Evaluation of the quality of cause of death statistics of the last decades in the European Union

Abstract Introduction The European Union (EU) do not publish the quality of cause-of-death statistics, when is possible to assess quality by reliability. Quality does not present consolidated indicators. Ill-defined and other inaccurate causes have presented different groupings. Objective To assess the quality of official cause-of-death statistics of the European Union by member states from 2006 to 2020. Methods Cases and population were from the WHO repertory. We selected causes in EU27 countries by up to fourth code-character of ICD10 -on the EuroStat website were not available-. Case counts were grouped into ill- defined, unspecific, less specific (the latter two, in inaccurate), and judicial (inaccurate external causes) categories, based on literature and expertise. We calculated age-adjusted rates to the Standard European Population by country, sex, period (2006-, 2011- and 2016-2020), and quality category. We tested the Comparative Mortality Ratio (CMR) of each country to the European Union median by a Bayesian approach, at 5% statistical significance. We plotted the rates proportion of each quality category in its all causes. Results We included 25 countries. Some did not report all years. Six countries showed >19% for ill-defined causes and 3 member states had <5% in both sex and last period. In inaccurate, for the same time period and sex, average pointed 10% with a range of 3-19%. In the same period, CMR exceeded significantly the EU median in 19 and 18 countries for women and men, respectively; and exceeded in unspecific causes in 12 countries for women and men. Discussion Literature showed that incorrect causes of death were random distributed. Probably major causes were biased and underestimated. Conclusions Quality of cause of death is a useful indicator of mortality statistics reliability. Quality indicators targeted national gaps across EU. We need a new EU task force on statistics of causes of death in accordance with the XXI century. Key messages • Quality indicators of causes of death statistics targeted national gaps across the European Union. • The statistics of death causes underestimated the main causes of death in the European Union.

In 2015 the German Prevention Act was implemented. The National Prevention Conference published the first National Prevention Report in 2019 to evaluate the health promotion activities. The second National Prevention Report is planned for 2023. Development of a harmonized prevention reporting system for the German Federal States is needed to form the basis for the contribution of the Federal States to the next National Prevention Report. A working group mandated from the sub-national health authorities has developed a harmonized prevention reporting system for the German Federal States since 2018. The Robert Koch Institute collaborated as representative of the national level during the process. Subject areas for indicators were selected based on a survey in which all 16 State Ministries of Health participated. Indicator subgroups developed indicators for each subject area based on predefined indicator selection criteria. Final set of indicators was adopted by indicator rating and majority voting process. The German Health Ministers Conference acknowledged the indicator system in June 2021. The conceptual framework is adapted from the health determinants model of Dahlgren and Whitehead. The indicator system is divided into 14 subject areas categorized into upstream, midstream and downstream level of prevention indicators. Seventy-three prevention indicators were included as a whole. The indicator short list consists of 32 Core indicators. An overview of the prevention indicator system will be given. First results of a pilot data collection will be shown. Health promotion and prevention reporting tools are needed to monitor prevention policies and evaluate health promotion measures. The prevention indicator system of the German Federal States will be used for the National Prevention Strategy in Germany of which one component is the next National Prevention Report 2023. Key messages: The prevention indicator system of the German Federal States is a useful tool to monitor prevention policies.
The indicator system will form the basis for the German Federal States' contribution to the National Prevention Report 2023.

Background:
The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland, in the context of disabilityadjusted life years (DALYs). Providing robust estimates of burden is the first step in identifying areas of prevention which could have the biggest impact on health; including identification of modifiable risk factors and changes in the underlying risk factor prevalence. Our aim was to estimate DALYs for 2019, to describe the current burden in Scotland and as a baseline for future burden scenarios.

Methods:
The SBoD 2016 study estimated the burden using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2019 observed deaths and the application of the Global Burden of Disease (GBD) aspirational life table. Population attributable fractions (PAFs) were sourced from the GBD 2019 and risk factor prevalence from the Scottish Health Survey.

Results:
In 2019 the leading causes of burden were ischaemic heart disease (IHD), Alzheimer's/other dementias, lung cancer, druguse disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Application of PAFs shows that a proportion of the burden for each of these causes can be attributed to modifiable risk factors.

Conclusions:
IHD continues to be the leading cause of health burden in Scotland in 2019. However recent years show an increase in burden of social causes and diseases affecting the ageing population. Application of PAFs demonstrate the importance of continuing to monitor both the burden of disease in Scotland and the prevalence of risk factors, to provide robust evidence for planning of local and national services. Key messages: The Scottish Burden of Disease continues to monitor the population health landscape of Scotland. Ischaemic heart disease continues to be the leading cause of burden in Scotland.

Methods:
Cases and population were from the WHO repertory. We selected causes in EU27 countries by up to fourth codecharacter of ICD10 -on the EuroStat website were not available-. Case counts were grouped into ill-defined, unspecific, less specific (the latter two, in inaccurate), and judicial (inaccurate external causes) categories, based on literature and expertise. We calculated age-adjusted rates to the Standard European Population by country, sex, period (2006-, 2011-and 2016-2020), and quality category. We tested the Comparative Mortality Ratio (CMR) of each country to the European Union median by a Bayesian approach, at 5% statistical significance. We plotted the rates proportion of each quality category in its all causes.

Results:
We included 25 countries. Some did not report all years. Six countries showed >19% for ill-defined causes and 3 member states had <5% in both sex and last period. In inaccurate, for the same time period and sex, average pointed 10% with a range of 3-19%. In the same period, CMR exceeded significantly the EU median in 19 and 18 countries for women and men, respectively; and exceeded in unspecific causes in 12 countries for women and men.

Discussion:
Literature showed that incorrect causes of death were random distributed. Probably major causes were biased and underestimated.

Conclusions:
Quality of cause of death is a useful indicator of mortality statistics reliability. Quality indicators targeted national gaps across EU. We need a new EU task force on statistics of causes of death in accordance with the XXI century.

Background:
Hypertension is largely asymptomatic and contributes to considerable lifetime cardiovascular morbidity and mortality, costing the NHS £2.1 billion annually. The national prevalence of hypertension is 13.7 % and lack of a national screening programme, despite meeting aspects of the Wilson Junger criteria, adds to delays in detection and treatment. Earlier detection could mitigate future cardiovascular risk. We wanted to understand the potential of detection of prehypertension in primary care to see if this fits the Wilson and Junger criteria for a screening programme.
Methods: GP records of adult patients n = 2178 with a known diagnosis of hypertension on the hypertension register from a practice population of 10,000 patients (prevalence is 22%.) were analysed for the prevalence of prehypertension systolic 120-139 mm hg and diastolic bp of 80-89. The average length of prehypertension, the time delay in detection and treatment were assessed, alongside the prevalence of clinical and therapeutic inertia.

Results:
A retrospective analysis of a sample size of 1809 patients out of 2178 patients (83.1%) with known hypertension across 3 primary care sites over 20 years was undertaken. Of these 1809 patients, we found that 1095 patients (60.5%) were prehypertensive prior to being diagnosed. The mean time interval between detection of prehypertension to a formal hypertension diagnosis was 10.6 years, with a standard deviation of 7.89 years with no variation with age or sex. However, 588 patients (32.5%) did not have readings within the prehypertensive ranges prior to diagnosis and were opportunistically detected. 51 patients (2.82%) never had readings recorded within the prehypertensive range.

Conclusions:
Prehypertension predates hypertension by an average of 10.6 years. Offering annual screening nationally to patients of risk groups e.g., those with a family history, obesity, and alcohol excess, would enable earlier detection, treatment, and considerable cost saving. Key messages: Prehypertension predates hypertension; therefore, hypertension meets the Wilson Junger criteria for earlier detection by a screening programme, which is lacking in the UK. Offering a national scheme to screen for hypertension to those at a higher risk, can only be considered a benefit to the public and should be implemented.