Academic journal article Demographic Research

Revisiting the Mortality of France and Italy with the Multiple-Cause-of-Death Approach

Academic journal article Demographic Research

Revisiting the Mortality of France and Italy with the Multiple-Cause-of-Death Approach

Article excerpt


In this paper we revisit the mortality profiles of France and Italy in 2003 using the multiple-cause-of-death approach. The method leads to a substantial upward reassessment of the role played by certain conditions - e.g. diseases of the blood and diseases of the skin - in overall mortality. Regarding the associations of causes, we distinguish three patterns of pairwise joint occurrence of causes that are common to both countries. The numerous similarities that emerge from the comparison of the two countries are a positive signal of the reliability of the multiple-cause-of-death data.

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1. Introduction

Although the monitoring of mortality trends is mostly based on the underlying cause of death - that is "the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury" (WHO 1949), a growing number of studies use the entire set of causes listed on the death certificate, hereafter referred to as the multiple causes of death (MCOD), to portray the mortality profile of a country (Chamblee and Evans 1982; Manton and Stallard 1982; Manton 1986; Manton and Myers 1987; White, Selvin, and Merrill 1989; Mackenbach et al. 1995; Stallard 2002; Désesquelles and Meslé 2004; Redelings, Sorvillo, and Simon 2006; Redeling, Wise, and Sorvillo 2007; Frova et al. 2009) or to re-evaluate the contribution of a specific cause (Wing and Manton 1981; Israel, Rosenberg, and Curtin 1986; Nizard and Munoz-Pérez 1993; Coste and Jougla 1994; Mannino et al. 1998; Wise and Sorvillo 2005; Fuhrman et al. 2006; Romon et al. 2008). As the first advocates of the MCOD approach (Janssen 1940; Dorn and Moriyama 1964) have stressed, the underlying-cause-of-death approach misdirects attention away from conditions that tend to be reported as contributory causes. As a consequence their contribution to overall mortality is underestimated. The MCOD approach should be especially useful for describing the medical circumstances surrounding the death of older people. At old ages, death is indeed often the final stage of a long morbid process involving several conditions. Clearly the MCOD approach is a potentially valuable tool for demographers, who are necessarily concerned with portraying the mortality profiles of aging populations as accurately as possible.

Notwithstanding these developments, studies that use multiple causes of death in order to compare a set of countries are still very scarce. This situation may be partly due to the quite widely shared scepticism about the quality, and consequently the comparability, of the multiple-cause-of-death data. To our mind, apart from certification issues, recent technological innovations in the coding systems represent a major advance towards improved quality of cause-of-death data. In a growing number of countries the recording of information on death certificates and the coding of causes have been automated (optical recognition and automatic coding system). Human intervention is limited to problematic cases that cannot be processed automatically and, at least in theory, the World Health Organization coding rules can be applied systematically and uniformly, irrespective of the coding agent or the country. Another consequence of these automated systems is that the number of coded causes is no longer limited. Researchers often have access to all medical information reported on the certificate instead of a limited selection of causes.

In this paper we use the MCOD approach in order to revisit the mortality profiles of France and Italy in 2003. Our goals are both substantive and methodological. First we re-evaluate the cause-specific mortality profiles of the two countries, taking into account all the conditions reported on the death certificates. We then measure the pairwise joint occurrence of any underlying and any contributory cause (i. …

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