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As the diagnosis of cancer relies on the WHO classifications of diseases ICD , which are regularly updated, it is difficult to examine time trends in cancer incidence by site covering different revisions of the ICD. They can also show the costs of care including informal care and the type of services dispensed. In addition to the notifiable diseases, these call for any event of potential international public health concern to be declared, including those of unknown causes or sources and those involving events or diseases other than those listed, if the public health impact is serious. Comparing survey and clinical information in Québec, these authors conclude that a survey questionnaire is not a valid method for accurately estimating disability in an older population. A register can also eventually give information on the prevalence of cancer and on the survival of cancer patients if deaths from cancer and the possible emigration of cancer patients are known. Does low response bias the results of a survey?

Data sources for evaluating healthcare performance and costs—such as in the EuroHOPE project—lie outside the scope of this paper, though these are of course crucial issues. A variety of sources of data on morbidity, health and mortality are available in developed societies. While each source has its own advantages and problems, some problems are common to a large majority of sources, such as population selection and representativeness, non-response and inadequate reporting, privacy rights and related ethical issues, cost of large operations and cross-country comparability.

Specific issues will be pointed out for each source. As stated in the conclusion, each source considered separately can already yield useful, though partial, results that can be used for research purposes and for informing health policies.

Record linkage among data sources can significantly improve the analysis even further. Data Kaubandusstrateegiad Magazine mortality This section deals with the vital registration of death and causes of death, including external causes of death.

It also refers to postmortem examinations that can improve cause-of-death reporting. Vital registration: the death certificate and registration of causes of death As Brolan et al.

Statistics on causes of death, used to measure the relative contributions of various diseases on mortality, are based on the death certificate delivered by a medical doctor. For an overview of the data production process and the main types of possible analyses Auto Trading System Anonymous, e.

Rey However, and especially for the GPs, the question is raised about their training in terms of knowing how to fill in the medical certificate and their interest in doing so McAllum et al. As an example of a special training programme addressed to students of medicine in their last year, family doctors and interns, with the objective of improving professional competence regarding the certification of causes of death according to the international regulations of the World Health Organisation WHOsee Alonso-Sardón et al.

Mortality, morbidity and health in developed societies: a review of data sources

Most European countries have adopted the use of the medical certificate of causes of death proposed by the WHO. This certificate was proposed in at the time of the International Classification of Diseases ICD-9 in order to ensure a better comparability of the statistics on this subject between countries. The certificate is set out in two parts. The first part is designed Auto Trading System Anonymous retrace the process which has led to death.

The starting point is the immediate, or direct, cause of death line 1. Then successive lines invite going back through the sequences that led to death, the last line of part 1 providing the underlying cause of death, and the lines between the first and the last delivering the intermediate cause s.

Part 2 of the death certificate is devoted to condition s which could have contributed to death but are not part of the main causal sequence leading to death. Finally, on the right-hand side of the certificate, a column allows stating the approximate time interval between the onset of each condition and death, in order to verify the coherence of the description of the process.

Statistics of causes of death are based on the underlying cause of death. WHO has also proposed Injury Surveillance Guidelines for recording non-fatal events by injury surveillance systems; the latter will not be considered in this review. Using the WHO classification in force currently, ICD—an ICD is in its final phase and is planned for implementation inthe reported conditions are translated into medical codes.

WHO b has formulated selection and modification rules in order to improve the reliability of mortality statistics and to allow selecting a single cause of death, the underlying cause, from a reported sequence of conditions.

An increasing number of countries are adopting the coding software Iris; this software ensures a high international comparability of cause-specific mortality data. Iris is a result of the international collaboration of several national statistical institutes for the selection of the underlying cause of death on the basis of ICD The user enters ICD codes corresponding to the conditions reported on the death certificates.

These are relevant for identifying vulnerable populations and factors associated with important risks against survival, possibly leading to the design of public health policies. As already stated, information published by statistical offices on causes of death usually relates to the underlying or initial cause of death. There are presently 20 chapters of causes in ICD The underlying cause of death can be used to analyse mortality differences between populations or over time.

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Policies can then be set up to close the gap by addressing specific causes of death. Several attempts have been made to bridge different ICDs by the reclassification of causes according to one of the ICD revisions. Meslé and Vallin The registration of causes of death is not without problems, however, and these can hamper comparisons over time and across countries, as when using the WHO Mortality Database on mortality by age, sex and cause of death.

Secondly, changes in the reports of causes of death may also be due to the use of new diagnostic techniques allowing a more efficient detection of diseases, to changes in the concept of diseases, and the appearance of new diseases such as HIV. Thirdly, training of MDs for the certification Auto Trading System Anonymous causes of death can vary greatly among countries.

In addition to the diagnostic accuracy issue, MDs only report diseases or conditions that they judge relevant for causing the death. According to WHO, the rate of ill-defined causes perpeople, at ages 0 to 64, varied from 0.

In addition, age misreporting can sometimes be a problem for some population groups, such as immigrants. Finally, even among developed countries, the coverage of the cause-of-death statistics can vary across countries Auto Trading System Anonymous over time. And one should also point out the difficulty, as with all classifications, in reaching univocal solutions in the ICD. Using data on multiple causes of death As seen in the previous section, contributory causes of death are also recorded on the death certificate, in addition to the underlying cause.

One can, for example, study hypertension-related deaths by taking into account any mention of hypertension on the death certificate, using multiple cause-of-death data.

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Though useful for determining associations among causes of death, causal sequences and patterns of diseases see for instance Redelings et al. In their book Recent Trends in Mortality Analysis, Manton and Stallard were among the first to thoroughly examine the use of Auto Trading System Anonymous mortality data in the context of medical demography.

In particular, they examined pattern-of-failure representations of mortality, i. A review of studies on the use of multiple causes of death is presented in Désesquelles et al. The authors also took up, to give an example among others, the issue of analysing multiple causes of death MCODwith an application to cancer-related mortality in France and Italy.

After studying the quality of the data on multiple causes of death, the authors present various indicators for analysing MCOD data. Using French and Italian data, they examine the most frequent associations of causes of death with cancer, the latter being reported either as the underlying cause of death or as a contributing cause. Five patterns of associations are distinguished in the present case.

Désesquelles et al. Though the multiple-cause-of-death approach can be recommended, the number of contributory causes reported on the death certificate varies from country to country, hampering to some extent international comparisons. Differences among countries with respect to certification and coding systems can be a problem.

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External causes of death While in the previous section the focus was on the disease as a cause of death, the monitoring of external causes of death is also an essential requirement for public health and policy purposes aimed at injury prevention. For example, falls and suicides are an important cause of death in the elderly; the death toll from traffic accidents is high among the Auto Trading System Anonymous. The main external causes dealt with in ICD chapter XX are accidents transport accidents and other external causes of accidental injury such as fallsintentional self-harm, Riskivaba valiku strateegia, operations of war and complications stemming from medical and surgical care.

In addition, one should state the place of occurrence of the external cause where relevant and the activity of the person at the time the event occurred. External cause-of-death registration is not without its problems, however.

For example, an international study from onwards has shown that out of 83 countries having cause-of-death registration, only 20 countries had high-quality death registration data that could Auto Trading System Anonymous used for estimating injury mortality, because elsewhere, injury deaths were frequently classified using imprecise, partially specified categories Bhalla et al.

Furthermore, it is well known that some types of external causes are difficult to evaluate. For example, suicides are often underreported, especially in countries where suicides are not morally or socially accepted Tøllefsen et al. It is also difficult in many cases to determine the intent of the death: intentional self-harm, or homicide or accident…?

Such is the case, for example, of single-vehicle accidents and drownings. To take another example, a death from a vehicle accident might occur not on the scene but some hours or days after the accident.

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What lapse of time after the accident should one choose after which the death will no longer be determined as resulting from that accident? WHO uses a day time limit in its publications, adjusting, when possible, the data provided by national sources.

Consider another case: that of pedestrian fatalities. There are several definitions of who is a pedestrian, and how pedestrians are defined has an effect on the number of deaths that are counted as pedestrian deaths see Noland et al. In order to improve data collection, some countries have set up special registration systems for covering violent deaths or have linked data from various sources.

Ylijoki-Sørensen et al.

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A forensic autopsy was performed in Their study shows that if all deaths in all age groups with unclear cause of death were systematically investigated with a forensic autopsy, only 2—3 per deaths per year would be coded as having an ill-defined and unknown cause of death in national mortality statistics. At the same time, the risk of unnatural deaths being overlooked significantly decreases. To achieve this, in Europe, it would require that the existing legislation on cause-of-death investigation be changed to ensure that all deaths of unknown cause be investigated with a forensic autopsy.

Actually, according to the information available, it seems that postmortem examinations are routinely performed in only a few countries, e.

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In most countries, they are executed solely in case of unexpected or especially suspicious death. Performance of autopsy is notified on death certificates in various countries. In Belgium, the requirement for an autopsy was notified on 1.

In France, inthe percentage was similar. When performed, autopsies may lead to changing the cause of death, and the registration system should be adapted to take this new information into account.

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To give an example of the procedure, in France and also in Belgiumthe autopsy is usually requested by the MD filling in the death certificate. In France, this request must be accepted by the coroner. Following postmortem results, the coroner fills in a second death certificate, cancelling the first. Even if autopsies lead to improving cause-of-death registration, they raise several problems.

Legal aspects have been pointed out above.

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Another issue is psychosocial—when the consent of the family is required, MDs can hesitate to seek Auto Trading System Anonymous of the family grieving the death of a close relation, the representation of the autopsy act remaining very negative in most countries Becart-Robert Another problem is the cost of an autopsy for the health system. To conclude this section, vital registration data have been used for decades for constructing life tables all causes and by cause. Taking multiple causes of death into account could improve the picture by pointing out possible associations among causes of death.

Data sources: morbidity This section discusses the main data sources on morbidity. These sources include the surveillance of infectious diseases; sentinel networks; specific disease registers such as cardiovascular diseases and cancer registers, hospital statistics and general practice records, and insurance statistics.

Surveillance of infectious diseases Though mortality from infectious diseases is low in developed countries compared to that from chronic diseases, this does not imply that infections have been overcome. Children, pregnant women, older individuals and people with pre-existing diseases are particularly vulnerable to infectious diseases. Furthermore, infections can lead to sepsis and septic shock, which can be lethal in the older population especially.

Auto Trading System Anonymous incidence of some infectious diseases that were deemed conquered—such as tuberculosis—has increased significantly, and some diseases—such as influenza—are still highly lethal in some years, especially for the young and the old.

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Infectious agents, such as Helicobacter pylori and human papillomavirus, can also be a cause of various cancers. In addition, some pathogenic bacteria have become resistant to the drugs that are used to kill them. To take into account the growth in international travel and trade, to Auto Trading System Anonymous one can add changes in environmental conditions—including climate change—impacting on vector-borne diseases, inWHO revised its International Health Regulations IHRwhich entered into Auto Trading System Anonymous in WHO In addition to the notifiable diseases, these call for any event of potential international public health concern to be declared, including those of unknown causes or sources and those involving Binaarsete variantide toenaosus or diseases other than those listed, if the public health impact is serious.

The IHR are thus no longer restricted to a specific set of infectious diseases. In the EU, a strategy for infectious disease surveillance was developed in It gathers surveillance data from the EU Member States on 52 communicable diseases and works in partnership with national health protection bodies across the European Union to strengthen and develop continent-wide disease surveillance and early warning systems. Thanks to this, one can detect for example clusters of incident cases such as a food-borne infection due to Listeria and locate their source, 5 or observe multiple cases of a particular communicable disease in different countries and trace them back to common international travel on the part of the individuals concerned.

New technologies for identifying pathogens 6 reduce the time needed for detection. Accuracy, the timely reporting of cases, and the prioritising of threats are critical for communicable disease control. Early detection can mean the difference between an outbreak and a pandemic. As the more severe cases are hospitalised, reported cases can be checked against hospital discharge data. Boehmer et al. For example, hepatitis A was poorly reported, while reporting was high for salmonellosis.

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The authors recommend the use of both medical records and hospital discharges for evaluating the quality of reporting. International comparisons may be hampered in Europe by the fact that reporting diseases not on the IHR list depends upon different national practices and laws.

Finally, it can happen that countries fail to inform others of the occurrence of a disease. We end this section by pointing out that environmental health surveillance systems have been set up to monitor environmental contamination, such as concentrations of contaminants in water and pollutants in ambient air, and more rarely to monitor contaminants in individuals. For example, the Flemish Environment and Health Survey on a representative sample of individuals collects data on biomarkers of exposure and effect, exposure-effect associations, time trends and geographical differences.

Sentinel networks According to the WHO, 7 a sentinel surveillance system is used when high-quality data are needed about a particular disease that cannot be obtained through a passive system. A sentinel system involves a limited network of reporting sites, such as large hospitals or laboratories.

For example, in Belgium, the surveillance of sexually transmitted diseases is carried out, i. A particular case of surveillance systems is that of GP sentinel networks, composed of a sample of GPs on a voluntary basis. These networks allow a picture to be drawn of diseases widespread in the general population, usually not leading to hospitalisation, and estimating trends in, for example, the prevalence of diabetes.

Diseases chosen for registration can vary over time. These physicians report their weekly number of patients to their national focal point for influenza surveillance. Several problems should be pointed out. Auto Trading System Anonymous

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Firstly, the actual reference population is unknown. When based on voluntary participation, the sample of participating units can be biased. For example, GPs participating voluntarily in a sentinel network may have practices and therapeutic schemes that are different from those of others; for example, they may be paying more attention to diagnostic precision.

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