Transcript Status of Medical Certification of Cause of Death in India

Overview
of Mortality Coding and its usage in
MEDICAL CERTIFICATION OF CAUSE OF
DEATH
BY
SHIV KUMAR
DRG(MCCD) OFFICE OF THE RGI
Background
 1961 Conference on Improvement of Vital
Statistics
endorsed
the
gradual
introduction of scheme on Medical
Certification of Cause of Death only in
limited areas with support by legal
sanction (as subsequently provided in the
Registration of Birth and Death Act of 1969).
Introduction of MCCD
 MEDICAL CERTIFICATION OF CAUSE OF DEATH (MCCD)
under Civil Registration System was initiated by the
office of the RGI during the Third Five Year Plan. It was
operational in many states in the beginning of 70s.
 It provides data on deaths by age and sex in respect of
18 major groups, 66 categories and 197 sub-categories
of causes (includes few single causes) as per National
list based on ICD-9 till 1998.
 National list based on ICD-10 is comprised of 20 Major
Groups, 69 categories and 194 sub-categories of
causes is prepared by ORGI and been adopted since
1999.
Legal Provisions
 Medical Certification of Cause of Death under Civil
Registration System has got statutory backing
under sections 10(2) and 10(3) of the Registration of
Births & Deaths Act, 1969.
 The Act also incorporates a clause about the
confidentiality of the information on cause of death,
forbidding to disclose this in any extract provided
from the registration records.
 Under Section 23(3) of the RBD Act, any Medical
Practitioner who neglects or refuses to issue a
certificate under section 10(3) and any person who
neglects or refuses to deliver such certificate shall
be punishable with fine, which may extend to fifty
rupees.
Cause of death
A cause of death is disease, abnormality, injury
or poisoning that contributed directly or
indirectly to death.
Underlying cause of death
a) The disease or injury which initiated the
train of events leading directly to death;
or
b) The circumstances of the accident or
violence which produced the fatal injury.
Form of medical certificate

Sixth Decennial International Conference held in
April 1948 at Paris endorsed the:
1) Selection of Underlying cause of death as main
cause of death for tabulation of mortality data;
and
2) Tabulation list of mortality & morbidity

The standard format of the certificate is incorporated
in the rules made by the State Government.

The format of the certificate proper (medical part)
conforms to the standard prescribed by (WHO) :
International Format
Interval between
onset & death
approx.
CAUSE OF DEATH
I.
Immediate cause:
State the disease. Injury or
complication which caused
death, not the mode of dying
such as heart failure, asthenia,
etc.
Antecedent cause :
Morbid conditions, if any, giving
rise to the above cause, stating
the underlying conditions last.
II. Other significant conditions
contributing to the death, but not
related to the diseases or
conditions causing it.
(a). . . . . . . .
(due to (or as
consequence of )
a
(b) . . . . . . . . . . . . .
(due to (or as a
consequence of)
(c) . . . . . . . . . . . . ..
................
Revised Form of Medical Certificate in the revamped
system of civil registration w.e.f 1.1.2000
Form 4 for hospital deaths
1. Name of the Hospital
2. Name of the deceased
3. Sex( Male/Female)
4. Age at death
5. Cause of Death
1(a) Immediate cause of death
1(b) Antecedent cause of death
1(c) Underlying cause of death
6. Internal between onset and deaths
7. Manner of death
(1. Natural, 2. Accident 3. Suicide,
4. Homicide, 5. Pending investigation)
8. How did the injury occur?
9. Whether death related to
pregnancy?
Form 4A for Non-hospital
deaths
1. Name of the deceased
2. Sex( Male/Female)
3. Age at death
4. Cause of Death
1(a) Immediate cause of death
1(b) Antecedent cause of death
1(c) Underlying cause of death
5. Internal between onset and
deaths
6. Whether death related to
pregnancy?
Implementation of MCCD
Implemented in all States/Uts except:
 Newly created States: Uttranchal
Jharkhand
and
 Union Territories of Dadra & Nagar Haveli
and Daman & Diu
Coverage of MCCD
RECOMMENDATIONS OF 1980 WORKSHOP ON MCCD:
 First phase: The scheme was to cover
teaching
hospitals at State Headquarter towns to gain
experience of problems that may arise in introducing
the scheme;
 Second phase: Specialized hospitals and district and
sub-divisional hospitals;
 Third phase: Private hospitals, other public hospitals
and Primary Health Centres (PHCs) ; and
 Final phase: Private physicians practicing modern
medicine.
Coverage of hospitals in 1998
States/UTS
Existing
Covered
Reported
Andhra Pradesh @
3133
1652
314
Arunachal Pradesh
262
262
262
136
2528
80
136
4
56
136
4
50
63
2
2
Karnataka @
293
369 (207 PH)
367
Kerala @
2107
162
162
Madhya Pradesh
363
399
265
Maharashtra
3115
3115
405
17
17
17
Goa
Gujarat @
Haryana @
Himachal Pradesh @
Manipur
States/UTS
Existing
Covered
Reported
Nagaland
Orissa
Punjab
34
273
220
34
73
208
34
72
208
Rajasthan
Sikkim @
Tamil Nadu
Tripura
253
1
408
29
253
1
334
16
253
1
334
16
A & N Islands @
Delhi
Lakshdweep
10
332
2
4
157
2
4
157
2
29
13,697
22
7,277
22
3,096
Pondicherry
TOTAL All Hospitals
@: Operational in urban hospitals.
Medically certified deaths during 1999
22 States/Uts reported data on medically certified
deaths during 1999:
 About 15.4% of the total registered deaths.
 About 41.3% of urban registered deaths.
 More than 50% of the urban registered deaths: In Arunachal
Pradesh, Goa, Maharashtra, Manipur, Meghalaya, Orissa,
Tamil Nadu, A & N Islands, Delhi and Pondicherry
 More than 100% Urban registered deaths: In Arunachal
Pradesh, Goa and Manipur due to inclusion the rural deaths.
 More than 50% of total registered deaths: In Arunachal
Pradesh, Goa, Manipur, Delhi and Pondicherry.
Mortality coding
Coding: It is the assignment of a code for a
diagnostic
statement,
related
health
conditions, or cause of death as identified by
the health care.
Classification of diseases: It can be defined as a
system of categories to which morbid entities
are assigned according to established criteria.
 International Classification of Diseases (ICD) is
used for coding cause of mortality.

Purpose & applicability of ICD

ICD permits the systematic recording,
analysis, interpretation and comparison of
mortality and morbidity data collected in
different countries or areas and at different
times.

It translates diagnoses of diseases and other
health problems from words into an
numeric/alphanumeric code, which permits
easy storage, retrieval and analysis of the data.
Simple situation
Part-I (a) Peritonitis
2 days
ICD
codes
(b) Perforation of Duodenum 3 days
(c) Duodenal ulcer
6 months
Part-II Carcinoma of bronchus
Complicated situation:
A lady aged 23 years was admitted to a hospital. She
had H/O suicidal burn- because of pouring of kerosene
and burnt herself. O/E patient had 78% burn (superficial
& deep). She developed septicemia and died after 3
days of admission.
Part-I (a) Septicemic shock
(b) Burn 78% (Deep & superficial)
(c) Intentional self-harm by
fire and flames
Part-II NIL
Manner of death
1. Natural,
2. Accident,
5. Pending investigation
3 . Suicide,
3 days
3 days
By 3 days
back
ICD
codes
4. Homicide,
Special Tabulation Lists for Mortality and
Morbidity
 ICD-10 provides four special tabulation lists for
mortality and one list for morbidity:
 List 1-General mortality-condensed list
(103 causes);
 List 2-General mortality-selected list (80 causes);
 List 3- Infant and child mortality-condensed list
(67 causes);
 List 4- Infant and child mortality-selected list
(51 causes); and
 Tabulation list for morbidity (298 causes)
 The ICD-10 tabulation lists are not being
adopted as such instead national list based on
ICD is used for tabulation of mortality.
 In National list major group, category and subcategory terms are used in place of Chapter,
Block and three/four character category.
 National list based on ICD-9 has been used up
to the year 1998.
 National list based on ICD-10 has been adopted
from the year 1999 onwards.
Characteristics of National list based on ICD-9 and ICD-10
National list based on ICD-9
National list based on ICD-10
Major Groups-17
Major Groups-19
Plus E code- Supplementary
Plus Major Group XX- External
Classification of External Causes Causes of Mortality & Morbidity
of Injury & Poisoning
Categories-56
Categories-58
(Group of three-digit categories) (Group of three-character
categories)
Sub-categories-192
1. Group of 3 –digit / 4 –digit
categories,
2. 3 –digit/4 -digit single
category
Sub-categories-185
1. Group of 3 –character/ 4–
character categories,
2. 3 –character /4 -character
single category
Deaths by type of medical attention during 1998
Deaths not Attended by
Medical Practitioners
54.9%
Institutional Deaths
26.9%
QMP(O)
5.7%
QMP(A)
12.5%
Leading causes of deaths during 1999
OTHERS
18.8%
IX
23.8%
X
7.7%
XVI
7.5%
I
14.6%
XIX
13.0%
XVIII
14.6%
Others: It include Major Cause Groups II, III, IV, V, VI, VII, VIII, XI, XII,
XIII, XIV, XV and XVII
Leading Causes of Deaths during 1991 to 1999 – All India
Major Causes of
Deaths
1991 1992
1993 1994
1995
1996 1997
1998 1999
Circulatory system
21.1
21.2
21.5
21.9
21.4
21.6
22.1
25.2
23.8
Infectious and
parasitic diseases
17.0
16.7
17.3
16.7
16.2
16.3
15.7
16.4
14.6
Symptoms, signs and
ill-defined conditions
14.5
14.2
12.6
13.4
14.6
14.3
14.4
12.3
14.6
Injury & poisoning
11.2
11.1
11.2
11.7
12.1
12.4
12.1
12.1
13.0
Certain conditions
originating in the
perinatal period
8.7
9.1
9.2
8.5
8.2
7.9
8.8
7.9
7.5
Respiratory system
8.1
7.7
7.7
7.4
7.3
7.5
7.1
7.3
7.7
80.6 80.0
79.5
79.6
79.8
80.0
80.2
81.2
81.2
Total all 6 major
causes
Trends in leading causes of death
30.0
Circulatory
System
Infectious &
Parasitic
20.0
15.0
Symptoms,
signs and ill
defined
10.0
Injury &
Poisoning
5.0
Certain
condition
originating
Year
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
0.0
1985
Percentage deaths
25.0
Respiratory
system
Level and Coverage of causes of deaths in India and
United States
United States- 1997
India-1998
Coverage: All States &
District of Columbia
23 States/UTs
Level of Causes of deaths: 99% 14.9% (4,98,586)
(23,14,245)
Certificates are filled by:
Funeral Directors,
Attending Physicians,
Medical Examiners,
Coroners
Attending Physicians,
Medical Examiners,
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Top ten causes of deaths in US in 1997
15.0
0.0
Top causes of deaths in India during 1998
19.8
20.0
0.6
0.6
0.9
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1.3
1.6
1.9
2.2
1.9
2.7
2.9
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3.6
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6.9
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Usefulness of MCCD
 MCCD provides cause-specific mortality profiles and
is a key indicator for analyzing the health trends of the
population in a scientific manner.
 The information is of considerable use to public health
planners, administrators, medical professionals and
research workers.
 The information is made use of in the assessment of
the effectiveness of public health programme.
 It is feedback for better health planning and
management as well as for deciding priorities of
health and medical research programme.
T
H
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N
K
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