# Presentation: 174840

## International Comparisons of Proportion of Unspecified External Causes of Death 

**Tsung-Hsueh (Robert) Lu**, MD, MPH
- Institute of Public Health, College of Medicine
- National Cheng Kung University, Tainan, Taiwan
- robertlu@mail.ncku.edu.tw

## Sep 1999

**Sep 1999**

**April 2003**

**Nov 1996**

## MADE 

**台灣多重死因中文診斷自動化輸入系統**
**MADE **
**in Taiwan**
**M**ultiple-cause-of-death **A**utomated
**D**ata **E**ntry System , 2004 version

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## Introduction

**IDEALLY****, external causes of death (ECD) provide information of circumstances related to the occurrence of injury events, which provide important ****information for injury prevention. ****(****Users****)**
**REALISTICALLY****, ****certifiers (medical examiners and coroners) did not provide sufficient information for ideal external causes coding. ****(****Producers****)**

## V243

**Transport accidents**

***Transport accidents***

***Mode of transport ***
***of the victim***

***Mode of transport ***
***of counterpart***

-  ***Circumstances of ***
***the event and ***
***the role of the victim***

## ECD: X59 exposure to unspecified factor

***Accidental head injury***

**Example One**

## ECD: V99 unspecified transport accident

***Head injury***

**Example Two**

***Transport accident***

## ECD: V244 motorcycle rider injured in collision with heavy transport vehicle or bus 

***Head injury***

**Example Three**

***Motorcyclist in collision with bus ***

## Research Questions

**What’s the proportion of injury deaths of which the information reported could only be coded as “unspecified”? *****---- an indicator of insufficiency of specific information the certifiers reported on the death certificates***
**Did this proportion differ by country?**
**Did this proportion differ by ECD?**

## Materials & Methods

**The number of deaths registered in the year 2001 for each three-character code in Chapter XX (External causes of morbidity and mortality) of the ICD-10 were provided by four countries participating in the ICE (International Collaborate Efforts on Automating Mortality Statistics), i.e., Australia, Sweden, Taiwan and the United States.**

## Materials & Methods (cont.)

| External Causes of Injuries | ICD-10 Code, U/B |
| --- | --- |
| All unintentional injuries | X59/V01-X59 |
| Transport accidents | V89&V99/V01-V99 |
| Falls | W19/W00-W19 |
| Accidental drowning and submersion | W74/W65-W74 |
| Other accidental threats to breathing | W84/W75-W84 |
| Exposure to smoke, fire and flames | X09/X00-X09 |
| Intentional self-harm | X84/X60-X84 |
| Assault | Y09/X85-Y09 |
| Event of undetermined intent | Y34/Y10-Y34 |

## Results

**Sweden (32.5%) had the highest proportion of unspecified code (ICD-10 code X59), followed by Australia (16.6%), Taiwan (13.2%) and the USA (7.2%). **
**The percentage of unspecified code was relatively high in ****falls**** and unintentional ****drowning**** and was relatively low in accidental ****poisoning****, intentional ****self-harm**** and event of undetermined intent.**

## Results (cont.)

**Sweden had highest unspecified percentage (63.7%) of deaths from falls, followed by Australia with 55.5%, the USA (50.9%) and Taiwan (49.1%)** **. The proportion increased with age in each country (Table 2).**
**Taiwan had an extremely high percentage of unspecified codes in transport accidents (86.5%), accidental drowning (98.7%) and fire and flame (98.7%).**

## Why the % in Aus & Swe are relatively high compared with US?

**Why the % in Aus & Swe are relatively ****high**** compared with US?**

**Why all countries had relatively ****high **** % in falls?**

**Why the % in Aus & Swe are relatively ****low**** compared with US?**

**Persons?**

## Explaining the variations

**Differences in the ****system**** of medical examiners and coroners?**
**Differences in the ****training**** of medical examiners and coroners?**
**Differences in the ****format**** of death certificate?**
**Differences in the ****query**** system?**

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## Taiwan’s attempts to improve

**Communicating**** with the medical examiners, coroners, and prosecutors. **
**Querying**** the certifiers for more specific information for coding.**
**Revising ****the format of death certificate.**
**Interviewing**** the families of the deceased to collect detail information.**
**Building ****the National Coroners Information System like those in Australia**

## Conclusions

**According to our findings, there were certain gaps between the ‘****ideal****’ and the ‘****reality****’ in classifying injury deaths among the four ICE participating countries. **
**Should the ‘****users****’ slow down the pace a little bit and spend more time with the ‘****producers****’ to improve the quality of data entry? **

## Comments are needed!

**Why the % in Aus & Swe are relatively ****high**** compared with US?**

**Why all countries had relatively ****high **** % in falls?**

**Why the % in Aus & Swe are relatively ****low**** compared with US?**

***Comments are needed!***

**Persons?**