenital anomalies
• 2 Antepartum infections
• 3 Immaturity related conditions
In or shortly after labour
• 4 Asphyxia, anoxia, or trauma
Postnatal
• 5 External conditions
• 6 Infections
• 7 Other specific conditions
• 9 Sudden infant deaths
Unclassified
• 0 Other conditions
Stillbirth Classification
Before the onset of labour
• 1 Congenital anomalies
• 2 Antepartum infections
• 3 Immaturity related conditions
In or shortly after labour
• 4 Asphyxia, anoxia, or trauma
• 5 External conditions
• 6 Infections
• 7 Other specific conditions
Unclassified
• 8a Asphyxia, anoxia, or trauma (antepartum)
• 8b Remaining antepartum
• 0 Other Conditions
Example of current coding
a. Necrotising Enterocolitis – P77b. Preterm 28 weeks gestation– P073
c. Maternal HIV infection – B24
d. Maternal Hepatitis B Infection – O984
ONS cause groups• 1 Congenital anomalies - No mention• 2 Antepartum infections - No mention (as the infections are maternal)• 3 Immaturity related conditions - P77 and P073
Analysis of IRIS coded data
• Developing English language dictionary
• Events that occurred in 2010
• 2014 Neonatal deaths, 3712 Stillbirths
1.ONS cause group based on IRIS coded mentions
2.ONS cause group based on IRIS coded underlying cause of death
ONS cause group based on IRIS coded mentions – Neonatal Deaths
ONS IRIS Difference % Difference
1. Congenital anomalies 584 569 -15 -3
2. Antepartum infections 39 159 120 308
3. Immaturity related conditions 1132 1024 -108 -10
4. Asphyxia, anoxia or trauma 175 170 -5 -3
5. External Conditions 3 2 -1 -33
6. Infections 27 21 -6 -22
7. Other specific 14 12 -2 -14
9. Sudden Infant Death 14 12 -2 -14
0. Other 26 45 19 73
IRIS mentions Vs. ONS mentions – Neonatal Deaths
ONS codes1. Congenital anomalies
2. Antepartum infections
3. Immaturity related conditions
4. Asphyxia, anoxia or trauma
5. External Conditions
6. Infections 7. Other specific
9. Sudden Infant Death
0. Other Total
IRIS 1. Congenital anomalies 559 1 7 1 1 5692. Antepartum infections 2 34 121 2 1593. Immaturity related conditions 12 1 990 8 1 3 9 10244. Asphyxia, anoxia or trauma 1 2 164 3 1705. External Conditions 2 26. Infections 1 1 19 217. Other specific 1 1 1 9 129. Sudden Infant Death 12 120. Other 10 1 11 2 2 1 2 16 45Total 584 39 1132 175 3 27 14 14 26 2014
Example 1 - Neonatal ONS codes Duration
a. Main diseases or conditions in infant/fetus Neonatal Sepsis – P369
b. Other diseases or conditions in infant/fetus Extreme Prematurity – P072
c. Main maternal diseases or conditions affecting infant/ fetus Chorioamnionitis – O411
ONS cause groups• 1 Congenital anomalies - No mention• 2 Antepartum infections - No mention (as infections maternal and neonatal)• 3 Immaturity related conditions - P072
Example 1 - Neonatal IRIS codes Duration
a. Main diseases or conditions in infant/fetus Neonatal Sepsis – P369
b. Other diseases or conditions in infant/fetus Extreme Prematurity – P072
c. Main maternal diseases or conditions affecting infant/ fetus Chorioamnionitis – P027
ONS cause groups• 1 Congenital anomalies - No mention• 2 Antepartum infections - P027
Example 2 - Neonatal ONS codes
a. Necrotising Enterocolitis – P77
b. Preterm 28 weeks gestation– P073
c. Maternal HIV infection – B24
d. Maternal Hepatitis B Infection – O984
ONS cause groups• 1 Congenital anomalies - No mention• 2 Antepartum infections - No mention (as infections is maternal)• 3 Immaturity related conditions - P77 and P073
Example 2 - Neonatal IRIS codes
a. Necrotising Enterocolitis – P77
b. Preterm 28 weeks gestation– P073
c. Maternal HIV infection – P002
d. Maternal Hepatitis B Infection – P002
ONS cause groups• 1 Congenital anomalies - No mention• 2 Antepartum infections - ONS cause groups include maternal condition
O353 (Maternal care for (suspected) damage to fetus from viral disease in mother , now code to P002 (Fetus/newborn affected by maternal infectious and parasitic diseases) – is it correct to assume antepartum?
IRIS mentions Vs. ONS mentions – Neonatal Deaths
ONS codes1. Congenital anomalies
2. Antepartum infections
3. Immaturity related conditions
4. Asphyxia, anoxia or trauma
5. External Conditions
6. Infections 7. Other specific
9. Sudden Infant Death
0. Other Total
IRIS 1. Congenital anomalies 559 1 7 1 1 5692. Antepartum infections 2 34 121 2 1593. Immaturity related conditions 12 1 990 8 1 3 9 10244. Asphyxia, anoxia or trauma 1 2 164 3 1705. External Conditions 2 26. Infections 1 1 19 217. Other specific 1 1 1 9 129. Sudden Infant Death 12 120. Other 10 1 11 2 2 1 2 16 45Total 584 39 1132 175 3 27 14 14 26 2014
Congenital Anomalies to Immaturity
• Majority mentioned Q33.6 Hypoplasia and dysplasia of lung
• Converted to P28.0 in IRIS Hypoplasia associated with short gestation
• Majority but not all recorded mentioned prematurity of some degree
Antepartum Infections - Stillbirths
• Other Specific Conditions:
Coding of AnhydramniosIRIS codes to P02.7
ONS currently codes to P02.8
• Remaining antepartum:
Coding of maternal infectionsIRIS codes to P00.2
Assumed antepartum?
Further work
• Implications for UK data
• Publication of dual coded data
• Publication of mapping document
• Publication of the stillbirth and neonatal cause of death dictionaries
Talking/Discussion points
• How to we balance maintaining an accurate internationally comparable classification with monitoring trends over time?
• What do you need in terms of impact analysis?
• Do you use the ONS hierarchical cause groups (Wigglesworth codes)?
Death Certification Reform
• Harold Shipman (GP) certified the deaths of 250 victims without challenge
• Inquiry into Shipman's crimes in 2004 recommend:• All deaths that do not require investigation by a
coroner will undergo the independent scrutiny of a locally appointed Medical Examiner
• Independent and proportionate scrutiny of relevant health records, examining the deceased person’s body (in most cases) and in all cases discussing the death with a relative or other appropriate person.
31
Decision: is death reportable?
Prepare MCCD
Coroner’s Post Mortem
Inquest
Issue MCCD
Form 99 or 120 & 121
Form
100B
Registration of death
Burial or Cremation
ReportableDeaths & Enquires
Current Process
Talk with Relatives?
Form100A
Activities carried out by the Coronial Service
Activities carried out by the Medical Examiners Service
Activities carried out by Attending Doctor certifying death
Key:
Abbreviations: MEO = Medical Examiner’s Officer. Note: ME-1 is the proposed name of the form used to document information required for scrutiny.
Advise NFA or 100A
Form 6 or Burial
Order
Discussion with doctor
Decision to carry out a PM
or open Inquest
Cremation Form 4
Cremation Form 5
Cremation Form 10
Verification of Fact of Death
Activities carried out by other people / services
Form 100A / “Part A”
Informant
delivers MCCD
32
Advise NFA or 100A
Decision to carry out a PM
or open Inquest
Decision: is death reportable?
Prepare MCCD
Coroner’s Post Mortem
Inquest
Issue MCCD
Form 99 or 120 & 121
Form
100B
Burial or Cremation
ReportableDeaths & Enquires
Death certification Reform - New Process
Talk with Relatives?
Discussion with doctor
Verification of Fact of Death
Advice to Doctors & Coroner
Referral
Copy of MCCD,records &
required info.
Scrutiny by Medical Examiner
ME-2
Decision toinvestigate death
Initial Assessment Investigation
Informant
delivers MCCD
Activities carried out by the Coronial Service
Activities carried out by the Medical Examiners Service
Activities carried out by Attending Doctor certifying death
Key:
Abbreviations: MEO = Medical Examiner’s Officer. Note: ME-1 is the proposed name of the form used to document information required for scrutiny.
Activities carried out by other people / services
Registration of death
RME & NFA
HMC-1
ME-2
Coroner’s Disposal
Order
Green Form
MEO: Prep.for Scrutiny
Information from public health surveillance and local clinical governance
Death Certification reform pilots
• The new process was piloted by the in six areas across England and Wales, commencing in 2008.
• Office for National Statistics (ONS) carried out a case study investigating records from five of the six pilot areas.
• The cause(s) of death proposed initially by the certifying medical practitioner and also the confirmed cause(s) of death following medical examiner scrutiny of the deceased’s medical history and hospital notes.
Impact
• More likely to add supplementary information to the death certificate.
• This often led to more conditions being mentioned and to the order in which they were presented on the cause of death certificate being altered.
• As a result there was a change to the underlying cause of death in 22 per cent of cases.
Impact by cause
• 1 % more death certificates with an underlying cause of cancer
• 6 % increase the proportion of deaths that were attributed to diseases of the circulatory system
• 7% decrease in deaths attributed to a respiratory disease
• In general, more conditions were mentioned on the death certificate as a result of scrutiny by medical examiners
Number of conditions mentioned
Implementation timetable - UK
• Scotland implemented in April 2015
• England, Wales and Northern Ireland – implementation has be delayed until further consultation can be carried out. Will not be until after SR15
Where to get more information
• Statistical Bulletin and underlying data:
http://www.ons.gov.uk/ons/rel/subnational-health2/death-certification-reform---a-case-study-on-the-potential-impact-on-mortality-statistics/england-and-wales/index.html