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Coding Quality of Deaths and its Impact on Elderly Unintentional Fall Mortality Data from 1990 to 2019: A Retrospective Analysis of the WHO Mortality Database
38 Pages Posted: 18 Aug 2021More...
Background: Several studies have assessed the reporting quality of all-cause mortality data from the WHO Mortality Database, but little is known about coding quality and its impact on elderly unintentional fall mortality data worldwide, We aimed to assess the coding quality of deaths and its impact on elderly unintentional fall mortality.
Methods: We extracted mortality data from the World Health Organization (WHO) Mortality Database, 1990-2019. We calculated number of countries/territories that had mortality data in the WHO Mortality Database, and proportion of deaths with five types of problematic codes based on the 10th international classification of disease (ICD-10) (unspecified deaths, injury deaths with undetermined intent, unspecified unintentional injury, unintentional falls with unspecified mechanism, unintentional falls with unknown occurrence place). We estimated age-adjusted unintentional fall mortality before and after correcting problematic codes.
Findings: Only 64% (124/194) WHO member states had at least one-year mortality data in the WHO Mortality Database during 1990-2019, and data unavailability was more common for under-developed countries/territories than for developed countries/territories. As for the proportion of five types of problematic codes, coding quality was poor for many countries/territories included in the WHO Mortality Database. Among the study years when countries/territories possessed mortality data, 80%, 53%, 51%, and 63% had a proportion of unintentional fall deaths with unspecified mechanism over 50% in low-income, lower middle-income, upper middle-income, and high-income countries/territories, respectively; comparable proportions for unintentional fall deaths with unknown occurrence place were 100%, 42%, 71%, and 62%. Among the 94 countries/territories having mortality data, problematic codes caused a relative mortality difference ≥50% in 59 countries/territories (63%). After correcting problematic codes, 5 of 55 countries/territories with data witnessed a reverse in mortality changes between 2005 and 2015. Among the 82 countries/territories with mortality data for 5 or more years, 18 countries/territories (22%) experienced a directional reverse in linear regression coefficient.
Interpretation: The availability and quality of global data related to elderly unintentional fall mortality in the WHO Mortality Database was poor between 1990 and 2019. Varying data quality across countries/territories and over time have a substantial impact on mortality estimates and mortality comparisons. Global agencies plus each individual government should be aware of the importance of collecting and sharing high-quality mortality data, and take actions to improve data quality for inclusion in the WHO Mortality Database.
Funding: Natural Science Foundation of Hunan Province, China, and Project Program of National Clinical Research Center for Geriatric Disorders (Xiangya Hospital).
Declaration of Interest: We declare no competing interests.
Ethical Approval: The research protocol was approved by the Medical Ethics Committee of Central
South University on 25 January 2021 (No. XYGW-2021-06).
Keywords: unintentional fall, mortality, data availability, coding quality, WHO Mortality Database
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