Evaluation of Causes-of-Death: Which statistics should We rely on, Hospital Deaths or Vital Statistics?
Sumitr Sutra MD*, Aroon Chirawatkul MSc**, Pichet Leelapanmetha MD***, Somnuk Sirisuwan MD ***, Kaewjai Thepsuthammarat PhD****
Affiliation : *Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand **Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand *** National Health Security Office, Thailand ****Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Age-specific causes of death yield important information for planning health services and medical education.
Objective : To compare the age-specific causes of death between in-hospital deaths and death registration statistics.
Material and Method: Information on in-hospital mortality in fiscal 2010 was extracted from the three health insurance
schemes. Death registrations (ICD-10 coding) were from the Bureau of Registration Administration, Ministry of Interior.
Statistics on the age-specific causes of death were analyzed.
Results : In-hospital deaths numbered 132,512 (47.5% occurring in tertiary care) vs. 411,331 recorded in vital statistics
(68% died outside hospitals). Most (74%) infants died in-hospital so causes were clearly documented vs. death registration.
A minority (6.2%) of in-hospital deaths and of death registrations (9.7%) were due to unnatural causes. The majority
(79.5%) of unnatural deaths died before arriving at hospital. Ill-defined codes for causes of death were found in 6.1% of in-
hospital records and 42.2% of death registrations. After censoring ill-defined codes, the ten leading, age-specific causes of
death agreed between the two data sets.
Conclusion : Medical personnel should receive training to do proper death certification. Periodic validation of hospital COD
certification should also be done. Use of verbal autopsy in the Thai context would help to standardize record-keeping and to
reduce ill-defined codes for deaths occurred outside hospital.
Keywords : Cause-of-death, Age-specific causes of death, In-hospital death
