Internationally comparable official mortality statistics are prepared by the regional statistical offices; they evaluate death certificates and encode the causes of death in accordance with ICD-10-WHO.

Causes of death statistics for research, planning and prevention

What preventive and medical-curative measures increase life expectancy and quality of life? This is the central question in the analysis of causes of death. Significant internationally and intertemporally comparable data are crucial in order to find an answer.

The causes of death statistic (mortality statistic) is used to gain important health indicators (parameters) such as number of deaths, lost life-years and avoidable deaths; regional specificities in mortality for specific causes of death and their development over time can also be examined. The results are used to derive recommendations for action and strategies for epidemiological research and prevention, health planning and health politics.

ICD-10-WHO as the basis for the causes of death statistic

In Germany, the causes of death of all deceased are recorded by the regional statistical offices; they are then included in the mortality statistics of the federal government and of the federal states. The standardised approach – complete record of all data and encoding/certification in accordance with ICD-10-WHO – and the continuity of data acquisition ensure that these data are reliably available for research and planning.

The legal basis for the causes of death statistic is the German Law on Population Statistics (Bevölkerungsstatistikgesetz BevStatG).

Death certificate as the basis for the causes of death statistic

The regional statistical offices record the causes of death on the basis of paper-based death certificates (also known as cause of death certificate). These are issued by the doctor who inspects the body and certifies the death.

The performance of the funeral inspection and the completion of the death certificate are regulated in the funeral laws or ordinances of the federal states. The death certificates are processed by health authorities, registry offices, statistical offices of the federal states and other authorities.

Death certificates are Federal state specific; they consist of a confidential and a non-confidential part.

  • The non-confidential part is handed to the next of kin for submission to the registry office.
  • The confidential part is passed to the relevant statistical office; it consists of two parts: 
    • Part I has to be completed in full; the causal chain of diseases leading to the death is entered here: from the underlying disease to diseases indirectly causing the death to the direct cause of death.
    • Part II can optionally include diseases that were a contributing factor towards the death but formed no direct part of the causal chain leading to the death.

To ensure the quality

  • of the survey and documentation of the causal chain by doctors,
  • of the communication chain from the filling situation to the coding and
  • of the coding by the signature

will improve, a number of measures have been and are being taken and projects set up.

Improvements through instruction and training

(c) DIMDI

Errors and gaps in the causal chain of causes of death result in inaccuracies in the causes of death statistics. For that reason, DIMDI in cooperation with the German Federal Statistical Office (DESTATIS) has developed a brief instruction to provide doctors with practical help in the completion of death certificates.

This short tutorial "Cause of death on the death certificate" as at January 2014 is only available in German language. In addition, DIMDI conducts encoding training courses at the regional statistical offices in order to ensure standardised encoding.

The Education and Implementation Committee (EIC) of the WHO-Family of International Classification Network has developed framework curricula for training on death certificates, the encoding of causes of death and also morbidity encoding. As a WHO collaboration centre, DIMDI is also represented on the EIC.

In addition, WHO offers an interactive training tool for its ICD-10 to explain the structure of ICD-10 and the encoding process; this tool can be used free of charge online.

Improvements through nationwide electronic certificate of death

A nationwide electronic death certificate with

  • a supportive user guidance in the collection and documentation of the causes of death chain by the physicians, and
  • a media-break-free and thus accelerated and safer communication chain from the filling situation to coding

would improve significantly the quality of the causes of death surveyed and the timeliness of statistics; both would contribute to an increase in the informative value of the statistics on causes of death in Germany and their international comparability.

Together with the German Federal Statistical Office (DESTATIS), DIMDI has developed a concept for the introduction of a nationwide electronic death certificate in Germany as part of a project sponsored by the Federal Ministry of Health (BMG). In addition to the analysis of the entire process from the filling to the coding, the end of the communication chain, the technical aspects for an electronic recording for the creation of the cause of death certificate were also examined.

The follow-up project launched in 2019 focuses on piloting a nationwide electronic death certificate. Together with DESTATIS, DIMDI is developing four work packages:

Work package 1: Technical realisation of an electronic death certificate based on an online portal (eTB-portal)

Work package 2: Determination of the nationwide data set for the piloting of the electronic death certificate

Work package 3: Specification of the eTB portal for later implementation by IT service providers, software manufacturers and other stakeholders

Work package 4: Piloting and evaluation of the nationwide electronic death certificate in test regions.

Improving the encoding of causes of death with electronic coding system "Iris"

Iris is an electronic system for coding multiple causes of death and for the selection of the underlying cause of death documented in the death certificate. Iris is developed and maintained by the Iris Institute, secretary is at DIMDI. Iris is used in many countries around the world for routine cause of death statistics. The aim is to achieve comprehensive use of Iris in Germany.

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