Garbage codes in the Norwegian Cause of Death Registry 1996-2019

Christian Lycke Ellingsen; G Cecilie Alfsen; Marta Ebbing; Anne Gro Pedersen; Gerhard Sulo; Stein Emil Vollset; Geir Sverre Braut

doi:10.1186/s12889-022-13693-w

Garbage codes in the Norwegian Cause of Death Registry 1996-2019

BMC Public Health. 2022 Jul 7;22(1):1301. doi: 10.1186/s12889-022-13693-w.

Authors

Christian Lycke Ellingsen^{1

2}, G Cecilie Alfsen^{3

4}, Marta Ebbing⁵, Anne Gro Pedersen⁶, Gerhard Sulo⁷, Stein Emil Vollset^{8

9}, Geir Sverre Braut¹⁰

Affiliations

¹ Department of Pathology, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway. christian.lycke.ellingsen@sus.no.
² Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020, Bergen, Norway. christian.lycke.ellingsen@sus.no.
³ Department of Pathology, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.
⁴ Faculty of Medicine, University of Oslo, PO Box 1078, Blindern, N-0316, Oslo, Norway.
⁵ Department of Research and Development, Haukeland University Hospital, PO Box 1400, N-5021, Bergen, Norway.
⁶ Department for Health Data and Collection, Norwegian Institute of Public Health, PO Box 973, Sentrum, N-5808, Bergen, Norway.
⁷ Centre for Disease Burden, Norwegian Institute of Public Health, PO Box 973, Sentrum, N-5808, Bergen, Norway.
⁸ Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020, Bergen, Norway.
⁹ Department of Health Metrics Sciences and Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
¹⁰ Department of Research, Stavanger University Hospital, PO Box 8100, N-4068, Stavanger, Norway.

Abstract

Background: Reliable statistics on the underlying cause of death are essential for monitoring the health in a population. When there is insufficient information to identify the true underlying cause of death, the death will be classified using less informative codes, garbage codes. If many deaths are assigned a garbage code, the information value of the cause-of-death statistics is reduced. The aim of this study was to analyse the use of garbage codes in the Norwegian Cause of Death Registry (NCoDR).

Methods: Data from NCoDR on all deaths among Norwegian residents in the years 1996-2019 were used to describe the occurrence of garbage codes. We used logistic regression analyses to identify determinants for the use of garbage codes. Possible explanatory factors were year of death, sex, age of death, place of death and whether an autopsy was performed.

Results: A total of 29.0% (290,469/1,000,128) of the deaths were coded with a garbage code; 14.1% (140,804/1,000,128) with a major and 15.0% (149,665/1,000,128) with a minor garbage code. The five most common major garbage codes overall were ICD-10 codes I50 (heart failure), R96 (sudden death), R54 (senility), X59 (exposure to unspecified factor), and A41 (other sepsis). The most prevalent minor garbage codes were I64 (unspecified stroke), J18 (unspecified pneumonia), C80 (malignant neoplasm with unknown primary site), E14 (unspecified diabetes mellitus), and I69 (sequelae of cerebrovascular disease). The most important determinants for the use of garbage codes were the age of the deceased (OR 17.4 for age ≥ 90 vs age < 1) and death outside hospital (OR 2.08 for unknown place of death vs hospital).

Conclusion: Over a 24-year period, garbage codes were used in 29.0% of all deaths. The most important determinants of a death to be assigned a garbage code were advanced age and place of death outside hospital. Knowledge of the national epidemiological situation, as well as the rules and guidelines for mortality coding, is essential for understanding the prevalence and distribution of garbage codes, in order to rely on vital statistics.

Keywords: Cause of death; Cause of death register; Death certificate; Garbage code; Non-informative code.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autopsy
Cause of Death
Disease Progression
Humans
International Classification of Diseases*
Registries