RESUMO
Improved health care brought about major changes in mortality pattern; life expectancy has increased and the causes of death are more likely to result from chronic diseases, death rarely result from a single cause and the use of the underlying cause of death [UCD] will overlook many of the contributing diseases that are highlighted by multiple cause of death [MCD] analysis. The paper addresses the demographic and non-clinical variables related to the number of causes recorded in the death certificates notification [DCN]. All the DCN for the Kuwaiti population, 40 years or over for the period 1993-2001 were compiled and all the causes up to five additional causes were recorded. A total of 13960 cases [7966 males and 5994 females], reported in the period 1993-2001, were analyzed. The causes of death were provided according to the WHO ICD9. A single cause [UCD] was reported in 5.6% of the cases, 27.1% had 3 causes and 12.5% had 6 causes. The mean number of causes amounted to 3.64 and 3.8 for the males and females. Variability according to the year was not marked. Those dying in the hospitals had a relatively higher mean number of causes compared to those dying in other places, and this was common to the 2 gender groups. A rising trend was seen with age; with the males the 60-, 70- or 80+ age groups had higher mean number of causes compared to the younger groups. With females the means for the 60- and 70- groups were relatively higher than the other groups, the group 40+ was having lower means Compared to the other groups and this was common to the 2 gender groups, particularly with the males. The UCD alone was reported for less than 7% of the causes of death among the Kuwaiti population 40 years or over. Use of multiple cause of death will add a lot of useful information that can be used to highlight several disease conditions not shown by the UCD