Counting injury deaths: a comparison of two definitions and two countries.

OBJECTIVES: This study sought to examine the discrepancy in counting injury deaths according to two definitions, that is, (a) external cause of injury as the underlying cause of death (UCOD), and (b) with mention of external cause of injury, and differences in certification practices between Taiwan and the USA. METHODS: We calculated the percentage (U/M%) in which external cause of injury was selected as the UCOD (U) among deaths with mention (M) of external cause of injury anywhere on the death certificate to assess the discrepancy between the two definitions in counting injury deaths. RESULTS: The discrepancy was small in Taiwan and in the USA for transport injuries (with U/M% 99% and 98%) and intentional self-harm (100% and 100%) and large for accidental suffocation (64% and 29%) as well as complications of medical and surgical care (61% and 10%). The magnitude of discrepancy was not consistent between countries in accidental falls (96% vs 81%) and accidental drowning (80% vs 97%). Certifiers in Taiwan were more likely to report an accidental fall in Part I of the death certificate and less likely to report medical conditions (such as stroke, Alzheimer's disease or Parkinson's disease, etc) with accidental suffocation than their counterpart US certifiers. CONCLUSIONS: The counting of injury deaths according to two definitions varied by external cause of injury as well as between countries. For some external causes of injury with high discrepancies, we suggest presenting the number of injury deaths according to two definitions.

Possible effect of implementing a national query program on site-specific cancer mortality rates in Taiwan.

BACKGROUND: This study aimed to examine possible effects of implementing a national query program on site-specific cancer mortality rates. MATERIALS AND METHODS: A total of 2,874 query letters were sent out by the Department of Statistics, Ministry of Health and Welfare of Taiwan between January 2009 and December 2011 to medical certifiers who reported "neoplasm with uncertain nature" on the death certificate asking for more detailed information for coding. RESULTS: Of the 2,571 responses, in 1,398 cases (54%) medical certifiers were still unable to determine the nature of the neoplasm. There were four neoplasm sites for which more than 50% of the responses changed the category to malignant, the gastrointestinal system (73%), urinary system (60%), stomach (55%) and rectum (53%). The liver was the cancer site that showed the largest absolute increase in the number of deaths after the query; however, the brain showed the largest relative increase, at 12%. CONCLUSIONS: Different neoplasm sites showed different magnitudes of change in nature after the query. Brain cancer mortality rates exhibited the largest increase.