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".

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 the International Classification of Diseases (ICD) codes according to the rules specified in the ICD.

Eurostat's CoD statistics build on standards set out by the World Health Organisation (WHO) in the International Classification of Diseases (ICD).

The regional breakdown is based on the Nomenclature of Territorial Units for Statistics (NUTS 2).

Classification and updates applied by years

Public Health, Causes of death

Concepts and definitions are described in the Commission regulation (EU) No 328/2011 in articles 2 and 3.

The characteristics collected are: gestational age, weight, crown-heel

The statistical units are the deceased persons and the stillborns, respectively.

All deaths and stillbirths occurring in Italy, distinguishing residents and non-residents.

Neonates of non-resident mothers are not considered residents as the residence of newborns is the residence of the mother.

The statistical data on causes of death refer to Italy.

Region of occurrence and residence (Nuts2) are indicated.

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 before and after 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.

Not applicable.

The unit is number.

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

CoD data was submitted 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.

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. 

CoD data according to this regulation is submitted to Eurostat since reference year 2011.

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.

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: https://www.istat.it/en/methods-and-tools/methods-and-it-tools/analyse

Annually, about 24 months after the end of the reference period.

Not applicable.

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.

Annual.

At Eurostat level, news releases on-line.

At National level it is not applicable.

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)

"Noi Italia" (http://noi-italia2019.istat.it/index.php?id=3&L=1)

"Italian Statistical Yearbook" (https://www.istat.it/it/files//2019/12/Asi-2019.pdf)

"BES. Benessere Equo Sostenibile" (https://www.istat.it/it/files//2019/12/BES-2019-en.pdf)

Please consult free data on-line: http://ec.europa.eu/eurostat/data/database

Health For All: http://www.istat.it/it/archivio/14562

I.Stat: http://dati.istat.it/

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.

Only for data of the reference years 2011-2013 a release was disseminated: https://www.istat.it/it/archivio/196880

Only for data of the reference year 2014 a release was disseminated: http://www.istat.it/it/archivio/199355

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

Process documents are available here: http://siqual.istat.it/SIQual/lang.do?language=UK

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

Since the 90s Istat adopted a systematic approach to ensure quality in both statistical information and service to the community: https://www.istat.it/en/organisation-and-activity/institutional-activities/quality-commitment

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.

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.

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.

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

1. For mandatory variables:

 100%

2. For voluntary variables:

 76% (19/25)

3. For additional variables:

• External CoD

 It is provided for general and neonatal deaths, not for stillbirths

• Place of occurrence for external CoD

  It is not provided

• Activity for external CoD

  It is not provided

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.

Not applicable. Data collection is from administrative sources.

Not applicable.

Not applicable. Data collection is from administrative sources.

Not applicable.

not applicable

24 months

From data collection with reference year 2011 onwards, Istat mets the deadline of the Implementing Regulation (EC) No. 328/2011, Article 4.

The data are geographically comparable because all data processing is managed centrally by Istat. Moreover geographical coverage is complete and missing events are of negligible order.

Not applicable.

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.

Not applicable, only annual data are available.

Not applicable.

Italian data on causes of death are internally consistent.

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

Not applicable.

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

Not applicable.

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.

Annual.

Not applicable because we do not have any statistics on certification training or post-mortem exam courses attended by certifiers. We also do not handle any post-mortem queries.

Table on certification (Percentage)

a) 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

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

https://www.istat.it/ws/fascicoloSidi/924/Scheda%20di%20morte%20-%20Modello%20ISTAT%20D.4%20BIS.pdf

Description of coding procedure (central level, distributed among other bodies, etc.):

The coding is performed at central level, using the automated coding system Iris. Percentage of rejects of Iris is about 20%. Rejected certificates are manually revised by trained coders.

Description of the procedures to detect errors (i.e.errors such as potential inconsistency in the death certificate or error due to mistake when filling the deaths certificates):

Inconsistencies between cause of death and other informations on death certificate (age, sex, manner of death) are detected with on-line alerts during coding, so the coders can check the original death certificate and correct. At the end of the year a consistency check is also run for the detection of inconsistencies.

Description of the measures taken in order to solve detected errors:

Errors detected are corrected manually by expert coders.

Coding performed by a certifier:

Certifiers do not perform coding in Italy

Estimation of the percentage of autopsy from which information is available for coding:

Not applicable

Description of double coding exercises and rate of codification errors for underlying cause of death:

Not applicable

ICD codes for the underlying cause (% of the Total)

Unknown country/region (%) for residents and non-residents who died in the country

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.

The imputation procedures are 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 procedures are based on the Nearest-neighbour Imputation Methodology (NIM, developed by Statistics Canada).

Age: 8.3%
Gender: 0.67%
Residence: 1%
Civil status: 2.2%
Educational level: 21.5%

Not applicable

Not applicable.

None.