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Achieving accurate mortality statistics requires accuracy in both the completion of death certificate COD statements and the process of assigning UCODs. Therefore, efforts to improve mortality statistics in Hermosillo should include analysis of the reliability of the UCOD codification process.
On an accurately completed death certificate, both the UCODs (the conditions that triggered the diseases, injuries, or complications leading to death) and the ICODs (the immediate or final complication resulting from the UCODs) are recorded in Part I (the "COD" portion) of the medical section of the death certificate (14, 15), while "other significant conditions" (those contributing to death but not resulting in its underlying causes) are recorded in Parts II and III (16).
The codes for the original UCODs were based on the three-digit category of the International Classification of Diseases, 10th Revision (ICD-10).
Both the original and new UCODs were classified into two categories: endogenous causes (including neoplasms; blood diseases; endocrine, nutritional, and metabolic diseases; certain conditions originating in the perinatal period; and congenital malformations, deformations, and chromosomal abnormalities), and exogenous causes (including respiratory infections, infectious and parasitic diseases, and accidents and other external CODs) (18).
The original UCODs (those from the 2002-2003 death certificates) were then compared to the new UCODs (those determined by the expert reviewers) to measure concordance between the two sets of data, with the new UCODs used as the "gold standard" for all subsequent analyses.
After excluding the deaths with missing and natural cause of death codes, there were 6,214 deaths remaining in the study extract with an ICD-10 external cause code, either as the UCoD or MCoD.
Examination of levels of agreement by intent and external cause categories revealed an exact match in 4,397 (70.8%) deaths with UCoD (n = 4,242) or MCoD (n = 155) ICD-10 codes in the NCIS.
Analysis illustrated that independently assigned external cause ICD-10 UCoD codes matched exactly with the ABS assigned codes in 4,397 (70.8%) deaths.
Changes to coding procedures implemented by the ABS for deaths occurring from 2007 will address this issue, with updates to the UCoD and MCoD being made as coronial investigations are finalized and changes to the decision making process for the coding of intentional self-harm.
There were significantly higher odds of a death certificate being assigned an undefined external cause code if the external cause was coded as an accident (compared with intentional self-harm), was a MCOD (compared to an UCOD), where the deceased was not Indigenous, where the death was certified by a doctor instead of a coroner, where the deceased was female and where the death was of an older individual.
In Table 4, after adjusting for major external cause code blocks, use of the codes as an UCOD or MCOD, whether the death was certified by a doctor or coroner, age of the decedent, sex and indigenous status, in general the odds ratio of use of an undefined code was still statistically significant.
Specificity was particularly problematic for causes assigned as MCOD rather than UCOD. This may be related to the other findings that deaths of elderly persons and deaths of females had significantly higher odds of being coded with an undefined code.
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