Accuracy of Mortality Statistics in Palestine

Mortality statistics are widely used for medical research, monitoring trends in public health, and the planning and evaluation of health care. It is vital to ensure a high degree of accuracy due to the important public health needs served by cause of death statistics. This requires an accurate diagnosis of the cause of death by the person certifying the event; in addition to the correct identification and coding of the underlying cause of death in line with international standards.

In Palestine, the Cause of Death Registry (CoDR) is part of the national vital statistics database that holds information on both births and deaths. It holds information on deaths and causes of deaths since1994 in a database at the Palestinian Health Information Centre (PHIC) at Ministry of Health (MoH). Prior to that date, causes of death were registered with the Israeli Civil Administration.

The main source of data for the registry is the Death Notification Form (DNF), filled either by the attending physician in hospitals or by a licensed physician if the death occurred outside a hospital.

Based on 2011 data, around 50-60% of deaths occur in hospitals.

For the sake of the study, PNIPH retrieved medical records for a random sample of hospital deaths reported in 2012: 371 deaths in the West Bank and 199 deaths in the Gaza Strip. Reviewers completed medical extraction forms and termed Evaluation Death Certificates (EDC), in order to evaluate original Death Notification Forms (DNF) on the basis of patients’ hospital records.

Main Results:

• Demographic data was better specified in Gaza sample than in West Bank
• At an aggregated level, less than half of the underlying causes in the PHIC registry stated the correct cause of death
• Original DNFs stated the correct underlying cause more often than the PHIC Cause of Death Registry, however, a substantial number of DNFs were still unsatisfactory.
• Procedures for coding and classification at the PHIC deviate considerably from the international norms defined in the ICD; and account to a considerable extent for the discrepancies between the cause of death determined on the EDC and the cause of death coded by the PHIC.
• In general, deaths due to malignant neoplasms were more accurately reported on DNFs than other causes of death, and metabolic diseases (including diabetes) were the most problematic. Issues with coding and classification at the PHIC were most apparent for perinatal conditions and congenital anomalies.

Study Recommendations:

The two major reasons for low accuracy in the causes of death recorded in the PHIC Registry are:

• Using of international coding software for coding and classification, such as Iris software.
• Using Iris software, which incorporates ICD coding instructions and an extensive dictionary of English medical terms. This would make coding more consistent and improve international comparability.
• Improving the adopted DNF design
• Providing certifiers with feedback
• Reviewing and improving data handling at hospitals with electronic patient records.