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High Israeli mortality rates from diabetes and renal failure - Can international comparison of multiple causes of death reflect differences in choice of underlying cause?

Goldberger N, Applbaum Y, Meron J, Haklai Z - Isr J Health Policy Res (2015)

Bottom Line: These results were compared to data from USA, France, Italy, Australia and the Czech Republic for 2009 or other available year.Renal disease was less strongly associated with IHD.Even with some changes in coding, mortality rates would be high compared to other countries, similar to the comparatively high diabetes prevalence in Israel at older ages and high rate of end-stage renal failure.

View Article: PubMed Central - PubMed

Affiliation: Division of Health Information, Ministry of Health, 39 Yirmiyahu Street, 9101002 Jerusalem, Israel.

ABSTRACT

Background: The age-adjusted mortality rate in Israel is low compared to most Western countries although mortality rates from diabetes and renal failure in Israel are amongst the highest, while those from cardiovascular diseases (CVD) are amongst the lowest. This study aims to assess validity of choice of underlying causes (UC) in Israel by analyzing Israeli and international data on the prevalence of these diseases as multiple causes of death (MCOD) compared to UC, and data on comorbidity (MCOD based).

Methods: Age-adjusted death rates were calculated for UC and MCOD and the corresponding ratio of multiple to underlying cause of death (SRMU) for available years between 1999 and 2012. Comorbidity was explored by calculating cause of death association indicators (CDAI) and frequency of comorbid disease. These results were compared to data from USA, France, Italy, Australia and the Czech Republic for 2009 or other available year.

Results: Mortality rates for all these diseases except renal failure have decreased in Israel between 1999 and 2012 as UC and MCOD. In 2009, the SRMU for diabetes was 2.7, slightly lower than other Western countries (3.0-3.5) showing more frequent choice as UC. Similar results were found for renal failure. In contrast, the SRMU for ischemic heart disease (IHD) and cerebrovascular disease were 2.0 and 2.6, respectively, higher than other countries (1.4-1.6 and 1.7-1.9, respectively), showing less frequent choice as UC. CDAI data showed a strong association between heart and cerebrovascular disease, and diabetes in all countries. In Israel, 40 % of deaths with UC diabetes had IHD and 24 % had cerebrovascular disease. Renal disease was less strongly associated with IHD.

Conclusion: This international comparison suggests that diabetes and renal failure may be coded more frequently in Israel as UC, sometimes instead of heart and cerebrovascular disease. Even with some changes in coding, mortality rates would be high compared to other countries, similar to the comparatively high diabetes prevalence in Israel at older ages and high rate of end-stage renal failure. This study highlights the importance of physician training on death certification practice and need for further progress towards automation in recording and coding death causes.

No MeSH data available.


Related in: MedlinePlus

Age-standardized underlying mortality rates in Israel, by causes of death, 1999–2012. Rates/100,000 population, age standardized to 2013 European standard population
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Fig1: Age-standardized underlying mortality rates in Israel, by causes of death, 1999–2012. Rates/100,000 population, age standardized to 2013 European standard population

Mentions: Figures 1 and 2 show trends in standardized mortality rates as UC and MCOD for diabetes, renal failure, IHD, other heart disease and cerebrovascular diseases. All these diseases, except renal failure, had steadily decreasing rates both as UC and MCOD between 1999 and 2012. The highest decrease, 51 %, was for IHD, 54 % as UC and 51 % as a MCOD between 1999 and 2012. The rate of decrease was similar for diabetes as UC and MCOD, 27 % and 30 % respectively. Cerebrovascular disease and other heart disease showed a greater decrease as MCOD than UC. The renal failure mortality rate increased by 25 % as UC, while as MCOD, after an initial increase, it decreased to the same rate in 2012 as 1999. The SRMU shown in Fig. 3 reflect the relative differences in change between MCOD and UC. For IHD and diabetes the SRMU was relatively stable over the years, although it decreased for all other diseases. The SRMU for diabetes ranged between 2.3 and 2.9, and for cerebrovascular disease started at 3.0 in 1999, but decreased over this period to 2.2 in 2012. The SRMU for renal failure, also decreased by about 20 % from 5.5 to 4.4, while that for other heart disease had a relatively smaller decrease from 6.7 to 5.9.Fig. 1


High Israeli mortality rates from diabetes and renal failure - Can international comparison of multiple causes of death reflect differences in choice of underlying cause?

Goldberger N, Applbaum Y, Meron J, Haklai Z - Isr J Health Policy Res (2015)

Age-standardized underlying mortality rates in Israel, by causes of death, 1999–2012. Rates/100,000 population, age standardized to 2013 European standard population
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590706&req=5

Fig1: Age-standardized underlying mortality rates in Israel, by causes of death, 1999–2012. Rates/100,000 population, age standardized to 2013 European standard population
Mentions: Figures 1 and 2 show trends in standardized mortality rates as UC and MCOD for diabetes, renal failure, IHD, other heart disease and cerebrovascular diseases. All these diseases, except renal failure, had steadily decreasing rates both as UC and MCOD between 1999 and 2012. The highest decrease, 51 %, was for IHD, 54 % as UC and 51 % as a MCOD between 1999 and 2012. The rate of decrease was similar for diabetes as UC and MCOD, 27 % and 30 % respectively. Cerebrovascular disease and other heart disease showed a greater decrease as MCOD than UC. The renal failure mortality rate increased by 25 % as UC, while as MCOD, after an initial increase, it decreased to the same rate in 2012 as 1999. The SRMU shown in Fig. 3 reflect the relative differences in change between MCOD and UC. For IHD and diabetes the SRMU was relatively stable over the years, although it decreased for all other diseases. The SRMU for diabetes ranged between 2.3 and 2.9, and for cerebrovascular disease started at 3.0 in 1999, but decreased over this period to 2.2 in 2012. The SRMU for renal failure, also decreased by about 20 % from 5.5 to 4.4, while that for other heart disease had a relatively smaller decrease from 6.7 to 5.9.Fig. 1

Bottom Line: These results were compared to data from USA, France, Italy, Australia and the Czech Republic for 2009 or other available year.Renal disease was less strongly associated with IHD.Even with some changes in coding, mortality rates would be high compared to other countries, similar to the comparatively high diabetes prevalence in Israel at older ages and high rate of end-stage renal failure.

View Article: PubMed Central - PubMed

Affiliation: Division of Health Information, Ministry of Health, 39 Yirmiyahu Street, 9101002 Jerusalem, Israel.

ABSTRACT

Background: The age-adjusted mortality rate in Israel is low compared to most Western countries although mortality rates from diabetes and renal failure in Israel are amongst the highest, while those from cardiovascular diseases (CVD) are amongst the lowest. This study aims to assess validity of choice of underlying causes (UC) in Israel by analyzing Israeli and international data on the prevalence of these diseases as multiple causes of death (MCOD) compared to UC, and data on comorbidity (MCOD based).

Methods: Age-adjusted death rates were calculated for UC and MCOD and the corresponding ratio of multiple to underlying cause of death (SRMU) for available years between 1999 and 2012. Comorbidity was explored by calculating cause of death association indicators (CDAI) and frequency of comorbid disease. These results were compared to data from USA, France, Italy, Australia and the Czech Republic for 2009 or other available year.

Results: Mortality rates for all these diseases except renal failure have decreased in Israel between 1999 and 2012 as UC and MCOD. In 2009, the SRMU for diabetes was 2.7, slightly lower than other Western countries (3.0-3.5) showing more frequent choice as UC. Similar results were found for renal failure. In contrast, the SRMU for ischemic heart disease (IHD) and cerebrovascular disease were 2.0 and 2.6, respectively, higher than other countries (1.4-1.6 and 1.7-1.9, respectively), showing less frequent choice as UC. CDAI data showed a strong association between heart and cerebrovascular disease, and diabetes in all countries. In Israel, 40 % of deaths with UC diabetes had IHD and 24 % had cerebrovascular disease. Renal disease was less strongly associated with IHD.

Conclusion: This international comparison suggests that diabetes and renal failure may be coded more frequently in Israel as UC, sometimes instead of heart and cerebrovascular disease. Even with some changes in coding, mortality rates would be high compared to other countries, similar to the comparatively high diabetes prevalence in Israel at older ages and high rate of end-stage renal failure. This study highlights the importance of physician training on death certification practice and need for further progress towards automation in recording and coding death causes.

No MeSH data available.


Related in: MedlinePlus