Identifying a single disease as the underlying cause of death is an oversimplification of the clinical-pathological process leading to death. The multiple causes of death approach examines any mention of a disease in death certificates. Taking heart disease as an example, the study investigates: patterns of death certification, differences in mortality figures based on the underlying cause of death and on multiple causes of death, factors associated to the mention of heart disease in death certificates, and potential of multiple causes of death in the analysis of the association between chronic diseases.
The whole mortality archive of the Rajkot Municipal Corporation was extracted from 2014 to 2018. Mortality rates and proportional mortality were computed for heart disease as the underlying cause of death and as multiple causes of death. The position of the death certificate where heart disease was mentioned was analyzed. A subset of 3,126 death certificates of known heart patients (identified from the archive of exemptions from medical charges) was analyzed, with mention of heart disease as the outcome and characteristics of subjects as well as other diseases reported in the certificate as predictors.
Year wise mortality from heart disease selected as the underlying cause of death (UCOD), or mentioned in any position of the death certificate: Rajkot Municipal Corporation, 2013–2018.
Table . 2
Gender and Year wise Proportional mortality by from heart disease selected as the underlying cause of death (UCOD), or mentioned in any position of the death certificate: Rajkot Municipal Corporation, 2013–2018.
Out of 84,282 deaths in the regional population in 2013 to 2018, heart disease was mentioned in 3126 decedents (0.037 %). The M/F ratio was 1.55. Table 1 shows that in approximately 3.7 % (i.e. 3126) of certificates, heart disease was mentioned heart disease as a UCOD. In these cases, 1900 were Male and 1226 Female. its selection as the UCOD was highly improbable. When heart disease was reported in Part I on the underlying cause line, a large proportion of certificates 96.3 % (i.e.81156) also mentioned other diseases on the same line. From above data we can also see that as compared to 2013 where 752 people died due to heart disease in 2018 only 290 people died. This shows that the heart treatment facilities are getting better. In same period total mortality increased from 13155 to 14950.
The use of multiple causes of death makes the analysis of mortality data more complex, but conveys more information than usual underlying cause of death analyses.