Discussion 7 Dealing with unspecifieds

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Last Update: July 15th 2009

Status of discussion: Closed

Lead authors: Kavi Bhalla & James Harrison

Additional author: Lois Fingerhut, Margaret Warner, Mohsen Naghavi

Lurking members: Saeid Shahraz, Tim Driscoll

Issue: The ICD includes categories that specify causes and conditions well and other categories that are less specific. For example, in ICD-10, R99 means "Other ill-defined and unspecified causes of mortality" and X59 means "Exposure to unspecified factor". Cases assigned such codes should be accounted for in GBD calculations, but to which cause or condition should they be attributed? This does not matter much if a small proportion of cases have such codes, but these codes appear frequently in some datasets. For example, X59 appears as the Underlying Cause of death for about 10% of injury deaths in Mexico. Common practice in previous GBD work has been to re-assign such cases in simple proportion to specifically-coded cases, within age and sex strata. Is this approach sufficiently reliable? This paper examines which poorly specified categories are important for injury, and whether the simple proportionate re-assignment method (within age- sex- strata) is sufficient for the purposes of the GBD 2005 project.

What are we doing?

Because of the importance of this issue for the expert group, various group members have volunteered to undertake analysis of dump codes in the data sets they use. Here is a list of what is currently being done:

    • To what extent are dump codes used in different countries?
    • What effects will the method for handling dump code have on GBD-2005 estimates?
      • Deaths from partially specified causes are handled differently in ICD9 and ICD10. We are assessing the joint impact of the use of unspecified codes and switches in ICD coding on GBD-2005 injury estimates. Please visit Discussion 7.2: Comparing dump codes in ICD9 and ICD10 to find out more.
    • Country-specific studies of use of dump codes: [COMING SOON]
      • USA
      • Mexico
      • Argentina
      • Australia
    • Deaths coded to undetermined intent: Past studies have suggested that in many countries these are primarily suicides. We are assessing the extent to which this is generalizable: [COMING SOON]
    • Comparisons of dump codes in death registration data with alternate data systems: [COMING SOON]
      • Comparisons with the IRTAD database (road traffic injuries)
      • Comparisons with violent deaths reported in the US-National Violent Death Reporting System