896Quantifying cause-related mortality incorporating multiple causes: challenges and opportunities. (2nd September 2021)

• Record Type: Journal Article
• Authors: Joshy, Grace; Eynstone-Hinkins, James; Moran, Lauren; Balogun, Saliu; Bishop, Karen; Moreno-Betancur, Margarita
• Is Part Of: International journal of epidemiology. Volume 50(2021)Supplement 1
• Publication Date: 2021-09-02
• Subjects: Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyab168.327
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Key contact person: Dr Grace Joshy, Fellow, Research School of Population Health, Australian National University. Focus and outcomes for participants: Mortality statistics are typically based on a single underlying cause of death (UCoD), derived from multiple conditions on the death certificate, and have provided critical evidence for policy and practice for over a century. There have been radical shifts in patterns of death in the past couple of decades; deaths in older ages are increasingly from chronic and degenerative diseases. The relevance of assuming that a single disease is causing the death is diminishing, especially with an aging population structure and increasing life expectancy. This symposium will enable participants to understand the complexities associated with mortality reporting/coding, strengths and limitations of available statistical methods for using multiple causes of death (MCoD) and the importance of quantifying mortality incorporating MCoD. Rationale for the symposium, including for its inclusion in the Congress: The use of a single UCoD rather than MCoD means that vast amounts of potentially useful data are largely ignored, which is likely to bias mortality estimates (including under- and over-reporting of the importance of certain causes of death). Despite global recognition of the urgent need to better integrate data on MCoD into mortality statistics, use of these data are challenging and limited. Complexities arise from the way mortality information is reported on death certificates and coded to form mortality collections; limited understanding of available statistical methods also adds to the complexity. International Classification of Diseases 10 th Revision (ICD-10) has been translated into 43 languages and it is being used by over 100 countries to report mortality data, a primary indicator of health status. The 2018 release of the 11th revision of the International Classification of Diseases, enriching data on multiple parameters including comorbidity, confers further urgency and a unique opportunity to optimise the use of MCoD in mortality reporting. The World Congress of Epidemiology 2020 will provide a unique platform for wider discussions on the challenges and opportunities for using MCoD data. The symposium will provide a deeper understanding and enhanced the use of MCoD data. The speakers are engaged in cutting-edge NHMRC-funded research on mortality incorporating MCoD and development of novel statistical methods. Presentation program: The symposium will feature presentations from six speakers. Current mortality data constructs: strengths and limitations of the underlying causes of death by Mr James Eynstone-Hinkins, Director of Health and Vital Statistics at the Australian Bureau of Statistics. There are complexities around death certification, coding rules and the automated processing to select and code the underlying cause for each registered death. Strengths and limitations of the underlying causes of death will be discussed. MCoD: complexities, existing uses and future enhancements in classification by Ms Lauren Moran, Assistant Director of the Health and Vital Statistics Section at the Australian Bureau of Statistics. The presentation will describe some of the complexities associated with the rich MCoD data collection, its existing uses and future enhancements in classification and compilation. Quantifying mortality using MCoD: a review of existing methods and practice by Dr Saliu Balogun, Research Fellow at the Australian National University. A comprehensive literature review and audit summarising of the methodological approaches currently used to analyse MCoD data will be presented. The merits and limitations of the different analytical frameworks will be discussed. Mortality reporting incorporating MCoD: examples using Australia mortality collection 2006-2017 by Ms Karen Bishop, Research Fellow at the Australian National University. Data for 1.8 million deaths registered in 2006–2017 will be used with an extended classification of 136 causes of death. Standard mortality indicators such as age-standardised rate ratios of multiple to UCoD and cause of death association indicator will be used to outline the relative contribution of MCoD (vs UCoD) to mortality and the strength of comorbid disease associations. Survival analysis methods for modelling multi-cause mortality by Dr Margarita Moreno-Betancur ARC DECRA fellow, and Senior Research Fellow at The University of Melbourne and the Murdoch Children's Research Institute. This work developed the first formal survival analysis methods for modelling multiple-cause mortality, based on weighting methods that allow exploitation of all the readily-available data from death certificates. These methods enable the estimation of mortality rates for descriptive purposes as well as the conduct of Cox-type regression analyses for explanatory analyses. Pragmatic weighting strategies for MCoD: challenges and opportunities by Dr Grace Joshy, Senior Research Fellow at the Australian National University. Three weighting methods will be applied to the Australian mortality data: 1) traditional approach using UCoD alone; 2) UCoD and associated causes of death (ACoDs) equally weighted and (3) UCoD weighted 0.5 arbitrarily and remaining 0.5 apportioned to the remaining ACoDs. Challenges to further refining this weighting method by applying weights only to causes that are noted as 'contributory' (reported in Part II of death certificate) will be discussed. Names of presenters: James Eynstone-Hinkins, Lauren Moran, Saliu Balogun, Karen Bishop, Margarita Moreno-Betancur, Grace Joshy