Steps through the revision process of reproductive health sections of ICD-11.

In 2007, the WHO initiated an organizational structure for the 11th revision of the International Classification of Diseases (ICD). Effective deployment of ICD-derived tools facilitates the use and collection of health information in a variety of resource settings, promoting quantitatively informed decisions. They also facilitate comparison of disease incidence and outcomes between different countries and different health care systems around the world. The Department of Reproductive Health and Research (RHR) coordinates the revision of chapters 14 (diseases of the genitourinary system), 15 (pregnancy, childbirth, and puerperium), and 16 (conditions originating in the perinatal period). RHR convened a technical advisory group (TAG), the Genito-Urinary Reproductive Medicine (GURM) TAG, for the ICD revision. The TAG's work reflects the collective understanding of sexual and reproductive health and is now available for review within the ICD-11 revision process.

Burden of mortality associated with autoimmune diseases among females in the United Kingdom.

OBJECTIVES: We estimated the collective burden of mortality from autoimmune diseases among females in the United Kingdom and the effects of death certificate coding changes on this estimate. METHODS: We analyzed 1993-2003 England and Wales death certificate data for 3,150,267 females aged 1 year or older. We identified death certificates that listed autoimmune conditions as underlying or contributory causes of death. The percentages of all female deaths attributed to autoimmune disorders and to UK official mortality categories were ranked to determine the leading causes of death. RESULTS: In 2003, autoimmune diseases were the sixth or seventh most frequent underlying cause of death among females in all age groups below 75 years. Results were similar when both underlying and contributory causes of death were considered. The proportion of females dying with an autoimmune disorder remained relatively constant from 1993 to 2003. Analyses indicated that death counts for specific autoimmune diseases had been underestimated. CONCLUSIONS: Autoimmune diseases are a leading cause of death among females in England and Wales, but their collective impact remains hidden in current disease classification systems. Grouping these disorders together may help promote research needed to identify common determinants and future prevention strategies.

Patterns of suicide by occupation in England and Wales: 2001-2005.

BACKGROUND: Suicide rates vary by occupation but this relationship has not been frequently studied. AIMS: To identify the occupations with significantly high suicide rates in England and Wales in 2001-2005 and to compare these with rates from previous decades. METHOD: Mortality data from death registrations in England and Wales over the calendar years 2001-2005 were used to calculate proportional mortality ratios (PMRs) and standardised mortality ratios (SMRs) for both men and women aged 20-64 years by their occupation. RESULTS: Among men, in 2001-2005, construction workers, and plant and machine operatives had the greatest number of suicides. The highest PMRs were for health professionals (PMR=164) and agricultural workers (PMR=133). Among women, administrative and secretarial workers had the greatest number of suicides yet the highest PMRs were found for health (PMR=232), and sport and fitness (PMR=244) occupations. CONCLUSIONS: Excess mortality from suicide remains in some occupational groups. The apparent changes in suicide patterns merits further exploration, for example examining the prevalence of depression and suicidal ideation in medical practitioners, dentists, veterinarians, agricultural workers, librarians and construction workers.

Tends in avoidable mortality in England and Wales, 1993-2005.

Avoidable mortality is a major public health concern but there has been little consensus among researchers on how it should be defined and reported. In this article two definitions of avoidable mortality are considered. These are used to present trends in avoidable deaths in England and Wales from 1993 to 2005, using two statistical indicators of mortality. Analysis of both definitions shows a substantial decline in causes of mortality that are considered amenable to medical intervention over this period. This article discusses which mortality indicator is most appropriate for measuring avoidable deaths, and highlights key issues in developing a National Statistics definition of avoidable mortality.

Trends in injury and poisoning mortality using the ICE on injury statistics matrix, England and Wales, 1979-2004.

This article shows trends in injury and poisoning mortality in England and Wales using a matrix of mechanism (e.g. fall, fire) by intent (e.g. accident, suicide) developed by the International Collaborative Effort (ICE) on injury statistics. Overall injury and poisoning mortality rates have declined for both males and females. Declines were greatest during the 1980s and early 1990s, with rates falling only slightly since. Rates were generally higher for males and were highest in the elderly. Transport death rates declined substantially. Death rates from falls declined to the mid 1990s but then increased. There were increases in death rates from drug abuse/dependence in both sexes and in homicide rates among males.

Trends in deaths related to drug misuse in England and Wales, 1993-2004.

In this article we report trends in deaths related to drug misuse in England and Wales from 1993 to 2004, looking particularly at the period between 1999 and 2004, for which there was a Government target to reduce these deaths by 20 per cent. Although there was an overall decline in deaths related to drug misuse between 1999 and 2004, the percentage reduction, at 9 per cent, was less than the Government target. There was an increase in deaths between 2003 and 2004, largely accounted for by deaths involving heroin/methadone and morphine. Mortality rates were highest in young adults and an increase in mortality rates within this group appears to have been the driver behind rising mortality trends during the 1990s.

Trends in mortality from Alzheimer's disease, Parkinson's disease and dementia, England and Wales, 1979-2004.

In this article we present trends in mortality from Alzheimer's disease, Parkinson's disease and dementia in England and Wales from 1979 to 2004. We describe the impact of mortality coding changes on the underlying cause of death, particularly the introduction of ICD-10 in 2001. We present rates for all mentions of the conditions on death certificates to interpret trends better. Mortality rates for the three conditions showed varying trends over the time period examined. Between 1985 and 2004, Alzheimer's disease showed a dramatic increase. Trends in mentions of dementia differed between males and females, with rates being relatively stable among males, but increasing among females. Rates for Parkinson's disease declined over this period.

The impact of introducing ICD-10 on analysis of respiratory mortality trends in England and Wales.

This article examines the impact of the introduction of ICD-10 on respiratory disease mortality statistics in England and Wales, specifically focussing on pneumonia, chronic lower respiratory diseases, and influenza. The main changes are highlighted and the article explains how figures can be adjusted to take account of these changes so that trends over time can be analysed. The number of deaths assigned to the respiratory disease chapter of the ICD as a whole decreased by 22 per cent as a result of the introduction of ICD-10. Although it is not usually recommended that comparability ratios from the CD-10 bridge-coding study are used to adjust rates prior to 1993, our analysis shows that unadjusted data for 1984 to 1992 can be used to examine longer time trends for respiratory diseases as a whole.

Leading causes of death in England and Wales--how should we group causes?

This article examines how best to identify the leading causes of mortality in England an Wales, by using different way of grouping causes of death, based on a list developed by the World Health Organization (WHO). Four different versions of this list are compared. The leading cause of death across all age groups depends on the ways in which common diseases and external causes are aggregated or disaggregated into groups. Areas of particular debate, examined in this article, are the grouping or splitting of accidents by mechanism and cancers by site within leading cause lists. These affect which causes appear in the top ten, and their order in different age groups.

Mortality from suicide and drug-related poisoning by day of the week in England and Wales, 1993-2002.

This article describes the pattern of mortality by day of the week in deaths from suicide and drug-related poisoning. An increased proportion of suicides occurred on Mondays, while the single day on which the largest number of suicides occurred was 1st January 2000, a Saturday. Together these suggest an effect of entering a new time period. The pattern for drug-related poisonings varied according to the coroner's verdict. An increased proportion of deaths from drug abuse/dependence and accidental drug-related poisoning deaths occurred on Saturdays among males, while the most common day of death for drug-related poisoning deaths with a suicide verdict was Monday for both sexes.

Trends in MRSA in England and Wales: analysis of morbidity and mortality data for 1993-2002.

This article examines trends in infection and mortality from methicillin-resistant Staphylococcus aureus (MRSA) over the period 1993 to 2002. Trends in the number of deaths where MRSA was mentioned on the death certificate were compared with national reporting of microbiologically-confirmed bacteraemia to the Health Protection Agency Communicable Disease Surveillance Centre (CDSC). Alongside national trends, patterns in the place of death were examined. Both the number of deaths and number of laboratory reports increased substantially over the period examined. MRSA mortality rates increased over 15-fold during the period 1993 to 2002. Reporting rates for bacteraemia increased 24-fold.

The effect of the introduction of ICD-10 on cancer mortality trends in England and Wales.

This article examines changes in deaths assigned to malignant and non-malignant neoplasms resulting from the introduction of ICD-10 in England and Wales. In particular the Government's target of reducing mortality rates from malignant cancers on those aged under 75. The main changes are highlighted and the article explains how data can be adjusted to take account of these changes so that trends in mortality rates over time can be analysed.

The impact of introducing ICD-10 on trends in mortality from circulatory diseases in England and Wales.

This article examines the impact of the introduction of ICD-10 on mortality from circulatory diseases in England and Wales. The article examines changes to specific types of circulatory disease, focussing on ischaemic heart disease (IHD) and cerebrovascular disease (stroke). The main changes are highlighted and the article explains how data can be adjusted to take account of these changes so that trends over time can be analysed. The article then looks at the impact of the changes on baselines for Government targets to reduce mortality from circulatory diseases. The number of deaths assigned to circulatory diseases increases by 3-4 per cent as a result of the introduction of ICD-10, replacing ICD-9. For cerebrovascular diseases specifically, the increase is 9 per cent for females and 13 per cent for males. Trends in mortality from IHD are unaffected by the introduction of ICD-10. However, the number of deaths assigned to acute myocardial infarction, which forms part of IHD, decreases by around 10 per cent when ICD-10 is used instead of ICD-9.