ISTAT - Istituto Nazionale di Statistica
Euro-SDMX Metadata Structure Definition (ESMS_MSD 3.0 ESTAT)
Causes of death
2016 - A0
1. Contact
1.1 Contact organisation

Istat, the Italian national institute of statistics

1.2 Contact organisation unit

Population Health, Healthcare and Social Assistance Division

1.3 Contact name

Marilena Pappagallo

1.4 Contact person function

Researcher in the Causes of Death Unit, Population Health, Healthcare and Social Assistance Division, Causes of death data base manager

1.5 Contact mail address

viale Liegi 13, 00198 Roma, ITALY

1.6 Contact email address

pappagal@istat.it

1.7 Contact phone number

+39 06 46737405

1.8 Contact fax number
2. Metadata update
2.1 Metadata last certified
15/12/2016
2.2 Metadata last posted
15/12/2016
2.3 Metadata last update
15/12/2016
3. Statistical presentation
3.1 Data description

Data on causes of death (COD) provide information on mortality patterns and form a major element of public health information.

COD data refer to the underlying cause which - according to the World Health Organisation (WHO) - 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".

Causes of death are classified by the 86 causes of the "European shortlist" of causes of death. This shortlist is based on the International Statistical Classification of Diseases and Related Health Problems (ICD).

COD data are derived from death certificates. The medical certification of death is an obligation in Italy. The information provided in the medical certificate of cause of death is coded into ICD codes according to the rules specified in the ICD.

Data are broken down by sex, 5-year age groups, cause of death and regional level (NUTS level 2), residence and occurrence. 
Annual national data are provided in absolute number. 

3.2 Classification system
Data year ICD revision used (ICD-8, ICD-9, ICD-10) For ICD-10: updates used
1990 ICD-9  
1991 ICD-9  
1992 ICD-9   
1993 ICD-9   
1994 ICD-9   
1995 ICD-9   
1996 ICD-9   
1997 ICD-9   
1998 ICD-9   
1999 ICD-9   
2000 ICD-9   
2001 ICD-9   
2002 ICD-9   
2003 ICD-10  2005
2004    
2005    
2006 ICD-10  2005 
2007 ICD-10  2007 
2008 ICD-10  2008 
2009 ICD-10  2009 
2010 ICD-10  2009 
2011 ICD-10  2009 
2012 ICD-10  2009 
2013 ICD-10 2009
2014 ICD-10  2009
2015 ICD-10 2009
2016 ICD-10 2016
3.3 Coverage - sector

Public Health, Causes of death

3.4 Statistical concepts and definitions

1. National definition used for usual residency

Usual residency refers to the Italian legal residency registered at Civil Registry and it is the place where a person
normally spends the daily period of rest, regardless of temporary absences

 

2. Stillbirths

a) National definition used for stillbirths

In Italy there is a definition applied in the survey on spontaneous abortion: stillbirths are foetal deaths with a gestional age of more than 180 days.
Nevertheless, the official information source used to report stillbirths, that is Birth Delivery Certificate (Decree of Ministry of Health 349/2001), collects data about stillbirths irrespective of the duration of pregnancy. This information source collects, in addition, all the characteristics used to classify and group stillbirths (gestational age, weight, crown-heel) according to the Commission Regulation (EU) No 328/2011.

 

b) What are the characteristics that you collect (gestational age, weight, crown-heel)?

Gestational age, weight, crown-heel 

3.5 Statistical unit

The statistical unit is the deceased person. The reporting unit is a physician for health section and the municipal register officer for socio-demographic section.

3.6 Statistical population

Statistical population: all deaths and stillbirths occurring in Italy, distinguishing residents and non-residents.

 

1. Neonates: Are neonatals of non-resident mothers considered residents?

No, they are not residents as the residence of newborns is the residence of the mother 

 

2. Coverage

a) Do you include non-residents in your national statistics?

Yes, if they die in our country. About  stillbirths, our national statistics include events occured in Italy from non-resident mothers.

 

b) Do you include residents dying abroad in your national statistics? If yes, how do you record the cause of death? 

No,our national statistics refer only to deaths occurred in the country. 

3.7 Reference area

The statistical data on causes of death refer to Italy.

Region of occurrence and residence (Nuts2) are indicated.

3.8 Coverage - Time

Italian data are available from 1994 onwards.


Note that due to the fact that 2011 data is the first data collection with a legal basis (and few changes in the requested variables and breakdowns), the data between 1994-2010 and starting from 2011 could not be always comparable (In part due to the different groupings of causes of deaths). Moreover time series for data on stillbirths starts in 2011 and no information on previous data is available.

3.9 Base period

Not applicable.

4. Unit of measure

The data are provided to Eurostat in absolute numbers. Then data are published in absolute numbers, crude death rate and standardised death rate.

5. Reference Period

Data refer to the calendar year (i.e. all deaths occurring during the year). 

6. Institutional Mandate
6.1 Institutional Mandate - legal acts and other agreements

Countries submitted data to Eurostat on the basis of a gentleman's agreement established in the framework Eurostat's Working Group on "Public Health Statistics" until data with reference year 2010. The first data submitted according to the Regulation (EU) No 328/2011 is data with reference year 2011.
A Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was signed by the European Parliament and the Council on 16 December 2008. This Regulation is the framework of the data collection on the domain.
Within the context of this framework Regulation, a Regulation on Community statistics on public health and health and safety at work, as regards statistics on causes of death (EU) No 328/2011 was signed by the European Parliament and the Council on 5 April 2011.

6.2 Institutional Mandate - data sharing

Common specifications with the World Health Organisation (WHO) were used in the data collection up to 2010; in addition, Eurostat asks for NUTS level 2. From 2011 onwards, Eurostat changed the specifications to take into account the data collected through the Regulation No 328/2011.

7. Confidentiality
7.1 Confidentiality - policy

Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.

Information on Istat confidentiality policy is available on the Istat website: http://www.istat.it/en/tools/methods-and-it-tools/analyse

7.2 Confidentiality - data treatment

All age groups showing a total mortality of less than 4 cases are considered as confidential. Therefore, any 'confidential' agegroup is grouped with another one to have higher numbers. In practice, this problem mainly occurs for young ages so, either the ages from 0 to 14 years old, or the ages from 0 to 14 and 15 to 24 years old are grouped. The age groups considered as confidential show then the value ':' and the age group '0-14y' (and '15-24y' if needed) shows the sum of all ages before 15 years old (or between 15 and 24 years old).

8. Release policy
8.1 Release calendar

Not applicable.

8.2 Release calendar access

Not applicable.

8.3 Release policy - user access

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

At national level aggregated data are disseminated for free to all users in electronic format (website, Istat datawarehouse), in the same time . 

9. Frequency of dissemination

Annual.

10. Accessibility and clarity
10.1 Dissemination format - News release

At Eurostat level, news releases on-line.

At National level it is not applicable.

10.2 Dissemination format - Publications

Causes of death data are disseminated in many different publicatons "multi-source".

Among the most relevant there are:

"Italy in figures"   (http://www.istat.it/en/archive/200600)

"Italian Statistical Yearbook" (https://www.istat.it/it/archivio/213021)

"BES. Benessere Equo Sostenibile" (https://www.istat.it/it/files//2017/12/Bes_2017.pdf)

10.3 Dissemination format - online database
10.4 Dissemination format - microdata access

According to the national laws, techniques have been adopted to protect the confidentiality of the microdata.

Given the sensitiveness of data, the microdata access is limited to the projects included in the National Statistical Program (PSN) approved by law.

10.5 Dissemination format - other

Only for data of the reference year 2014 a release was disseminated: http://www.istat.it/it/archivio/199352

For data of the reference year 2012 a release was disseminated : http://www.istat.it/it/archivio/140871

A relevant publication is also the following: "La mortalità dei bambini ieri e oggi: l’Italia post-unitaria a confronto con i Paesi in via di sviluppo" http://www.istat.it/it/archivio/40505

10.6 Documentation on methodology

Documents for COD are available in CIRCABC, Causes of Death section.

Process documents are available here: http://siqual.istat.it/SIQual/dettaglioIndagine.do?dispatch=docGenerali&id=5000131&language=UK

10.7 Quality management - documentation

The official quality documentation on causes of death statistics is available on the Istat official quality documentation system (SIQual) : http://siqual.istat.it/SIQual/visualizza.do?id=5000131

11. Quality management
11.1 Quality assurance

Since the 90s Istat adopted a systematic approach to ensure quality in both statistical information and service to the community: http://www.istat.it/en/about-istat/quality

11.2 Quality management - assessment

During 2015 an audit procedure to assess the system of statistics on causes of death has been performed.

The overall assessment was positive, the aims of system are clear and well defined, and they are shown on a wiki page. The audit showed that there are not issues related to the coverage and the list of reference of the survey. Furthermore any attempt to reduce the statistical burden was performed. Regarding the IT, the validated data are systematically stored on an Oracle DB, and they are adequately protected following the standards of the Institute. The data released on the web are accompanied by links to SIQual, the Istat official quality documentation system.

12. Relevance
12.1 Relevance - User Needs

Main users are public national and local government, public research institutes and private researchers.

Data are mainly used to support the decisions about public policies on health and to study the mortality (trend, risk factors, etc)

Sometimes users ask for more detailed data (e.g. nuts3 level, microdata), but generally these requests cannot be met for confidentiality reasons.

12.2 Relevance - User Satisfaction

The views and opinions of the users are not regularly collected but during the meeting for the arrangement of the National Statistical Program (PSN) the Committee of Statistical Information Users (CUIS) is consulted to highlight the possible weaknesses of data. In general terms the users resulted satisfied.

12.3 Completeness

All data requested are sent and disseminated on Eurostat's website.

13. Accuracy
13.1 Accuracy - overall

As the data collection is total population based, the sampling error is not applicable. Many efforts are spent to detect and to obtain the missing models by the non-respondent municipalities, reaching a coverage level of about 100%. An editing and imputation procedure is applied to data to check and correct the measurement errors and item non-responses. Significant investments (tools to support encoding, training coders, etc.) are continously made to improve the quality of causes of death coding.

13.2 Sampling error

Not applicable.

13.3 Non-sampling error

see 13.1

14. Timeliness and punctuality
14.1 Timeliness

From data collection with reference year 2011 onwards the submission of final data for the year N is at N+24 months, as requested by the European Regulation.

14.2 Punctuality

From data collection with reference year 2011 onwards, Istat mets the deadline of the Regulation.

15. Coherence and comparability
15.1 Comparability - geographical

The comparability of the data across different countries is limited by the fact that the revision of classification used to collect information on underlying causes of death may be different. Italy adopts the tenth revision of the ICD since 2003 reference year. The recommended WHO's updates are applied as indicated in the table of point 3.2.

15.2 Comparability - over time

Due to the fact that in 2003 the tenth revision of the ICD has been adopted the data between 1994-2002 and starting from 2003 could not be always comparable. Moreover time series for data on stillbirths starts in 2011 and no information on previous data is available.

15.3 Coherence - cross domain

Two different data sources for collecting mortality data in Italy are carried out by the National Institute of Statistics (Istat):

1)       “Deleted to death from population registers” (Demographic Statistics or DS)

2)       “Causes of death” (CoD). 

The DS survey refers to cancellation due to death from the Population register of all residents in Italy, including those died abroad. CoD statistics instead refer to all deaths occurred in Italy (for both residents and non residents).

The discrepancies found between DS and CoD data are primarily ascribed to the different data source: acquisition of an administrative archive cancellation for the DS data versus a data collection of death certificates completed by physicians for the CoD data and to the different population that these two different data sources belongs to, actually the residents dying outside the country are collected only by DS.

 

Is there any missing information (uncomplete geographical coverage, missing certificates, …)? If yes, please indicate also the %.

Yes, there may be missing certificates. We can estimate an uncomplete geographical coverage rate of about 1% of municipalities (but only very small municipalities). Regarding stillbirths, geographical coverage is complete and missing events are of negligible order.

15.4 Coherence - internal

Italian data on causes of death are internally consistent.

16. Cost and Burden

Main costs concern the recording and coding phases. Nevertheless increasing use of IT tools allowed to reduce costs. 

17. Data revision
17.1 Data revision - policy

Not applicable.

17.2 Data revision - practice

There is no systematic revision of previous year data. Data are occasionally revised, e.g. if the "NUTS" changes.

18. Statistical processing
18.1 Source data

For each death a death certificate is filled in by a physician. He must indicate "all diseases, morbid or traumatic conditions that led or contributed to death, and the circumstances of the accident or violence that provoked these traumatisms" in the health section of certificate, hereby also reporting other relevant information linked to the death. Once the physician has filled in the health section, the form is sent to the pertinent municipality. The registrar must complete the certificate by indicating the socio-demographic data of the deceased. In particular, other than the dates of birth and death this information concerns the place of birth and residence, marital status, educational level, profession, branch of economic activity, citizenship and individual code of the deceased. If death has occurred during the first year of life, the form is slightly different and, as regards the demographic section, the requested information mainly refers to the condition of the parents. Having been filled out in duplicate, the form follows two different paths: one copy is sent to the ASL (where the death occurred), whereas the other copy, before being sent to Istat, is sent to the Prefectures and Regional Offices.

18.2 Frequency of data collection

Annual.

18.3 Data collection
1. Automated Coding
Data year a) Did you use any form of automated coding? [Yes / No] b) If yes, please indicate the system used (IRIS, MICAR, ACME, STYX, MIKADO, others)
1990 No  
1991 No   
1992 No   
1993 No   
1994 No   
1995 Yes   
1996 Yes   
1997 Yes   
1998 Yes   
1999 Yes   
2000 Yes   
2001 Yes   
2002 Yes   
2003 Yes   
2004    
2005    
2006 Yes  ACTR_MICAR_ACME
2007 Yes  ACTR_MICAR_ACME 
2008 Yes  ACTR_MICAR_ACME 
2009 Yes  ACTR_MICAR_ACME 
2010 Yes  ACTR_MICAR_ACME 
2011 Yes  ACTR_MICAR_ACME 
2012 Yes  ACTR_MICAR_ACME 
2013 Yes ACTR_MICAR_ACME
2014  Yes ACTR_MICAR_ACME
2015 Yes ACTR_MICAR_ACME
2016 Yes IRIS

 

2. Underlying cause of death selection and modification
Data year a) only manual selection of underlying cause b) manual with ACME decision tables (if yes, which version of ACME) c) ACS utilising ACME decision tables (if yes, which version of ACME) d) own system (ACS without ACME) e) Comments
1990 Yes No No No  
1991 Yes  No  No  No  
1992 Yes  No  No  No   
1993 Yes  No  No  No   
1994 Yes  No  No  No   
1995 YES for external causes, HIV infections some cases*, some drug-related deaths, infant deaths**         No        ACME for mainframe  No  * sentinel codes for HIV, AIDS were identified in multiple causes file, if HIV infection was not selected as u.c. (codes 042-044) the record was extracted for manual check-coding;** less than 1 year of age; *** MC not coded, only strings are availables       
1996 No ACME for mainframe
No 
1997 No ACME for mainframe  No 
1998 No 1998  No 
1999 No 1998   No 
2000 No 1998   No 
2001 No 1998   No 
2002 No 1998   No 
2003   YES (2005) for external causes and infant deaths  2005.02 No   
2004          
2005          
2006   YES (2005) for external causes and infant deaths  2005.02  No   
2007   YES (2007) for external causes and infant deaths   2005.02  No   
2008   YES (2008) for external causes and infant deaths   2008.30  No   
2009   YES (2008) for external causes and infant deaths   2008.30  No   
2010   YES (2009) for external causes and infant deaths   2009.10  No   
2011   YES (2009) for external causes and infant deaths   2009.10  No   
2012   YES (2009) for external causes and infant deaths   2009.10  No   
2013   YES (2009) for external causes and infant deaths 2009.10 No  
2014   YES (2009) for external causes and infant deaths 2009.10 No  
2015   YES (2009) for external causes and infant deaths 2009.10 No  
2016   YES (2009) for external causes and infant deaths 2009.10 No  

 

3. Information available in the national COD database
Data year Which information do you store in your national COD database - the underlying cause (UC) only or multiple causes (MC)?
1990 UC
1991 UC 
1992 UC 
1993 UC 
1994 UC 
1995 UC + MC *** 
1996 UC + MC *** 
1997 UC + MC *** 
1998 UC + MC *** 
1999 UC + MC *** 
2000 UC + MC *** 
2001 UC + MC *** 
2002 UC + MC *** 
2003 UC + MC 
2004  
2005  
2006 UC + MC 
2007 UC + MC 
2008 UC + MC 
2009 UC + MC 
2010 UC + MC 
2011 UC + MC 
2012 UC + MC 
2013 UC + MC
2014 UC + MC
2015 UC + MC
2016 UC + MC

In Italy, data are collected by a paper death certificate. The same certificate for males and females is used.

 

4. Stillbirths and Neonates: Do you have a different death certificate or do you code these data differently from other deaths? If yes, how?

a) Stillbirths

Yes, about  stillbirths, the source of data is Birth Delivery Certificate for which the Ministry of Health is responsible (Decree of Ministry of Health 349/2001). This information source collects data about births, stillbirths and congenital anomalies at birth, irrespective of the duration of pregnancy.

 

b) Neonates

Yes, Istat has a different death certificate for neonatal and infant deaths (all deaths under 1 year of age)

18.4 Data validation

What are the criteria (external source, local registers, …) used for the validation of the coverage?

We use external sources such as the data of demographic events of civil registry.
Regarding stillbirths, as external source we use Hospital Discharges Information for the validation of the coverage of deliveries.

18.5 Data compilation

The Italian statistics on causes of death are produced by a centralized system of coding and data processing.

Causes of death are coded by an automated coding system (ACS), that requires alphanumerical registration of the health section of the death certificate. Only causes rejected by this system are manually coded. Since reference year 2003 also data on multiple causes are coded.

An editing and imputation procedure is applied to check and correct the measurement errors and item non-responses. The procedure is based on both deterministic (health and socio-demographic data) and probabilistic approach (socio-demographic data), to input incorrect and missing data. Much of the probabilistic procedure is based on the Nearest-neighbour Imputation Methodology (NIM, developed by Statistics Canada).

18.6 Adjustment

no applicable

19. Comment

None.