national mortality registry

National

Mortality

Registry

Annual Mortality Report

2011

II

Document Information

Document reference

DHIR/MNMR/2011

Current version

1.0

Release date

June 2013

Document owner

Directorate of Health Information and Research

Document type

National mortality statistics

Personal data

No personal data

Website http://tiny.cc/deathsmalta

e-mail [email protected] Telephone number

00356 25599000

Version Control

Version Date Action Name 1.0 June 2013 Compilation Dr Roberto Debono

Comments

The accuracy of this document may be limited by factors beyond the author’s control. Some data in this document may be subject to interpretation. Data in this document is based on information obtained from the death certificate, in some cases additional information has been sought.

Users should always acknowledge the source in all works based on information supplied in this document.

Acknowledgements

The compiler of this document would like to acknowledge the support of colleagues and the Director, Dr. Neville Calleja at the Directorate of Health Information and Research. Close collaboration with certifying doctors, pathologists, public health specialists, the Police Statistics Office, the Medical Records Department at Mater Dei Hospital, the Mortuary Department and the National Statistics Office were vital to the maintenance of an updated mortality register whose aim is to always improve accuracy and timeliness.

Special thanks go to Ms Connie Scicluna and Ms Doris Baldacchino who work unremittingly on the National Mortality Registry.

III

Table of Contents

Summary Statistics for Mortality during the year 2011 ........................................................... VI Introduction ......................................................................................................................... VII

Glossary ................................................................................................................................ IX Definitions ............................................................................................................................. X

Section 1: Overview ................................................................................................................. 15

Distribution by gender and age group .................................................................................. 17 Distribution by type of place of death .................................................................................. 19 Distribution by month of death ............................................................................................ 20 Causes of death ..................................................................................................................... 21

Leading causes of death: number, rate and percent ............................................................. 22 Leading causes of death in males ......................................................................................... 23 Leading causes of death in females ...................................................................................... 24 Commonest causes of death by age group ........................................................................... 25 Potential years of life lost (PYLL) ....................................................................................... 28 Diseases of the circulatory system (ICD 10 codes I00-I99) ................................................. 30 Neoplasms (ICD-10 codes C00-D48) .................................................................................. 35 Diseases of the respiratory system (ICD 10 code J00-J98) .................................................. 39 Smoking attributable mortality ............................................................................................. 40 Diseases of the digestive system (ICD 10 codes K00-K93) ................................................ 42

Some infectious and parasitic diseases (ICD 10 codes A00-B99 (excluding A41.9), G00, G03-G04, N70-N73) ............................................................................................................ 42 External causes of morbidity and mortality (ICD 10 codes V01-Y98) ................................ 43

Section 3: Perinatal and infant mortality .................................................................................. 47 Section 4: Deaths in non-residents who died in Malta during 2010 ........................................ 50

Number of deaths in non residents by country of residence ................................................ 51 Section 5: Statistical tables ....................................................................................................... 52

Annex ....................................................................................................................................... 74

IV

List of Tables

Table 1: Mid-year resident population 2011 ............................................................................. X Table 2: European Standard Population ................................................................................... XI Table 3: Leading causes of death by number, rate and percent ............................................... 22 Table 4: Commonest causes of death in the 15-44 age group .................................................. 25 Table 5: Commonest causes of death in the 45-64 age group .................................................. 26 Table 6: Commonest causes of death in the 65-84 age group .................................................. 26 Table 7: Commonest causes of death in the 85+ age group ..................................................... 27 Table 8: Potential years of life lost under 65 years of age during the year 2011 (PYLL-65) by major category .......................................................................................................................... 28

Table 9: Potential years of life lost under 65 years during the year 2011 (PYLL-65) by MTL1 sub-grouping ............................................................................................................................. 29

Table 10: Average age at death from diseases of the circulatory system & diabetes mellitus in 2011 .......................................................................................................................................... 34

Table 11: Average age at death from the commonest neoplasms ............................................ 38

Table 12: Smoking attributable mortality in males .................................................................. 41 Table 13: Smoking attributable mortality in females ............................................................... 41 Table 14: Average age at death from some external causes .................................................... 43 Table 15: EMCDDA definition of codes used in illicit drug overdose .................................... 46

Table 16: Foetal, neonatal & infant deaths by birth weight, age group & presence or absence of malformation as UCD. ......................................................................................................... 47

Table 17: Foetal, neonatal & infant deaths by weeks of gestation & presence or absence of malformation as UCD. ............................................................................................................. 48

Table 18: Deaths in non-residents by country of residence ..................................................... 51 Table 19: Standardised mortality rate (ESP) per 100,000 population by gender & cause ....... 52

Table 20: Deaths by specific cause, age group and gender ...................................................... 56

V

List of Figures

Figure 1: Trends in the yearly number of deaths and crude death rate in Malta between 2000 and 2011 ................................................................................................................................... 15

Figure 2: Trends in standardised mortality rates (on the European Standard Population) in Malta as compared to EU-15 and EU-12. ................................................................................ 16 Figure 3: Age-specific mortality rates in males and females ................................................... 17 Figure 4: Percentages of deaths in each gender by age group ................................................. 18 Figure 5: Distribution of deaths by type of place of death ....................................................... 19 Figure 6: Distribution of deaths by month of death and age group.......................................... 20 Figure 7: Commonest causes of death using broad categories ................................................. 21 Figure 8: Percentages of leading causes of death in males ...................................................... 23 Figure 9: Percentages of leading causes of death in females ................................................... 24 Figure 10: SDR (ESP), diseases of the circulatory system per 100,000 in Malta compared to EU15 and EU12 for all ages ..................................................................................................... 30 Figure 11: SDR, Ischaemic heart disease in Malta compared to EU15 and EU12 for all ages. Source: WHO/Europe-Health for all Database (HFA-DB) ...................................................... 31 Figure 12: SDR, Diabetes in Malta compared to EU15 and EU12, all ages. ........................... 32

Figure 13: SDR, Cerebrovascular disease in Malta compared to EU15 and EU12, all ages. .. 33

Figure 14: SDR, malignant neoplasms per 100,000 in Malta compared to EU-15 & EU-12, all ages. .......................................................................................................................................... 35

Figure 15: Most common cancer deaths in both sexes ............................................................. 36 Figure 16: Most common cancer deaths in males .................................................................... 36 Figure 17: Most common cancer deaths in females ................................................................. 37 Figure 18: SDR, malignant neoplasm of trachea, bronchus & lung per 100,000 in Malta compared to EU-15 & EU-12, all ages. ................................................................................... 37 Figure 19: SDR, malignant neoplasm of female breast per 100,000 in Malta compared to EU-15 & EU-12, all ages in females. ............................................................................................. 38 Figure 20: SDR, all respiratory conditions per 100,000 in Malta compared to EU-15 & EU-12, all ages. ............................................................................................................................... 39

Figure 21: SDR, chronic bronchitis/emphysema/asthma, in males per 100,000, all ages, in Malta compared to EU-15 & EU-12. ....................................................................................... 40 Figure 22: SDR, chronic liver disease & cirrhosis per 100,000 in Malta compared to EU-15 & EU-12 all ages. ......................................................................................................................... 42

Figure 23: Number of deaths due to external causes, in males and females. ........................... 43

Figure 24: SDR, motor vehicle accidents, all ages, in Malta compared to EU-15 & EU-12. .. 44

Figure 25: Deaths due to falls by gender and age group .......................................................... 45 Figure 26: SDR, Intentional self harm, all ages, per 100000, in Malta compared to EU-15 & EU-12 ....................................................................................................................................... 46

Figure 27: Perinatal mortality weight specific (1000g and over) in Malta compared to EU-15 and EU-12. ............................................................................................................................... 49

Figure 28: Causes of death in non-residents ............................................................................ 50 Figure 29: Deaths in non-residents by gender and age group .................................................. 51

VI

Summary Statistics for Mortality during the year 2011

There were 3267 deaths in Maltese residents during the year 2011. Of these, 1664 were male and 1603 were female deaths. The vast majority of deaths (84.1%) occurred in hospitals or in residential homes. Half of all deaths occurred in Mater Dei Hospital. Diseases of the circulatory system and neoplasms accounted for the vast majority of deaths, accounting for 44.8% and 27.0% respectively. Ischaemic heart disease, cerebrovascular diseases and other heart diseases (including heart failure) were the leading causes of death. Despite a downward trend in the age-standardised mortality rate from diseases of the circulatory system, Malta had higher rates of mortality from ischaemic heart disease than the EU-15 Member States. Diabetes mellitus is an important risk factor for ischaemic heart disease. There was a dramatic decrease in the age-standardised mortality rate from diabetes mellitus between 2009 and 2011. This is probably due to a change in the manner of coding where diabetes mellitus is increasingly seen as a contributory cause of death rather than an underlying cause of death. Malignant neoplasm of the lung, colorectal, breast and pancreas were also leading causes of death. While lung, colorectal, prostate and stomach were the leading causes of death in males; breast, colorectal, ovary and pancreas were the leading causes of death in females. There was an increase in deaths from malignant neoplasm of the stomach from 3.6% of all cancer deaths in 2010 to 5.7% of all cancer deaths in 2011. The trend of age-standardised mortality rate from malignant neoplasms is a downward one and compares favourably with that of the EU-15 Member States. Neoplasms, followed by diseases of the circulatory system and external causes of death, were the most important cause of premature mortality in those under the age of 65 years. Whereas ischaemic heart disease, transport accidents and intentional self-harm were the leading causes of premature mortality in men, malignant neoplasms of breast and lung cancer were the leading causes of premature mortality in women. Although the trend in the annual number of deaths between 2002 and 2011 increased, the crude mortality rate remained steady at a 10-yearly average of 771 deaths per 100,000 population. When age-standardised, the mortality rates for Malta compare very closely with those of the EU-15 and the trend is a downward one. The life expectancy at birth in males and females stands at 79 and 83 respectively according to the latest data from the NSO1.

1 Life expectancy figures are for 2010.

VII

Introduction

The Annual Mortality Report 2011 presents mortality statistics for the year 2011 by cause of death in residents of the Maltese Islands, and includes residents dying abroad for which we have information.

Data Analysis

The information used is based on details obtained from death certificates. This is supplemented by reviewing of deceased patients’ records, newspaper cuttings as well as collaboration with pathologists, public health doctors, police and certifying doctors. Data is also cross-checked with other registries at the Department of Health Information & Research and databases held by other entities. These additional sources of information are needed for verification. They add detail and ensure that mortality data is as reliable and as accurate as possible.

The International Statistical Classification of Diseases and Related Health Problems- ICD 10 is used to translate diagnoses of diseases from words into alphanumeric codes in order to permit easier storage, retrieval and analysis of the data. This also allows comparison between different countries and over different periods of time.

Additional Sources of Data

The National Statistics Office of Malta was the source from which information about mid-year population 2011 by age group and gender was obtained.

Number of births and live births were obtained from the National Obstetrics Information system (NOIS).

The European Health for All database - HFA-DB, (WHO Regional Office for Europe, Copenhagen, Denmark) was used as a source of data for some of the figures in this report.

Quality of Mortality Data

The quality of mortality data depends on a number of entities/persons and processes. The ‘Certificate of Death and Cause thereof” is filled in by the certifying doctor or, in the case of autopsies, by the pathologist. An underlying cause of death is chosen from the causes of death in the certificate by the registry manager and the registry leader at the Directorate of Health Information & Research (DHIR). This is done in collaboration with certifying doctors where the underlying cause of death is unclear. Deceased patient medical records are also examined in a number of cases to ascertain the underlying cause of death. Data in the death certificate is then coded and inputted in a database.

The quality of the information on death certificates varies according to the certifying habits and knowledge of the certifying doctors. Moreover, data coding depends to a certain degree on the coding practices of the registry manager and the registry leader. This inevitably affects quality of data, especially when analysing trends over time. Finally, a degree of human error as regards data inputting always persists albeit small. Data is double-checked and cross-checked both internally and with other databases.

A number of validation processes and quality checks are done by the National Mortality Registry in order to produce data that is as accurate as possible. These include reviewing

VIII

patients’ files, discussion with certifying doctors as well as checking all data that has been entered. Periodic validation of data coding is also undertaken to ensure that coding is done as accurately as possible and the choice of the underlying cause of death is correct. The database is also cross-checked against the Patient Administration System (PAS) at Mater Dei Hospital (MDH), NOIS at DHIR and data received from the Midwifery Services at MDH.

IX

Glossary

DHIR Directorate Health Information and Research ECHI European Community Health Indicators ESP European Standard Population EU-12 12 EU Member States after May 2004: Poland (PL), Czech Republic (CZ),

Cyprus (CY), Latvia (LV), Lithuania (LT), Slovenia (SI), Estonia (EE), Slovakia (SK), Hungary (HU), Malta (MT), Bulgaria (BG), Romania (RO)

EU-15 15 EU Member States before May 2004: Austria (AT), Belgium (BE), Finland (FI), Greece (EL), Luxembourg (LU), Denmark (DK), Spain (ES), Netherlands (NL), Germany (DE), France (FR), Portugal (PT), Ireland (IE), Italy (IT), United Kingdom (UK), Sweden (SE)

HFA-DB European Health For All Database ICD-10 International Statistical Classification of Diseases and Related Health

Problems: Tenth Revision MDH Mater Dei Hospital NOIS National Obstetrics Information System NSO National Statistics Office PAS Patient Administration System SDR Age-standardised death rate on the European Standard Population (see more in

Chapter: Definitions) WHO World Health Organisation

X

Definitions

Crude Death Rate

This is equal to the total number of registered deaths divided by the estimated resident mid-yearly population of that year multiplied by 1000 (or 100,000). The following mid-year population of 2011 has been used for this annual report.

Table 1: Mid-year resident population 2011 Age group Total Males Females

0-4 19853 10284 9569 5-9 19468 9990 9478 10-14 22638 11560 11078 15-19 26477 13633 12844 20-24 29416 15109 14307 25-29 30340 15677 14663 30-34 30286 15677 14609 35-39 28409 14570 13839 40-44 25139 12791 12348 45-49 27375 13841 13534 50-54 30605 15266 15339 55-59 29072 14553 14519 60-64 30632 15137 15495 65-69 22744 10934 11810 70-74 16352 7463 8889 75-79 13109 5436 7673 80-84 8382 3159 5223 85+ 6428 2177 4251

Total 416725 207257 209468

Births

Total number of births weighing 500g or over at birth during 2011 = 4305

Total number of live births weighing 500g or over at birth during 2011 = 4282

Total number of births weighing 1000g or over at birth = 4282

Total number of live births weighing 1000g or over at birth = 4263

Total number of births of 22 weeks gestation or more during 2011 = 4311

Total number of live births of 22 weeks gestation or more during 2011 = 4283

Total number of births of 28 weeks gestation or over at birth = 4284

Total number of live births of 28 weeks gestation or over at birth = 4265

Source: National Obstetric Information System

XI

Age-Standardised Death Rate

The age-standardised death rate for a particular condition is that which would have occurred if the observed age-specific death rates for the condition were applied in a given standard population. The European Standard Population has been used in this report.

Table 2: European Standard Population Age groups (yrs)

European standard population (ESP)

0 1600

1-4 6400

5-9 7000

10-14 7000

15-19 7000

20-24 7000

25-29 7000

30-34 7000

35-39 7000

40-44 7000

45-49 7000

50-54 7000

55-59 6000

60-64 5000

65-69 4000

70-74 3000

75-79 2000

80-84 1000

85+ 1000

Total 100000

European Health for All Database

The European Health for All Database provides easy and rapid access to a wide range of basic health statistics for the 52 Member States of the WHO European Region. It was developed by the WHO Regional Office for Europe in the mid-1980s to support the monitoring of health trends in the region. This database has been used to produce a number of charts for the report comparing Malta with other European regions.

http://www.euro.who.int/HFADB

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The definitions described below are those presented in the International Statistical Classification of Diseases and Related Health Problems ICD-10 volume 2.

Birth Weight

The first weight of the foetus or newborn obtained after birth.

Low birth weight is less than 2500g (up to and including 2499g).

Very low birth weight is less than 1500g (up to and including 1499g).

Extremely low birth weight is less than 1000g (up to and including 999g)

Gestational Age

The duration of gestation is measured from the first day of the last menstrual period. Gestational age is expressed in complete days or completed weeks.

For the purposes of calculation of gestational age from the date of the first day of the last normal menstrual period to the date of delivery, it should be borne in mind that the first day is day zero and not day one; days 0-6 therefore correspond to completed week zero;

Foetal Death

Foetal death is the death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy; the death is indicated by the fact that after such separation, the foetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Foetal Death Rate

The number of foetal deaths in a year expressed as a proportion of the total number of births (live births plus foetal deaths) in the same year. All foetuses with a birth weight of 500g and over are considered. Rates are usually expressed per 1000 total births.

Foetal death rate = no. of foetal deaths in a year weighing 500g or more *1000 Number of live births plus foetal deaths in that year weighing 500g or more Foetal death rate = no. of foetal deaths in a year weighing 1000g or more *1000 (weight specific) Number of live births plus foetal deaths in that year weighing 1000g or more

Live Birth

Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after separation, breathes or shows any evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of the voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born.

XIII

Neonatal Period

The neonatal period commences at birth and ends 28 completed days after birth. Neonatal deaths (deaths among live births during the first 28 completed days of life) may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before 28 completed days of life.

Age at death during the first day of life (day 0) should be recorded in units of completed minutes or hours of life. For the second (day 1), third (day 2) and through 27 completed days of life, age at death should be recorded in days.

Neonatal Mortality Rate

The number of deaths during the neonatal period in that year expressed as a proportion of the total number of live births in the same year. Rates are expressed per 1000 live births.

Neonatal mortality rate = no. of neonatal deaths in a year * 1000 no. of live births in that year Neonatal mortality rate = no. of neonatal deaths in a year (1000g or over) * 1000 (weight specific) no. of live births in that year (1000g or over)

Perinatal Period

The perinatal period commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500g) and ends at seven completed days after birth.

Perinatal Mortality Rate

The number of deaths during the perinatal period in a year expressed as a proportion of the total number of births (live births plus foetal deaths) in the same year.

Perinatal mortality rate = no. of perinatal deaths in a year *1000 no. of live births plus foetal deaths in that year Perinatal mortality rate = no. of perinatal deaths in a year (weight 1000g or over) *1000 (weight specific) no. of live births plus foetal deaths in that year (weight 1000g or over)

Infant Mortality Rate

The number of deaths in children less than 1 year of age in a year expressed as a proportion of the total live births in the same year. Rates are usually expressed per 1000 live births.

Infant mortality rate = no. of infant deaths (under 1 year of age) in a year * 1000 No. of live births in that year Infant mortality rate = no. of infant deaths (under 1 year of age) in a year (weight 1000g or over) * 1000 (weight specific) No. of live births in that year (weight over 1000g)

XIV

Potential Years of Life Lost (PYLL)

A measure of the relative impact of various diseases on society, PYLL highlights the loss to society as a result of youthful or early deaths. The figure for potential years of life lost due to a particular cause is the sum of the years of life lost due to that cause for all individuals dying before a particular age (65 years in the case of PYLL-65).

Annual Mortality Report 2011

15

Section 1: Overview

During the year 2011, there were 3267 deaths among residents dying in Malta or abroad. There were 1664 male deaths and 1603 female deaths in residents, an increase of 175 males and 82 females over the previous year. Deaths in residents included 12 residents who died abroad. In addition, 63 non-residents died in Malta. The remainder of this report concentrates on deaths in residents unless otherwise specified.

There were also 23 foetal deaths (stillbirths weighing 500g or over).

The crude death rate for males was 803 deaths per 100,000 and for females it was 765 deaths per 100,000. The overall crude death rate was 784 per 100,000 population.

Although the trend in the number of deaths per year has increased steadily over a 10-year period, the crude mortality rate has remained relatively steady at a 10-yearly average of 771 deaths per 100,000 population (Figure 1).

0

500

1000

1500

2000

2500

3000

3500

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Nu

mb

er

of

de

ath

s p

er

ye

ar

Year

Number of deaths Crude death rate

Figure 1: Trends in the yearly number of deaths and crude death rate in Malta between 2000 and 2011

The age-standardised death rate (using the European Standard Population) for males was 657.12 per 100,000 and for females was 439.58 per 100,000. The overall age-standardised death rate was 535.59 per 100,000.


16

0

200

400

600

800

1000

1200

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

SD

R/1

00

,00

0

Year

Malta EU-15 EU-12

Figure 2: Trends in standardised mortality rates (on the European Standard Population) in Malta as compared to EU-15 and EU-12. Source: WHO/Europe-Health for all Database (HFA-DB) The age-standardised death rate (SDR) for Malta is decreasing; this is also seen for old EU member states (EU-15) as well as the new member states (EU-12). The SDR in Malta compares very well with that of the EU-15.

In 2011, the life expectancy at birth for Maltese males was 79 years and for females was 83 years.2 The oldest male death was 104 years and the oldest female death was 105 years. The median age at death was 76 years in males and 81 years in females.

2 In view of ongoing work on the census data, the figures on life expectancy are provisional.


17

Distribution by gender and age group

0%

5%

10%

15%

20%

25%

30%

35%

0-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-44

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

-89

90

-94

95

+

Ag

e-s

pe

cifi

c ra

te

Age group (yrs)

Male Female

Figure 3: Age-specific mortality rates in males and females Age-specific mortality rates increase exponentially with age.

The age-specific mortality rate for males was consistently higher than that for females for all age groups except for the 95+ year age group.


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0%

5%

10%

15%

20%

25%

0-4

5-9

10

-14

15

-19

20

-24

25

-29

30

-34

35

-39

40

-44

45

-49

50

-54

55

-59

60

-64

65

-69

70

-74

75

-79

80

-84

85

-89

90

-94

95

+

Age group (yrs)

Male Female

Figure 4: Percentages of deaths in each gender by age group The 80-84 and 85-89 year age groups accounted for the largest number of deaths in both sexes (36.2% of all deaths). Whereas the 75-79 and the 80-84 year age groups accounted for the largest number of deaths in males (33.2% of all male deaths), the 80-84 and the 85-89 year age groups accounted for the largest number of deaths in females (41.1% of female deaths). 38.1% of female deaths (in comparison with 21.6% of male deaths) occurred in the 85+ year age group. In contrast, 23.0% of male deaths (in comparison to 14.0% of female deaths) occurred in the 0-64 year age group.


19

Distribution by type of place of death

MDH

50.1%

Other hospitals

16.4%

SVPR

10.6%

Residential

homes

7.0%

Usual residence

12.9%

Remainder, 3.0%

Figure 5: Distribution of deaths by type of place of death There was no important difference in the distribution of type of place of death between 2010 and 2011.


20

Distribution by month of death

0

50

100

150

200

250

300

350

400

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Nu

mb

er

of

de

ath

s

0-64 65+ Total

Figure 6: Distribution of deaths by month of death and age group Figure 6 shows the seasonal variation in the number of deaths. There were more deaths in the cold winter months. This variation is more pronounced in deaths of those aged 65 years and over. Hypothermia, while often not the underlying cause of death, contributes to death in older people.


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Causes of death

The main source of information as to the causes of death is obtained from the death certificate. Accuracy is increased by collaboration with certifying doctors, pathologists and police as well as other sources of information. The value of the mortality register depends on its level of accuracy and completeness.

The cause of death is often clearer in the younger and middle-aged persons than in older persons. Older persons tend to have a number of contributory causes of death making it difficult for the data coder to decide on the underlying cause of death.

The International Statistical Classification of Diseases and Related Health Problems: ICD-10 is used to code the underlying cause of death. This helps to increase comparability between different countries worldwide.

Circulatory

44.8%

Neoplasms

27.0%

Respiratory

7.1%

Mental &

behavioural

4.2%

Digestive system

3.0%

External causes

3.0%

Nervous

2.9%

Other

8.0%

Figure 7: Commonest causes of death using broad categories There were 1463 deaths due to diseases of the circulatory system, an increase of 311 deaths from the year 2010. As in previous years, diseases of the circulatory system were the leading cause of death accounting for 44.8% of all deaths. The number of deaths from neoplasm totalled 881, an increase of 16 deaths over 2010. Deaths in the mental and behavioural category were mainly due to dementia.


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Leading causes of death: number, rate and percent

The Mortality Tabulation List 1 (MTL) of the International Classification of Diseases ICD-10 was used as the source for grouping diseases in the following tables. Remainder categories were sometimes excluded, as these tend to group several ‘less common’ conditions together and would give them undeserved importance. Remainder categories were however used when the number of deaths from an individual cause constitutes a large part of the respective category or when this was deemed to be important information. (The full list of the mortality tabulation list is found in Section 5 of this report, Table 18 and Table 19).

Table 3: Leading causes of death by number, rate and percent

Cause of death (ICD-10 code) Number of deaths

SDR/100,000 (ESP)*

% of total

deaths M F T M F T

Ischaemic heart diseases (I20-I25) 451 359 810 176 91 129 24.8% Cerebrovascular diseases (I60-I69) 152 184 336 59 45 51 10.3% Other heart diseases (I26-I51) including heart failure (I50) 97 148 245 40 37 38 7.5% Malignant neoplasm of trachea, bronchus and lung (C33-C34) 126 31 157 48 11 27 4.8% Malignant neoplasm of colon, rectum and anus (C18-C21) 66 44 110 25 13 18 3.4% Malignant neoplasm of breast (C50) 1 85 86 0 26 15 2.6% Pneumonia (J12-J18) 35 43 78 13 10 12 2.4% Malignant neoplasm of pancreas (C25) 32 31 63 12 9 10 1.9% Chronic lower respiratory diseases (J40-J47) 47 16 63 18 4 10 1.9% All other causes 657 662 1319 266 193 226 40.4%

Total 1664 1603 3267 657 440 536 100.0% *Standardised death rate per 100,000 (on the European Standard Population) Diseases of the circulatory system, mainly ischaemic heart disease, cerebrovascular disease and heart failure, ranked as the most common causes of death. Malignant neoplasms of the lung, colorectal, breast and pancreas were among the leading causes of death and comprised 12.7% of all causes of deaths.

In contrast to previous years, diabetes mellitus did not classify among the top ten leading causes of death. This could have been due to a change in data reporting or data coding practices. It is not always easy to decide whether to classify diabetes mellitus as a contributory cause of death or an underlying cause of death.


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Leading causes of death in males

27.1%

9.1%

7.6%

5.8%

4.0%

2.8%

2.2%

2.1%

2.0%

1.9%

Ischaemic heart diseases (I20-I25)

Cerebrovascular diseases (I60-I69)

Malignant neoplasm of trachea, bronchus and lung (C33-C34)

Other heart diseases (I26-I51) including heart failure (I50)

Malignant neoplasm of colon, rectum and anus (C18-C21)

Chronic lower respiratory diseases (J40-J47)

Malignant neoplasm of prostate (C61)

Pneumonia (J12-J18)

Malignant neoplasm of stomach (C16)

Malignant neoplasm of pancreas (C25)

Figure 8: Percentages of leading causes of death in males The main cause of death in males was ischaemic heart disease which accounted for 27.1% of all male deaths in 2011. This was an increase of 7.1% over 2010. Cerebrovascular disease surpassed lung cancer as the second leading cause of death in males, accounting for 9.1% of all male deaths, an increase of 2.2%.

Lung cancer and chronic lower respiratory diseases continue to feature as a commoner cause of death in males than in females. Colorectal, prostate, stomach and pancreatic cancers were also leading causes of death in males.


24

Leading causes of death in females

22.4%

11.5%

9.2%

5.3%

2.7%

2.7%

2.3%

1.9%

1.9%

1.9%

Ischaemic heart diseases (I20-I25)

Cerebrovascular diseases (I60-I69)

Other heart diseases (I26-I51) including heart failure (I50)

Malignant neoplasm of breast (C50)

Malignant neoplasm of colon, rectum and anus (C18-C21)

Pneumonia (J12-J18)

Malignant neoplasm of ovary (C56)

Malignant neoplasm of pancreas (C25)

Malignant neoplasm of trachea, bronchus and lung (C33-C34)

Other acute lower respiratory infections (J12-J22)

Figure 9: Percentages of leading causes of death in females Diseases of the circulatory system continued to feature as the leading causes of death in females. Ischaemic heart disease and cerebrovascular disease did not increase in proportion as much as they did in males.

Malignant neoplasm of the breast is a leading cause of death specific to females. Colorectal, ovarian, pancreatic and lung cancer were also among the leading causes of death in females.

Chest infections were also an important cause of death, especially in older females.


25

Commonest causes of death by age group

The relative importance of different causes of death varies in different age groups.

Deaths in children below the age of one year

There were 26 deaths in infants (born at 500g or over) during the year 2011 accounting for 0.8% of the total deaths. Of these, 13 were male and 13 were female. This was an increase of 4 infant deaths over 2010. The most important causes of death in this age group were conditions originating in the early neonatal period (17 deaths). Almost half of all infant deaths were due to congenital anomalies (12 deaths).

Deaths in children between 1-14 years of age

In this age group there were 6 deaths – 1 male and 5 female - accounting for 0.2% of total deaths. The causes of death were diverse.

Deaths in 15-44 age group

There were 102 deaths in this age group accounting for 3.1% of the total deaths. Of these, 67 were male and 35 were female. External causes of death accounted for the largest number of deaths in this age group i.e. 36 deaths. Of these, transport accidents were responsible for 13 deaths.

Table 4: Commonest causes of death in the 15-44 age group

Underlying cause of death Number % of all

deaths M F T Transport accidents (V01-V99) 10 3 13 12.7%

Remainder of diseases of the nervous system (G04-G25, G31-G98) includes infantile cerebral palsy (G80) and Huntington's disease (G10) 8 3 11 10.8% Intentional self-harm (X60-X84) 10 0 10 9.8% All other external causes (W20-W64, W75-W99, X10-X39, X50-X59, Y10-Y89) 6 1 7 6.9% Ischaemic heart diseases (I20-I25) 6 1 7 6.9% Other heart diseases (I26-I51) includes heart failure (I50) 6 1 7 6.9%


26

Deaths in the 45-64 age group

There were 471 deaths in this age group representing 14.4% of all deaths. Neoplasms (47.1%) and diseases of the circulatory system (32.1%) dominate this relatively young age group.



deaths M F T Ischaemic heart diseases (I20-I25) 82 21 103 21.9% Malignant neoplasm of trachea, bronchus and lung (C33-C34) 32 14 46 9.8% Malignant neoplasm of breast (C50) 0 26 26 5.5%

Remainder of malignant neoplasms (C17, C23-C24, C26-C31, C37-C41, C44-C49, C51-C52, C57-C60, C62-C66, C68-C69, C73-C81, C88, C96-C97) 10 14 24 5.1% Cerebrovascular diseases (I60-I69) 13 8 21 4.5% Diseases of the liver (K70-K76) 13 6 19 4.0% Malignant neoplasm of colon, rectum and anus (C18-C21) 12 7 19 4.0% Other heart diseases (I26-I51) includes heart failure (I50) 9 10 19 4.0% Malignant neoplasm of pancreas (C25) 10 6 16 3.4%

Remainder of diseases of the nervous system (G04-G25, G31-G98) includes Huntington's disease (G10), motor neuron disease (G12.2), Parkinson's disease (G20) and epilepsy (G40-G41) 9 3 12 2.5%

Deaths in the 65-84 age group

There were 1691 deaths in this age group accounting for 51.8% of all deaths. Diseases of the circulatory system (44.4%) followed by neoplasms (30.9%) dominate this age group as the commonest causes of death. Dementia becomes a leading cause of death in this age group.



deaths M F T Ischaemic heart diseases (I20-I25) 104 156 260 26.8% Cerebrovascular diseases (I60-I69) 47 86 133 13.7% Other heart diseases (I26-I51) includes heart failure (I50) 42 84 126 13.0% Remainder of mental and behavioural disorders (F01-F09, F20-F99) includes unspecified dementia (F03) 25 58 83 8.6% Pneumonia (J12-J18) 7 28 35 3.6% Remainder of diseases of the nervous system (G04-G25, G31-G98) includes Parkinson's disease (G20) 13 14 27 2.8%

Remainder of diseases of the genito-urinary system (N17-N98) includes renal failure (N17-N19) and urinary tract infection (N39.0) 10 14 24 2.5% Chronic lower respiratory diseases (J40-J47) 15 7 22 2.3% Other acute lower respiratory infections (J20-J22) 10 12 22 2.3% Falls (W00-W19) 7 10 17 1.8%


27

Deaths in the 85+ age group

There were 970 deaths in this age group accounting for 29.7% of all deaths.

Table 7: Commonest causes of death in the 85+ age group


deaths M F T Ischaemic heart diseases (I20-I25) 104 156 260 26.8% Cerebrovascular diseases (I60-I69) 47 86 133 13.7% Other heart diseases (I26-I51) includes heart failure (I50) 42 84 126 13.0% Remainder of mental and behavioural disorders (F01-F09, F20-F99) includes unspecified dementia (F03) 25 58 83 8.6% Pneumonia (J12-J18) 7 28 35 3.6% Remainder of diseases of the nervous system (G04-G25, G31-G98) includes Parkinson's disease (G20) 13 14 27 2.8%

Remainder of diseases of the genito-urinary system (N17-N98) includes renal failure (N17-N19) and urinary tract infection (N39.0) 10 14 24 2.5% Chronic lower respiratory diseases (J40-J47) 15 7 22 2.3% Other acute lower respiratory infections (J20-J22) 10 12 22 2.3% Falls (W00-W19) 7 10 17 1.8% Circulatory diseases again predominate in this age group. However, other conditions including dementia, respiratory infections, Parkinson’s disease, renal failure, urinary tract infections and falls were important causes of mortality in older persons.

It is important to note that deciding on the underlying cause of death in this age group is challenging, given that several co-morbidities are often present. Malignancies tend to be a less important cause of death in this age group.


28

Potential years of life lost (PYLL)

The index ‘Potential years of life lost’ (PYLL) is an important indicator of premature mortality. From an economic point of view, premature mortality gives an indication of which diseases are affecting persons of working age.

PYLL is defined as the sum of years lost for all individuals dying from a particular cause before a particular age (65 years in the case of PYLL-65).

Deaths occurring in the perinatal period and under 1 year of age were excluded as these over-inflate the figures. Table 8 and 9 list those conditions that contribute mostly to the largest number of potential years lost.

Table 8: Potential years of life lost under 65 years of age during the year 2011 (PYLL-65) by major category

Potential years of life lost under 65 years during the year 2011 (PYLL-65)

Underlying cause of death by major categories Number % of all

deaths M F T Neoplasms (C00-D48) 1096 1304 2400 33.8% Diseases of the circulatory system (I00-I99) 1150 421 1571 22.1% External causes of morbidity and mortality (V01-Y98) 1220 225 1445 20.4% Diseases of the nervous system (G00-G99) 305 212 517 7.3% Diseases of the digestive system (K00-K93) 220 100 320 4.5% Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) 73 171 244 3.4% Diseases of the respiratory system (J00-J99) 134 31 165 2.3% Remainder 259 173 432 6.1% Total 4457 2637 7094 100.0%

Neoplasms are the leading category of potential years of life lost, followed by diseases of the circulatory system and external causes of death. Whereas external causes of mortality and diseases of the circulatory system, as well as neoplasms, are important leading causes of premature mortality in men; neoplasms, in particular lung and breast cancer, are the single most important leading cause of premature mortality in females.


29

Table 9: Potential years of life lost under 65 years during the year 2011 (PYLL-65) by MTL1 sub-grouping

Potential years of life lost under 65 years during the year 2011 (PYLL-65)

Underlying cause of death by MTL1 sub-grouping Number % of all

deaths M F T Ischaemic heart diseases (I20-I25) 758 154 912 12.9% Transport accidents (V01-V99) 349 110 459 6.5% Intentional self-harm (X60-X84) 452 0 452 6.4% Remainder of diseases of the nervous system (G04-G25, G31-G98) includes infantile cerebral palsy (G80) 305 145 450 6.3% Malignant neoplasm of trachea, bronchus and lung (C33-C34) 199 203 402 5.7% Other heart diseases (I26-I51) includes heart failure (I50) 247 128 375 5.3%

Remainder of malignant neoplasms (C17, C23-C24, C26-C31, C37-C41, C44-C49, C51-C52, C57-C60, C62-C66, C68-C69, C73-C81, C88, C96-C97) 158 205 363 5.1% All other external causes (W20-W64, W75-W99, X10-X39, X50-X59, Y10-Y89) 253 40 293 4.1% Diseases of the liver (K70-K76) 201 80 281 4.0% Malignant neoplasm of breast (C50) 0 272 272 3.8% Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) 73 171 244 3.4% Remainder 1462 1129 2591 36.5% Total 4457 2637 7094 100.0% More in-depth analysis shows that ischaemic heart disease, intentional self-harm and transport accidents are the most important causes of premature mortality in men.

Breast and lung cancers are the leading causes of premature mortality in females.

Diseases of the nervous system (including infantile cerebral palsy) and disease of the liver are also important causes of premature mortality in both men and women.


30

Section 2: Individual diseases

Diseases of the circulatory system (ICD 10 codes I00-I99)

Diseases of the circulatory system accounted for 44.8% of all deaths. These were mainly ischaemic heart disease, stroke and heart failure. Diseases of the circulatory system were of particular importance in the 65-84 year age group and in the 85+ year age group in terms of leading causes of death but also an important cause of premature mortality as shown in the PYLL-65.

The age-standardised death rate (SDR) from diseases of the circulatory system was 229.8 per 100,000 population, an increase over the previous year of 40.5. This was mainly due to the increase in the number of deaths from diseases of the circulatory system between 2010 and 2011.

0

100

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300

400

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600

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

SD

R, d

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Figure 10: SDR (ESP), diseases of the circulatory system per 100,000 in Malta compared to EU15 and EU12 for all ages Source: WHO/Europe-Health for all Database (HFA-DB)

As shown in Figure 10, a decreasing trend is seen with rates for Malta comparing well with EU-12 and slightly above EU-15. SDRs for subsequent years will show whether this blip was a matter of chance or indicative of a change in trend.


31

Ischaemic heart disease (I20-I25) and Diabetes Mellitus (E10-E14)

Ischaemic heart disease was the leading cause of death accounting for 24.8% of all deaths. There were 451 male deaths and 359 female deaths, an increase of 132 male and 31 female deaths over the previous year.

Diabetes mellitus is an important risk factor for ischaemic heart disease as well as being an important disease in its own right accounting for 1.4% of all deaths.

0

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2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

SD

R, i

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Figure 11: SDR, Ischaemic heart disease in Malta compared to EU15 and EU12 for all ages. Source: WHO/Europe-Health for all Database (HFA-DB)


32

0

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R, d

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ete

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Figure 12: SDR, Diabetes in Malta compared to EU15 and EU12, all ages. Source: WHO/Europe-Health for all Database (HFA-DB) As shown in Figure 11, the SDR from ischaemic heart disease is quite high for Malta when compared with the EU-12.

Diabetes dropped from an SDR of 17.2 in 2010 to an SDR of 6.9 in 2011. This drop is attributed to a change in coding practices whereby diabetes mellitus is increasingly seen as a contributory cause of death rather than the underlying cause of death, along with hypertension, hypercholesterolaemia and other risk factors for ischaemic heart disease.


33

Cerebrovascular diseases (ICD-10 codes I60-I69)

There were 336 deaths from cerebrovascular diseases in 2011, accounting for 10.3% of all deaths. An increase of 73 deaths was noted from the previous year. Females out-number males in the number of deaths due to cerebrovascular disease with 184 females versus 152 males having died of stroke during 2011.

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2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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Figure 13: SDR, Cerebrovascular disease in Malta compared to EU15 and EU12, all ages. Source: WHO/Europe-Health for all Database (HFA-DB) Figure 13 shows that Malta has followed a decreasing trend in SDRs from cerebrovascular disease since 2000, and has slightly higher rates when compared to the EU-12.


34

Average age at death from diseases of the circulatory system and diabetes mellitus

Table 10 shows that for all deaths due to circulatory diseases and diabetes, the average age at death for males is lower than that for females.

Table 10: Average age at death from diseases of the circulatory system & diabetes mellitus in 2011 Average age at death (yrs) Underlying cause of death* M F T Cerebrovascular diseases (I60-I69) 78.9 82.3 80.8 Ischaemic heart diseases (I20-I25) 74.7 81.5 77.7 Other heart diseases (I26-I51) includes heart failure (I50) 77.6 83.0 80.8 Remainder of diseases of the circulatory system (I71-I99) 75.5 84.9 79.5 All circulatory diseases (I00-I99) 76.0 81.9 79.0 Diabetes mellitus (E10-E14) 74.8 81.8 77.7 * Underlying causes of death with small numbers (n<10) were not included in the table or marked as “n/a”


35

Neoplasms (ICD-10 codes C00-D48)

There were 881 deaths due to neoplasms accounting for 27.0% of all deaths. Of these, 473 were male and 408 were female. Lung cancer is the leading cause of death due to malignancy accounting for 17.8% of all cancer deaths and 4.8% of all deaths.

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Figure 14: SDR, malignant neoplasms per 100,000 in Malta compared to EU-15 & EU-12, all ages. Source: WHO/Europe-Health for all Database (HFA-DB) In Figure 14, a downward trend in SDRs from malignant neoplasms can be observed for Malta as well as EU-15 and EU-12. Rates for Malta compare favourably with EU-15 and EU-12.


36

Most common cancer deaths

Lung, 17.8%

Colorectal, 12.5%

Breast, 9.8%

Pancreas, 7.2%Stomach, 5.7%

Ovary, 4.2%

Prostate, 4.1%

Bladder, 4.0%

Leukaemia, 2.7%

Liver, 2.6%

Brain, 2.6%

Remainder, 26.9%

Figure 15: Most common cancer deaths in both sexes

Lung, 26.6%

Colorectal, 14.0%

Prostate, 7.6%Stomach, 7.0%

Pancreas, 6.8%

Bladder, 4.4%

Liver, 3.6%

Oral cavity, 3.4%

Brain, 3.0%

Oesaphagus, 3.0%

Remainder, 20.7%

Figure 16: Most common cancer deaths in males


37

Breast, 20.8%

Colorectal, 10.8%

Ovary, 9.1%

Pancreas, 7.6%Lung, 7.6%

Stomach, 4.2%

Uterus, 3.7%

Bladder, 3.4%

Leukaemia, 2.9%

Non-Hodgkin's

lymphoma, 2.7%

Remainder, 27.2%

Figure 17: Most common cancer deaths in females

Death due to lung cancer in Malta compared to EU-15 and EU-12

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2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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Figure 18: SDR, malignant neoplasm of trachea, bronchus & lung per 100,000 in Malta compared to EU-15 & EU-12, all ages. Source: WHO/Europe-Health for all Database (HFA-DB)


38

Deaths due to breast cancer in Malta compared to EU-15 and EU-12 in females

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2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

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ast

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ge

s/1

00

,00

0)

Year

Malta EU-15 EU-12

Figure 19: SDR, malignant neoplasm of female breast per 100,000 in Malta compared to EU-15 & EU-12, all ages in females. Source: WHO/Europe-Health for all Database (HFA-DB) As shown in Table 11, the average age at death from neoplasms was 8 years less than that from circulatory diseases. The average at death was 71.0 years for those dying from neoplasms and 79.0 years for those dying from circulatory disease. The average age at death from neoplasms increased by one year between 2010 and 2011.

Table 11: Average age at death from the commonest neoplasms

Underlying cause of death* Average age at death (yrs) M F T

Malignant neoplasm of trachea, bronchus and lung (C33-C34) 71.4 64.9 70.1 Malignant neoplasm of colon, rectum and anus (C18-C21) 72.1 74.6 73.1 Malignant neoplasm of breast (C50) n/a 70.8 70.7 Malignant neoplasm of pancreas (C25) 70.8 72.3 71.6 Malignant neoplasm of stomach (C16) 70.9 71.4 71.1 Malignant neoplasm of ovary (C56) n/a 66.6 66.6 Malignant neoplasm of prostate (C61) 77.8 n/a 77.8 All neoplasms (C00-D48) 71.0 70.9 71.0 * Underlying causes of death with small numbers (n<10) were not included in the table or marked as “n/a”


39

Diseases of the respiratory system (ICD 10 code J00-J98)

There were 232 deaths due to respiratory conditions during 2011 accounting for 7.1% of all deaths. Of these, 127 were male and 105 were female. Deaths due to respiratory conditions tend to affect the older age groups.

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Figure 20: SDR, all respiratory conditions per 100,000 in Malta compared to EU-15 & EU-12, all ages. Source: WHO/Europe-Health for all Database (HFA-DB) The overall average age at death due to diseases of the respiratory system was 81.4. The average age at death in males was 78.8 and that in females was 84.6.


40

Chronic lower respiratory diseases (ICD 10 codes J40-J47)

There were 47 deaths in males and 16 deaths in females accounting for 1.9% of all deaths. Rates compare well with EU-12 and EU-15. A decreasing trend can be observed.

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Figure 21: SDR, chronic bronchitis/emphysema/asthma, in males per 100,000, all ages, in Malta compared to EU-15 & EU-12. Source: WHO/Europe-Health for all Database (HFA-DB)

Smoking attributable mortality

WHO definition

According to a method of calculation that has been used by the WHO, there were 387.3 deaths attributable to smoking in Maltese residents during the year 2011. Of these, 260.7 were male and 126.7 were female. Whereas the smoking attributable mortality for females remained constant, that for males increased by 19.7 deaths over 2010. This can be attributed to the increase in the number of deaths from ischaemic heart disease in males between 2010 and 2011.

These figures were obtained using the method described below (as recommended by the WHO).


41

Males Table 12: Smoking attributable mortality in males

Cause of death ICD-10 codes Total no. of

deaths

% advised by WHO related to smoking

Attributable to smoking

Deaths from cancer of trachea/bronchus/lung C33-C34 126 90% 113.4

Deaths from chronic bronchitis/emphysema J40-J44 46 75% 34.5

Deaths from ischaemic heart disease I20-I25 451 25% 112.8 Total 260.7

Females Table 13: Smoking attributable mortality in females

Cause of death ICD-10 codes Total no. of

deaths

% advised by WHO related to smoking

Attributable to smoking

Deaths from cancer of trachea/bronchus/lung C33-C34 31 90% 27.9

Deaths from chronic bronchitis/emphysema J40-J44 12 75% 9.0

Deaths from ischaemic heart disease I20-I25 359 25% 89.8 Total 126.7

ECHI definition

The Joint Action on European Community Health Indicator Monitoring (ECHIM) developed a set of indicators, one of which is the indicator for smoking attributable mortality. This indicator is believed to be finer than the previous WHO definition for smoking attributable mortality and may better reflect the number of deaths that are actually attributable to smoking. The calculation takes into consideration the prevalence of smoker, ex-smokers and non-smokers in the population. For more detail on the calculation and the references, kindly refer to Annex. According to the ECHI calculation, the smoking attributable mortality for males was 369.6 (178.3 per 100,000 male population) and 185.1 for females (88.4 per 100,000 female population).


42

Diseases of the digestive system (ICD 10 codes K00-K93)

There were 99 deaths due to diseases of the digestive system accounting for 3.0% of all deaths. Of these, 45 were male and 54 were female.

Diseases of the liver (ICD 10 codes K70-K76)

There were 41 deaths from disease of the liver, of which 27 were male and 14 were female. Of these, 18 male and 3 female deaths were attributed to alcoholic liver disease (ICD-10: K70).

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Figure 22: SDR, chronic liver disease & cirrhosis per 100,000 in Malta compared to EU-15 & EU-12 all ages. Source: WHO/Europe-Health for all Database (HFA-DB) The SDR for diseases of the liver was 7.9 per 100,000 population. Mortality due to chronic liver disease is low when compared with EU-15 and EU-12.

The overall average age at death from chronic liver disease and cirrhosis, in 2011, was 72.5 years. The average age at death in males was 67.2 and in females was 77.0 years.

Some infectious and parasitic diseases (ICD 10 codes A00-B99 (excluding A41.9), G00, G03-G04, N70-N73)

There were 20 deaths due to infectious and parasitic diseases in the above-mentioned categories. Of these, 9 were male and 11 were female. Seven died from hepatitis (B15-B19), 3 died from tuberculosis (A15-A19), 3 died from meningitis/encephalitis (G00, G03-G04), 2 died from diarrhoea and gastroenteritis and 2 died from Human Immunodeficiency Virus (HIV) infection. There were single cases of death from leishmaniasis and tetanus infection.


43

External causes of morbidity and mortality (ICD 10 codes V01-Y98)

There were 98 deaths due to external causes during the year 2011 accounting for 3.0% of all deaths. Of these, 74 were male and 24 were female.

0

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15

20

25

Falls (W00-W19)

Transport accidents

(V01-V99)

Intentional self-harm (X60-

X84)

All other external

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W99, X10-X39, X50-

X59, Y10-Y89)

Accidental drowning and

submersion (W65-W74)

Assault (X85-Y09)

Accidental poisoning by

and exposure to noxious

substances (X40-X49)

Nu

mb

er

of

de

ath

s

Male Female

Figure 23: Number of deaths due to external causes, in males and females. Table 14: Average age at death from some external causes Average age of death (years) Underlying cause of death* Male Female Total Falls (W00-W19) 78.8 87.0 82.1 Transport accidents (V01-V99) 44.5 43.8 44.4 Intentional self-harm (X60-X84) 42.4 n/a 42.4 Accidental drowning and submersion (W65-W74) 52.7 n/a 52.9 All external causes 53.4 68.0 56.9 * Underlying causes of death with small numbers (n<5) were not included in the table or marked as “n/a”


44

Transport accidents (V01-V99)

There were 20 deaths due to transport accidents during the year 2011. Of these, 15 were male and 5 were female.

The SDR from transport accidents is smaller in Malta compared to EU-15 and EU-12, but may be observed to be approaching the rates of the EU-15. Most deaths occur in males and in those under 65 years of age.

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Figure 24: SDR, motor vehicle accidents, all ages, in Malta compared to EU-15 & EU-12. Source: WHO/Europe-Health for all Database (HFA-DB)


45

Falls (ICD 10 codes W00-W19)

There were 32 deaths due to accidental falls. Of these, 19 were male and 13 were female. A number of deaths due to falls occur in young males associated with occupational accidents. Falls and associated hip fractures are an important cause of morbidity and mortality in older persons.

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Figure 25: Deaths due to falls by gender and age group


46

Intentional self harm (ICD 10 codes X60-X84)

It is not always easy to ascertain whether a death was intentional or accidental. Most probably, suicides tend to be under-reported. They carry a stigma and are rarely written down on the death certificate.

The National Mortality Registry collaborates very closely with the Police Statistics Office to determine the circumstantial evidence surrounding a death and to cross-check the cases of suicide between the two databases. Where the information given is very suggestive of suicide, deaths are coded as such. However, when this is dubious, deaths are coded under the heading ‘undetermined intent’.

During the year 2011 there were 20 deaths due to suicide. All of these were in males. Hanging and jumping from height were the commonest methods of suicide.

0

2

4

6

8

10

12

14

16

18

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

SD

R, i

nte

nti

on

al s

elf

ha

rm

all

ag

es/

10

0,0

00

Year

Malta EU-15 EU-12

Figure 26: SDR, Intentional self harm, all ages, per 100000, in Malta compared to EU-15 & EU-12. Source: WHO/Europe-Health for all Database (HFA-DB)

Deaths due to illicit drug overdose (EMCDDA definition)

Table 15: EMCDDA definition of codes used in illicit drug overdose Underlying cause of death Selected ICD-10 code(s) Disorders F11-F12, F14-F16, & F19 Accidental poisoning X44¹, X42¹, X41¹ Intentional poisoning X62¹, X61¹ , X64¹ Poisoning of undetermined intent Y12¹, Y11¹, Y14¹

¹ In combination with T codes T40.0-9, T43.6

There were 4 deaths due to drug overdose by illicit drugs. All of these were male. The average age at death was 34.3 years. Drugs of abuse included heroin, cocaine and other psycho-stimulants, in order of importance.


47

Section 3: Perinatal and infant mortality

Infant mortality statistics are an important source of information. They give an indication of the social and economic state of a country as well as the level of health care that is provided to an especially vulnerable group: infants.

During the year 2011, there were 40 perinatal deaths reported to the National Mortality Registry, consisting of 23 foetal deaths and 17 early neonatal deaths. There were 26 infant deaths. These deaths do not include foetuses or infants weighing less than 500g.

Table 16 gives a more detailed breakdown of foetal, neonatal and infant deaths according to the presence or otherwise of congenital anomalies classified the underlying cause of death.

Table 16: Foetal, neonatal & infant deaths by birth weight, age group & presence or absence of malformation as UCD.

500-999g or equivalent

>=1000g or equivalent Total

M F T M F T M F T Foetal deaths 2 2 4 7 12 19 9 14 23 FD with malformations 0 0 0 3 1 4 3 1 4 FD without malformations 2 2 4 4 11 15 6 13 19 Early neonatal deaths (END) 2 2 4 7 6 13 9 8 17 END with malformations 0 0 0 6 2 8 6 2 8 END without malformations 2 2 4 1 4 5 3 6 9 Late neonatal deaths (LND) 2 2 4 0 1 1 2 3 5 LND with malformations 0 0 0 0 1 1 0 1 1 LND without malformations 2 2 4 0 0 0 2 2 4 Post neonatal deaths (PND) 0 0 0 2 2 4 2 2 4 PND with malformations 0 0 0 2 1 3 2 1 3 PND without malformations 0 0 0 0 1 1 0 1 1 Infant deaths (ID) 4 4 8 9 9 18 13 13 26 ID with malformations 0 0 0 8 4 12 8 4 12 ID without malformations 4 4 8 1 5 6 5 9 14 *Malformations include ICD 10 codes: G47.3, Q00-Q99 Foetuses or infants weighing less than 500g are not included in the rates described below.

Foetal mortality rate: 23/ (4282+23)*1000= 5.34 per 1000 total births

Perinatal mortality rate : 40/ (4282+23)*1000= 9.29 per 1000 total births

Neonatal mortality rate: 22/ 4282*1000= 5.14 per 1000 live births

Post neonatal mortality rate: 4/4282*1000= 0.93 per 1000 live births

Infant mortality rate : 26/4282*1000= 6.07 per 1000 live births


48

International Statistics:

For international comparisons, only deaths with a birth weight of over 1000g are considered.

Foetal death rate, weight specific = 19/ (4263+19)*1000 = 4.44 per 1000 total births

Perinatal mortality rate, weight specific = 32/ (4263+19)*1000 = 7.47 per 1000 total births

Neonatal death rate, weight specific = 14/4263*1000 = 3.28 per 1000 live births

Post neonatal death rate, weight specific = 4/4263*1000 = 0.94 per 1000 live births

Infant mortality rate, weight specific = 18/4263*1000 = 4.22 per 1000 live births

Table 17: Foetal, neonatal & infant deaths by weeks of gestation & presence or absence of malformation as UCD.

22-27 wks or

equivalent >= 28 weeks or

equivalent Total M F T M F T M F T Foetal deaths 5 4 9 7 12 19 12 16 28 FD with malformations 0 0 0 3 1 4 3 1 4 FD without malformations 5 4 9 4 11 15 9 15 24 Early neonatal deaths (END) 1 3 4 8 6 14 9 9 18 END with malformations 0 0 0 6 2 8 6 2 8 END without malformations 1 3 4 2 4 6 3 7 10 Late neonatal deaths (LND) 2 2 4 0 1 1 2 3 5 LND with malformations 0 0 0 0 1 1 0 1 1 LND without malformations 2 2 4 0 0 0 2 2 4 Post neonatal deaths (PND) 0 0 0 2 2 4 2 2 4 PND with malformations 0 0 0 2 1 3 2 1 3 PND without malformations 0 0 0 0 1 1 0 1 1 Infant deaths (ID) 3 5 8 10 9 19 13 14 27 ID with malformations 0 0 0 8 4 12 8 4 12 ID without malformations 3 5 8 2 5 7 5 10 15 *Malformations include ICD 10 codes: G47.3, Q00-Q99 Foetuses or infants of less than 22 weeks gestation are not included in the rates described below.

Foetal mortality rate: 28/ (4283+28)*1000= 6.50 per 1000 total births

Perinatal mortality rate : 34/ (4283+28)*1000= 10.67 per 1000 total births

Neonatal mortality rate: 23/4283*1000= 5.37 per 1000 live births

Post neonatal mortality rate: 4/4283*1000= 0.93 per 1000 live births

Infant mortality rate: 27/4283*1000= 6.30 per 1000 live births


49

International Statistics:

For international comparisons, only deaths over 28 weeks of gestation are considered.

Foetal death rate, gestation specific = 19/ (4265+19)*1000 = 4.44 per 1000 total births

Perinatal mortality rate, gestation specific = 33/ (4265+19)*1000 = 7.70 per 1000 total births

Neonatal death rate, gestation specific = 15/ 4265*1000 = 3.52 per 1000 live births

Post neonatal death rate, gestation specific = 4/4265*1000 = 0.94 per 1000 live births

Infant mortality rate, gestation specific = 19/4265*1000 = 4.45 per 1000 live births

0

1

2

3

4

5

6

7

8

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Pe

rin

ata

l de

ath

s /1

00

0 b

irth

s

wt.

sp

eci

fic

Year

Malta EU-15 EU-12

Figure 27: Perinatal mortality weight specific (1000g and over) in Malta compared to EU-15 and EU-12.


50

Section 4: Deaths in non-residents who died in Malta during 2010

There were 63 deaths in non-residents in Malta. Of these, 43 were male and 19 were female. The gender of one non-resident could not be determined. The commonest causes of death were diseases of the circulatory system and external causes of mortality. Three of the 5 cases of deaths due to diseases of the digestive system, were from liver disease.

Circulatory

52.4%

External causes

17.5%

Digestive

7.9%

Neoplasms

6.3%

Other causes

15.9%

Figure 28: Causes of death in non-residents


51

0

2

4

6

8

10

12

14

16

18

20

<45 45-64 65-84 85+

Nu

mb

er

of

de

ath

s

Age group

M F

Figure 29: Deaths in non-residents by gender and age group

Number of deaths in non residents by country of residence

Table 18: Deaths in non-residents by country of residence

Deaths in non-residents dying in Malta by country of residence Country of residence Number United kingdom 33 Libya 8 Germany 4 Canada 2 Netherlands 2 Australia 1 Belgium 1 Bulgaria 1 France 1 Israel 1 Italy 1 Latvia 1 Nigeria 1 Norway 1 Russia 1 Sweden 1 Switzerland 1 Unknown 2 Total 63


52

Section 5: Statistical tables

Table 19 represents the age standardised death rate (ESP) per 100,000 population by gender and cause.

The Mortality Tabulation List 1 (MTL1) of the International Classification of Diseases (ICD-10) was used as the source of grouping of causes of death in this table.

Table 19: Standardised mortality rate (ESP) per 100,000 population by gender & cause

Age standardised mortality rate ICD-10 code MTL1 Cause of death males female persons

All causes 657.12 439.58 535.59

A00-B99 1001 Certain infectious and parasitic diseases 4.04 4.96 4.47

A09 1003 Diarrhoea and gastroenteritis of presumed 0.46 0.24 0.31 infectious origin A15-A16 1005 Respiratory tuberculosis 0.00 0.19 0.12 A17-A19 1006 Other tuberculosis 0.63 0.00 0.24 A33-A35 1008 Tetanus 0.00 0.19 0.12 A40-A41 1012 Septicaemia 0.92 1.54 1.27 B15-B19 1019 Viral hepatitis 1.11 1.76 1.44 B20-B24 1020 Human immunodeficiency virus (HIV) disease 0.92 0.00 0.46 B55 1022 Leishmaniasis 0.00 0.57 0.28 A21-A32, A38, A42-A49, 1025 Remainder of certain infectious and 0.00 0.48 0.23 A65-A79, A81, A83-A89, parasitic diseases

B00-B04, B06-B09,

B25-B49, B58-B64,

B66-B94, B99

C00-D48 1026 Neoplasms 180.87 126.62 149.26

C00-C97 Malignant neoplasms 180.87 125.20 148.37

C00-C14 1027 Malignant neoplasm of lip, oral cavity & pharynx 6.13 0.00 2.94 C15 1028 Malignant neoplasm of oesophagus 5.24 2.06 3.40 C16 1029 Malignant neoplasm of stomach 12.63 5.02 8.36 C18-C21 1030 Malignant neoplasm of colon, rectum & anus 25.20 12.55 18.23 C22 1031 Malignant neoplasm of liver & intrahepatic bile 6.49 1.70 3.94


53

Age standardised mortality rate ICD-10 code MTL1 Cause of death males female persons

ducts C25 1032 Malignant neoplasm of pancreas 11.70 9.23 10.35 C32 1033 Malignant neoplasm of larynx 2.72 0.00 1.21 C33-C34 1034 Malignant neoplasm of trachea, bronchus & lung 47.74 10.95 26.83 C43 1035 Malignant melanoma of skin 2.01 1.10 1.57 C50 1036 Malignant neoplasm of breast 0.37 26.49 14.66 C53 1037 Malignant neoplasm of cervix uteri - 1.89 0.97 C54-C55 1038 Malignant neoplasm of other & unspecified parts - 5.52 2.84 of uterus C56 1039 Malignant neoplasm of ovary - 12.71 6.75 C61 1040 Malignant neoplasm of prostate 14.06 - 5.65 C67 1041 Malignant neoplasm of bladder 8.15 4.06 5.79 C70-C72 1042 Malignant neoplasm of meninges, brain & other 5.59 3.22 4.39 parts of the central nervous system C82-C85 1043 Non-Hodgkin's lymphoma 4.75 2.90 3.83 C90 1044 Multiple myeloma & malignant plasma cell 4.06 2.29 3.01 neoplasms C91-C95 1045 Leukaemia 4.78 2.95 3.88 C17, C23-C24, C26-C31, 1046 Remainder of malignant neoplasms 19.25 20.57 19.78 C37-C41,C44-C49, C51- C52, C57-C60, C62-C66, C68-C69, C73-C81, C88, C96-C97 D00-D48 1047 Remainder of neoplasms 0.00 1.42 0.89

D50-D89 1048 Diseases of the blood & blood-forming organs 1.59 2.11 1.84 & certain disorders involving the immune mechanism

D50-D64 1049 Anaemias 0.83 0.87 0.79 D65-D89 1050 Remainder of diseases of the blood & blood- 0.76 1.25 1.04 forming organs & certain disorders involving the

immune mechanism

E00-E88 1051 Endocrine, nutritional & metabolic diseases 10.83 6.63 8.58

E10-E14 1052 Diabetes mellitus 9.95 4.43 6.93


54

Age standardised mortality rate ICD-10 code MTL1 Cause of death males female persons E00-E07, E15-E34, E50-E88 1054 Remainder of endocrine, nutritional & metabolic 0.88 2.20 1.65 diseases F01-F99 1055 Mental & behavioural disorders 19.95 21.25 20.91 F10-F19 1056 Mental & behavioural disorders due to 0.41 0.57 0.48 psychoactive substance use F01-F09, F20-F99 1057 Remainder of mental & behavioural disorders 19.54 20.68 20.43 G00-G98 1058 Disorders of the nervous system 19.17 14.56 16.46 G00, G03 1059 Meningitis 0.00 1.67 0.81 G30 1060 Alzheimer's disease 0.00 2.14 1.33 G04-G25, G31-G98 1061 Remainder of diseases of the nervous system 19.17 10.75 14.32 H60-H93 1063 Disease of the ear and mastoid process 0.33 0.00 0.16 I00-I99 1064 Diseases of the circulatory system 286.94 184.03 229.81 I00-I09 1065 Acute rheumatic fever & chronic rheumatic heart 0.00 1.77 0.94 diseases I10-I14 1066 Hypertensive diseases 2.24 3.99 3.37 I20-I25 1067 Ischaemic heart diseases 176.45 90.77 128.90 I26-I51 1068 Other heart diseases 39.70 37.09 38.44 I60-I69 1069 Cerebrovascular diseases 58.90 45.38 51.03 I70 1070 Atherosclerosis 0.92 0.90 0.90 I71-I99 1071 Remainder of diseases of the circulatory system 8.73 4.12 6.23 J00-J98 1072 Diseases of the respiratory system 49.11 25.37 35.20 J12-J18 1074 Pneumonia 13.16 10.39 11.81 J20-J22 1075 Other acute lower respiratory infections 7.58 7.14 7.15 J40-J47 1076 Chronic lower respiratory diseases 18.31 4.10 9.72 J00-J06, J30-J39,J60-J98 1077 Remainder of diseases of the respiratory system 10.07 3.74 6.53 K00-K92 1078 Diseases of the digestive system 17.71 14.67 16.55 K25-K27 1079 Gastric and duodenal ulcer 1.86 0.91 1.23 K70-K76 1080 Diseases of the liver 11.29 4.80 7.89 K00-K22, K28-K66, K80- 1081 Remainder of diseases of the digestive system 4.56 8.96 7.43


55

Age standardised mortality rate ICD-10 code MTL1 Cause of death males female persons K92

L00-L98 1082 Diseases of the skin & subcutaneous tissue 3.60 5.49 4.79

M00-M99 1083 Diseases of the musculoskeletal system & 2.52 1.02 1.70 connective tissue

N00-N98 1084 Diseases of the genitourinary system 14.06 10.39 11.87

N00-N15 1085 Glomerular & renal tubulo-interstitial diseases 1.60 0.83 1.16 N17-N98 1086 Remainder of diseases of the genitourinary 12.46 9.56 10.71 system

P00-P96 1092 Certain conditions originating in the perinatal 3.89 6.69 5.24 period

Q00-Q99 1093 Congenital malformations, deformations & 8.34 6.44 7.39 chromosomal abnormalities

R00-R99 1094 Symptoms, signs & abnormal clinical & 2.25 1.56 1.91 laboratory findings, not elsewhere classified

V01-Y89 1095 External causes of morbidity & mortality 31.91 7.78 19.45

V01-V99 1096 Transport accidents 6.46 2.19 4.26 W00-W19 1097 Falls 7.62 3.00 4.98 W65-W74 1098 Accidental drowning and submersion 2.82 0.46 1.59 X40-X49 1100 Accidental poisoning by & exposure to noxious 0.51 0.00 0.26 substances X60-X84 1101 Intentional self-harm 9.13 0.00 4.63 X85-Y09 1102 Assault 0.00 0.98 0.48

W20-W64, W75-W99, X10- 1103 All other external causes 5.35 1.15 3.24 X39, X50-X59,Y10-Y89


56

Table 20: Deaths by specific cause, age group and gender ICD-10 Age in years Code Cause of death Sex 0-4 5- 15- 25- 35- 45- 55- 65- 75- 85- 95+ Total

All deaths T 30 3 19 35 48 128 343 599 1092 857 113 3267 All male deaths M 13 1 16 22 29 82 219 371 552 329 30 1664 All female deaths F 17 2 3 13 19 46 124 228 540 528 83 1603

A00-B99 Certain infectious and parasitic diseases

M 0 0 0 0 0 1 3 1 2 3 0 10

F 1 0 0 1 1 0 1 2 4 4 1 15

A09 Other gastroenteritis and colitis of infectious and unspecified origin

M 0 0 0 0 0 0 0 0 0 1 0 1

F 0 0 0 0 0 0 0 0 0 0 1 1

A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

A17 Tuberculosis of nervous system

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

A18 Tuberculosis of other organs

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

A35 Other tetanus M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

A41 Other septicaemia M 0 0 0 0 0 0 0 0 0 2 0 2 F 0 0 0 0 0 0 0 1 1 4 0 6

B16 Acute hepatitis B M 0 0 0 0 0 0 2 0 0 0 0 2 F 0 0 0 0 0 0 1 0 0 0 0 1

B17 Other acute viral hepatitis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

B18 Chronic viral hepatitis M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 1 0 0 0 1

B19 Unspecified viral hepatitis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

B21 Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

B24 Unspecified human immunodeficiency virus [HIV] disease

M 0 0 0 0 0 1 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

B34 Viral infection of unspecified site

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 1 0 0 0 0 0 0 0 1


57

ICD-10 Age in years Code Cause of death Sex 0-4 5- 15- 25- 35- 45- 55- 65- 75- 85- 95+ Total

B55 Leishmaniasis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 1 0 0 0 0 0 0 1

C00-D48 Neoplasms M 0 0 3 3 3 25 93 148 150 45 3 473 F 0 1 0 4 12 32 72 98 127 58 4 408

C00-C97 Malignant neoplasms M 0 0 3 3 3 25 93 148 150 45 3 473 F 0 1 0 4 12 32 72 98 124 55 4 402

C02 Malignant neoplasm of other and unspecified parts of tongue

M 0 0 0 0 0 0 1 2 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

C05 Malignant neoplasm of palate

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

C06 Malignant neoplasm of other and unspecified parts of mouth

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

C09 Malignant neoplasm of tonsil

M 0 0 0 0 0 0 1 2 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

C10 Malignant neoplasm of oropharynx

M 0 0 0 0 0 1 0 0 1 0 0 2 F 0 0 0 0 0 0 0 0 0 0 0 0

C11 Malignant neoplasm of nasopharynx

M 0 0 0 0 1 1 1 0 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

C12 Malignant neoplasm of piriform sinus

M 0 0 0 0 0 0 1 1 0 0 0 2 F 0 0 0 0 0 0 0 0 0 0 0 0

C13 Malignant neoplasm of hypopharynx

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

C15 Malignant neoplasm of oesophagus

M 0 0 0 0 0 1 4 1 7 1 0 14 F 0 0 0 0 0 2 1 1 1 1 0 6

C16 Malignant neoplasm of stomach

M 0 0 0 0 2 1 3 13 11 3 0 33 F 0 0 0 0 1 0 5 2 6 3 0 17

C17 Malignant neoplasm of small intestine

M 0 0 0 0 0 0 0 2 0 0 0 2 F 0 0 0 0 0 0 0 0 0 0 0 0

C18 Malignant neoplasm of colon

M 0 0 0 0 0 1 6 20 17 2 0 46 F 0 0 0 0 0 3 3 11 13 6 0 36

C19 Malignant neoplasm of rectosigmoid junction

M 0 0 0 0 0 0 2 0 1 1 0 4 F 0 0 0 0 0 0 0 0 0 1 0 1

C20 Malignant neoplasm of rectum

M 0 0 0 0 0 0 3 7 5 1 0 16 F 0 0 0 0 0 0 1 2 3 1 0 7


58


C22 Malignant neoplasm of liver and intrahepatic bile ducts

M 0 0 0 0 0 3 5 3 5 1 0 17

F 0 0 0 0 0 0 0 3 2 1 0 6

C24 Malignant neoplasm of other and unspecified parts of biliary tract

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 1 0 0 0 1

C25 Malignant neoplasm of pancreas

M 0 0 0 0 0 1 9 9 12 1 0 32 F 0 0 0 1 0 0 6 9 8 7 0 31

C26 Malignant neoplasm of other and ill-defined digestive organs

M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0 0 2 0 1 3

C32 Malignant neoplasm of larynx

M 0 0 0 0 0 0 4 0 4 0 0 8 F 0 0 0 0 0 0 0 0 0 0 0 0

C34 Malignant neoplasm of bronchus and lung

M 0 0 0 0 0 6 26 44 37 13 0 126 F 0 0 0 1 0 8 6 6 7 3 0 31

C37 Malignant neoplasm of thymus

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

C41 Malignant neoplasm of bone and articular cartilage of other and unspecified sites

M 0 0 1 0 0 1 0 0 0 0 0 2 F 0 0 0 0 0 0 0 0 1 0 0 1

C43 Malignant melanoma of skin

M 0 0 0 0 0 1 1 2 1 0 0 5 F 0 0 0 0 0 1 0 0 3 0 0 4

C44 Other malignant neoplasms of skin

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 1 0 0 0 0 1

C45 Mesothelioma M 0 0 0 0 0 0 0 2 2 0 0 4 F 0 0 0 0 0 0 1 1 1 0 0 3

C49 Malignant neoplasm of other connective and soft tissue

M 0 0 0 0 0 0 0 1 0 0 0 1

F 0 0 0 0 2 0 1 1 0 0 0 4

C50 Malignant neoplasm of breast

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 1 3 7 19 19 21 14 1 85

C51 Malignant neoplasm of vulva

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 3 0 0 3

C53 Malignant neoplasm of cervix uteri

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 1 3 0 1 0 0 5

C54 Malignant neoplasm of corpus uteri

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 2 0 3 7 0 0 0 12

C55 Malignant neoplasm of uterus, part unspecified

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 1 0 1 1 0 0 3


59


C56 Malignant neoplasm of ovary

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 3 3 9 10 11 1 0 37

C61 Malignant neoplasm of

prostate M 0 0 0 0 0 1 4 8 12 10 1 36

F 0 0 0 0 0 0 0 0 0 0 0 0

C64 Malignant neoplasm of kidney, except renal pelvis

M 0 0 0 1 0 1 3 2 3 2 0 12

F 0 0 0 0 0 0 4 2 1 2 0 9

C65 Malignant neoplasm of renal pelvis

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 1 0 0 0 1

C67 Malignant neoplasm of bladder

M 0 0 0 0 0 0 3 8 7 2 1 21 F 0 0 0 0 0 1 4 0 5 4 0 14

C71 Malignant neoplasm of brain

M 0 0 0 1 0 3 3 4 3 0 0 14 F 0 1 0 0 0 1 1 3 2 1 0 9

C73 Malignant neoplasm of thyroid gland

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 1 0 0 0 1 0 2

C75 Malignant neoplasm of other endocrine glands and related structures

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 1 0 0 0 0 0 1

C76 Malignant neoplasm of other and ill-defined sites

M 0 0 0 0 0 0 0 1 1 0 0 2

F 0 0 0 0 0 0 0 1 1 2 0 4

C78 Secondary malignant neoplasm of respiratory and digestive organs

M 0 0 0 0 0 0 1 0 0 1 0 2 F 0 0 0 0 0 0 0 0 1 0 0 1

C79 Secondary malignant neoplasm of other and unspecified sites

M 0 0 0 0 0 0 0 0 3 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

C80 Malignant neoplasm, without specification of site

M 0 0 0 0 0 2 0 5 4 3 0 14

F 0 0 0 0 1 0 2 8 14 3 1 29

C81 Hodgkin lymphoma M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 1 0 1 2 1 0 0 0 5

C83 Non-follicular lymphoma

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 1 0 1 0 0 2

C85 Other and unspecified types of non-Hodgkin lymphoma

M 0 0 0 1 0 1 4 0 4 1 0 11

F 0 0 0 0 0 0 0 3 4 1 1 9

C88 Malignant immunoproliferative diseases

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0


60


C90 Multiple myeloma and malignant plasma cell neoplasms

M 0 0 0 0 0 0 2 4 4 0 1 11 F 0 0 0 0 0 1 0 3 2 1 0 7

C91 Lymphoid leukaemia M 0 0 2 0 0 0 1 0 1 1 0 5 F 0 0 0 0 0 0 0 1 2 2 0 5

C92 Myeloid leukaemia M 0 0 0 0 0 0 1 3 2 1 0 7 F 0 0 0 0 0 0 0 0 5 0 0 5

C93 Monocytic leukaemia M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

C94 Other leukaemias of specified cell type

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

D10-D36 Benign neoplasms M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 2 1 0 3

D32 Benign neoplasm of meninges

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 2 1 0 3

D37-D48 Neoplasms of uncertain or unknown behaviour

M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0 0 1 2 0 3

D46 Myelodysplastic syndromes

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 2 0 2

D47 Other neoplasms of uncertain or unknown behaviour of lymphoid, haematopoietic and related tissue

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

M 0 0 0 1 0 0 0 0 2 1 0 4 F 0 0 0 0 0 0 1 3 2 1 0 7

D56 Thalassaemia M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0 1 0 0 0 1

D59 Acquired haemolytic anaemia

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 0 1

D61 Other aplastic anaemias

M 0 0 0 0 0 0 0 0 1 1 0 2 F 0 0 0 0 0 0 0 0 1 0 0 1

D65 Disseminated intravascular coagulation [defibrination syndrome]

M 0 0 0 1 0 0 0 0 1 0 0 2 F 0 0 0 0 0 0 0 1 0 0 0 1

D69 Purpura and other haemorrhagic conditions

M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0 0 1 1 0 2


61


D80 Immunodeficiency with

predominantly antibody defects

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 0 0 0 0 1

E00-E90 Endocrine, nutritional and metabolic diseases

M 0 0 0 0 1 1 4 8 12 3 0 29

F 1 0 0 0 0 0 2 2 10 10 0 25

E03 Other hypothyroidism M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

E05 Thyrotoxicosis [hyperthyroidism]

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 0 1

E10 Insulin-dependent diabetes mellitus

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

E11 Non-insulin-dependent diabetes mellitus

M 0 0 0 0 0 0 1 2 1 0 0 4 F 0 0 0 0 0 0 0 0 4 1 0 5

E14 Unspecified diabetes mellitus

M 0 0 0 0 0 1 2 5 11 3 0 22 F 0 0 0 0 0 0 1 1 6 6 0 14

E22 Hyperfunction of pituitary gland

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

E34 Other endocrine disorders

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

E71 Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism

M 0 0 0 0 1 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

E75 Disorders of sphingolipid metabolism and other lipid storage disorders

M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

E85 Amyloidosis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 0 0 0 0 1

E86 Volume depletion M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

F00-F99 Mental and behavioural disorders

M 0 0 0 1 0 1 2 2 18 23 2 49 F 0 0 0 0 1 0 1 4 25 45 13 89

F03 Unspecified dementia M 0 0 0 0 0 1 0 1 18 22 2 44 F 0 0 0 0 0 0 0 3 21 44 11 79

F06 Other mental disorders due to brain damage and dysfunction and to physical disease

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 0 1 1 2


62


F10 Mental and behavioural

disorders due to use of alcohol

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 1 0 0 0 0 0 0 1

F20 Schizophrenia M 0 0 0 1 0 0 1 1 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

F25 Schizoaffective disorders

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

F31 Bipolar affective disorder

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

F32 Depressive episode M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 1 1 0 1 4

F79 Unspecified mental retardation

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

G00-G99 Diseases of the nervous system

M 0 0 1 3 4 2 7 5 12 11 2 47 F 2 0 1 1 1 2 2 7 13 18 1 48

G00 Bacterial meningitis, not elsewhere classified

M 0 0 0 0 0 0 0 0 0 0 0 0

F 2 0 0 0 0 0 0 0 0 0 0 2

G04 Encephalitis, myelitis and encephalomyelitis

M 0 0 0 0 1 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

G10 Huntington disease M 0 0 0 0 1 1 2 0 0 0 0 4 F 0 0 0 0 1 0 0 4 0 1 0 6

G12 Spinal muscular atrophy and related syndromes

M 0 0 0 1 0 0 1 1 1 0 0 4

F 0 0 0 0 0 1 0 1 2 0 0 4

G13 Systemic atrophies primarily affecting central nervous system in diseases classified elsewhere

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 1 0 0 0 0 0 1

G20 Parkinson disease M 0 0 0 0 1 1 1 1 7 11 1 23 F 0 0 0 0 0 0 0 0 7 11 0 18

G23 Other degenerative diseases of basal ganglia

M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0 1 0 0 0 1

G30 Alzheimer disease M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 0 3 4 1 9

G31 Other degenerative diseases of nervous system, not elsewhere classified

M 0 0 0 0 0 0 1 1 1 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

G40 Epilepsy M 0 0 0 0 0 0 1 1 1 0 0 3 F 0 0 1 0 0 0 0 0 1 0 0 2


63


G41 Status epilepticus M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 1 0 0 0 0 1

G62 Other polyneuropathies M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

G71 Primary disorders of muscles

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

G80 Cerebral palsy M 0 0 1 2 1 0 0 0 0 0 0 4 F 0 0 0 1 0 0 0 0 0 0 0 1

G81 Hemiplegia M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 1 0 1

G82 Paraplegia and tetraplegia

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 1 0 0 0 1

G93 Other disorders of brain

M 0 0 0 0 0 0 0 0 1 0 1 2 F 0 0 0 0 0 0 0 0 0 0 0 0

H60-H95 Diseases of the ear and mastoid process

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

H66 Suppurative and unspecified otitis media

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

I00-I99 Diseases of the circulatory system

M 0 0 0 4 8 31 78 157 254 183 16 731 F 0 0 1 2 1 9 33 84 256 303 43 732

I05 Rheumatic mitral valve diseases

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 1 0 1 0 0 0 1 0 3

I06 Rheumatic aortic valve diseases

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 0 1

I09 Other rheumatic heart diseases

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

I10 Essential (primary) hypertension

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 1 1 1 5 0 8

I11 Hypertensive heart disease

M 0 0 0 0 0 1 0 2 2 0 0 5 F 0 0 0 0 0 0 1 2 3 0 0 6

I12 Hypertensive renal disease

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

I20 Angina pectoris M 0 0 0 0 0 0 1 2 0 0 0 3 F 0 0 0 0 0 0 0 0 2 2 0 4

I21 Acute myocardial infarction

M 0 0 0 2 3 16 33 72 86 47 3 262 F 0 0 0 0 1 3 8 29 79 65 6 191


64


I24 Other acute ischaemic

heart diseases M 0 0 0 0 1 0 1 1 2 0 1 6

F 0 0 0 0 0 0 1 0 0 1 0 2

I25 Chronic ischaemic heart disease

M 0 0 0 0 0 7 24 40 56 48 5 180 F 0 0 0 0 0 1 8 19 52 69 13 162

I26 Pulmonary embolism M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 1 1 1 6 1 0 10

I27 Other pulmonary heart diseases

M 0 0 0 0 0 0 1 1 0 0 0 2 F 0 0 0 0 0 0 0 0 1 0 0 1

I28 Other diseases of pulmonary vessels

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

I31 Other diseases of pericardium

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 1 0 0 0 1

I33 Acute and subacute endocarditis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

I34 Nonrheumatic mitral valve disorders

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 0 0 0 0 1

I35 Nonrheumatic aortic valve disorders

M 0 0 0 0 0 0 0 1 1 0 0 2 F 0 0 0 0 0 0 0 0 0 1 0 1

I38 Endocarditis, valve unspecified

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 2 0 0 2

I42 Cardiomyopathy M 0 0 0 0 0 2 1 2 1 0 0 6 F 0 0 0 0 0 0 2 0 2 1 0 5

I46 Cardiac arrest M 0 0 0 0 1 0 0 0 6 3 0 10 F 0 0 0 0 0 0 0 2 5 4 2 13

I47 Paroxysmal tachycardia

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

I48 Atrial fibrillation and flutter

M 0 0 0 0 0 0 0 1 1 1 0 3 F 0 0 0 0 0 0 0 0 3 4 0 7

I49 Other cardiac arrhythmias

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 0 3 0 3

I50 Heart failure M 0 0 0 1 1 1 4 5 17 34 3 66 F 0 0 0 0 0 2 2 5 23 55 9 96

I51 Complications and ill-defined descriptions of heart disease

M 0 0 0 1 2 0 0 0 1 0 0 4

F 0 0 0 1 0 1 0 2 0 3 0 7

I60 Subarachnoid haemorrhage

M 0 0 0 0 0 1 0 2 3 0 0 6 F 0 0 0 0 0 0 2 0 1 1 0 4


65


I61 Intracerebral haemorrhage

M 0 0 0 0 0 1 7 4 15 4 0 31 F 0 0 0 0 0 0 5 4 7 3 0 19

I62 Other nontraumatic intracranial haemorrhage

M 0 0 0 0 0 0 0 0 2 1 0 3

F 0 0 0 0 0 0 0 2 3 0 0 5

I63 Cerebral infarction M 0 0 0 0 0 0 1 2 2 3 0 8 F 0 0 1 0 0 0 1 1 2 5 0 10

I64 Stroke, not specified as haemorrhage or infarction

M 0 0 0 0 0 2 0 13 45 32 3 95

F 0 0 0 0 0 0 0 10 55 57 11 133

I67 Other cerebrovascular diseases

M 0 0 0 0 0 0 1 1 1 2 1 6 F 0 0 0 0 0 0 0 2 2 6 0 10

I69 Sequelae of cerebrovascular disease

M 0 0 0 0 0 0 0 1 1 1 0 3

F 0 0 0 0 0 0 0 0 0 3 0 3

I70 Atherosclerosis M 0 0 0 0 0 0 0 0 0 2 0 2 F 0 0 0 0 0 0 0 0 1 3 0 4

I71 Aortic aneurysm and dissection

M 0 0 0 0 0 0 3 3 6 2 0 14 F 0 0 0 0 0 0 0 1 2 1 0 4

I72 Other aneurysm and dissection

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

I73 Other peripheral vascular diseases

M 0 0 0 0 0 0 1 2 4 0 0 7 F 0 0 0 0 0 0 0 0 3 6 1 10

I74 Arterial embolism and thrombosis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 1 2

I80 Phlebitis and thrombophlebitis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

I84 Haemorrhoids M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

J00-J99 Diseases of the respiratory system

M 0 0 1 0 0 4 8 18 58 33 5 127 F 0 0 0 0 1 0 1 9 38 44 12 105

J15 Bacterial pneumonia, not elsewhere classified

M 0 0 0 0 0 0 0 0 2 0 0 2

F 0 0 0 0 0 0 0 0 0 0 0 0

J18 Pneumonia, organism unspecified

M 0 0 0 0 0 2 2 3 19 6 1 33 F 0 0 0 0 0 0 1 2 12 22 6 43

J22 Unspecified acute lower respiratory infection

M 0 0 0 0 0 0 0 2 7 7 3 19

F 0 0 0 0 1 0 0 1 16 11 1 30


66


J38 Diseases of vocal

cords and larynx, not elsewhere classified

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

J42 Unspecified chronic bronchitis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 0 1

J44 Other chronic obstructive pulmonary disease

M 0 0 0 0 0 1 3 7 20 14 1 46

F 0 0 0 0 0 0 0 3 2 3 3 11

J45 Asthma M 0 0 0 0 0 1 0 0 0 0 0 1 F 0 0 0 0 0 0 0 1 1 0 0 2

J47 Bronchiectasis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 1 0 2

J61 Pneumoconiosis due to asbestos and other mineral fibres

M 0 0 0 0 0 0 0 1 1 0 0 2 F 0 0 0 0 0 0 0 0 0 0 0 0

J67 Hypersensitivity pneumonitis due to organic dust

M 0 0 0 0 0 0 1 0 0 0 0 1

F 0 0 0 0 0 0 0 0 0 0 0 0

J69 Pneumonitis due to solids and liquids

M 0 0 0 0 0 0 1 0 2 2 0 5 F 0 0 0 0 0 0 0 0 1 4 2 7

J81 Pulmonary oedema M 0 0 1 0 0 0 0 1 0 0 0 2 F 0 0 0 0 0 0 0 0 1 1 0 2

J84 Other interstitial pulmonary diseases

M 0 0 0 0 0 0 1 4 5 3 0 13 F 0 0 0 0 0 0 0 1 4 2 0 7

J85 Abscess of lung and mediastinum

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

J98 Other respiratory disorders

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

K00-K93 Diseases of the digestive system

M 0 1 0 0 1 6 10 11 13 3 0 45 F 0 0 0 1 0 2 6 8 20 14 3 54

K22 Other diseases of oesophagus

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

K25 Gastric ulcer M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

K26 Duodenal ulcer M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 1 0 0 1 0 0 2

K27 Peptic ulcer, site unspecified

M 0 0 0 0 0 0 0 1 2 0 0 3 F 0 0 0 0 0 0 0 0 1 0 0 1


67


K29 Gastritis and duodenitis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

K46 Unspecified abdominal hernia

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

K52 Other noninfective gastroenteritis and colitis

M 0 0 0 0 0 1 0 0 0 0 0 1

F 0 0 0 0 0 0 0 0 0 0 1 1

K55 Vascular disorders of intestine

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 0 4 1 0 6

K56 Paralytic ileus and intestinal obstruction without hernia

M 0 0 0 0 0 0 0 0 1 0 0 1

F 0 0 0 0 0 0 0 1 4 1 0 6

K57 Diverticular disease of intestine

M 0 0 0 0 0 0 1 1 1 0 0 3 F 0 0 0 0 0 0 0 1 1 1 0 3

K63 Other diseases of intestine

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 2 2 1 6

K65 Peritonitis M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 1 0 0 1

K70 Alcoholic liver disease M 0 0 0 0 1 4 5 7 0 1 0 18 F 0 0 0 0 0 0 3 0 0 0 0 3

K72 Hepatic failure, not elsewhere classified

M 0 1 0 0 0 0 1 1 1 0 0 4 F 0 0 0 0 0 1 0 1 0 0 0 2

K73 Chronic hepatitis, not elsewhere classified

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 1 0 0 0 0 1

K74 Fibrosis and cirrhosis of liver

M 0 0 0 0 0 1 2 0 1 1 0 5 F 0 0 0 0 0 0 1 2 1 2 0 6

K75 Other inflammatory liver diseases

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 0 1

K76 Other diseases of liver M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 1 0 0 0 0 0 0 0 1

K80 Cholelithiasis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 2 0 3

K81 Cholecystitis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 1 2

K82 Other diseases of gallbladder

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

K83 Other diseases of biliary tract

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 1 0 1


68


K85 Acute pancreatitis M 0 0 0 0 0 0 1 0 1 0 0 2 F 0 0 0 0 0 0 0 1 1 0 0 2

K92 Other diseases of digestive system

M 0 0 0 0 0 0 0 0 3 0 0 3 F 0 0 0 0 0 0 0 0 2 1 0 3

L00-L99 Diseases of the skin and subcutaneous tissue

M 0 0 0 0 0 0 0 2 4 1 2 9

F 0 0 0 0 0 0 0 1 17 4 2 24

L89 Decubitus ulcer and pressure area

M 0 0 0 0 0 0 0 2 4 1 2 9 F 0 0 0 0 0 0 0 1 17 4 2 24

M00-M99 Diseases of the musculoskeletal system and connective tissue

M 0 0 1 0 0 0 0 3 0 2 0 6

F 0 0 0 0 0 0 0 0 3 1 0 4

M00 Pyogenic arthritis M 0 0 0 0 0 0 0 1 0 1 0 2 F 0 0 0 0 0 0 0 0 2 0 0 2

M06 Other rheumatoid arthritis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 1 0 0 1

M34 Systemic sclerosis M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

M40 Kyphosis and lordosis M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

M41 Scoliosis M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

M48 Other spondylopathies M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

M88 Paget disease of bone [osteitis deformans]

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

N00-N99 Diseases of the genitourinary system

M 0 0 0 0 0 1 1 8 15 11 0 36 F 0 0 0 0 0 0 1 7 20 14 1 43

N03 Chronic nephritic syndrome

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 1 0 0 1

N11 Chronic tubulo-interstitial nephritis

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 1 0 0 0 1

N13 Obstructive and reflux uropathy

M 0 0 0 0 0 0 0 2 0 1 0 3 F 0 0 0 0 0 0 0 0 0 0 1 1

N17 Acute renal failure M 0 0 0 0 0 0 0 1 2 2 0 5 F 0 0 0 0 0 0 0 1 6 3 0 10

N18 Chronic kidney disease M 0 0 0 0 0 1 1 5 8 4 0 19 F 0 0 0 0 0 0 1 5 7 4 0 17


69


N19 Unspecified kidney

failure M 0 0 0 0 0 0 0 0 2 0 0 2

F 0 0 0 0 0 0 0 0 1 2 0 3

N39 Other disorders of urinary system

M 0 0 0 0 0 0 0 0 2 4 0 6 F 0 0 0 0 0 0 0 0 5 5 0 10

P00-P96 Certain conditions originating in the perinatal period

M 5 0 0 0 0 0 0 0 0 0 0 5

F 8 0 0 0 0 0 0 0 0 0 0 8

P02 Fetus and newborn affected by complications of placenta, cord and membranes

M 1 0 0 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

P07 Disorders related to short gestation and low birth weight, not elsewhere classified

M 4 0 0 0 0 0 0 0 0 0 0 4 F 6 0 0 0 0 0 0 0 0 0 0 6

P21 Birth asphyxia M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

P56 Hydrops fetalis due to haemolytic disease

M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

Q00-Q89 Congenital malformations, deformations and chromosomal abnormalities

M 8 0 1 0 1 0 2 0 1 0 0 13 F 5 1 0 1 0 0 3 0 0 0 0 10

Q00 Anencephaly and

similar malformations M 1 0 0 0 0 0 0 0 0 0 0 1

F 0 0 0 0 0 0 0 0 0 0 0 0

Q05 Spina bifida M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 1 0 0 0 0 0 0 0 1

Q20 Congenital malformations of cardiac chambers and connections

M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

Q21 Congenital malformations of cardiac septa

M 2 0 0 0 0 0 0 0 0 0 0 2

F 0 0 0 0 0 0 1 0 0 0 0 1

Q23 Congenital malformations of aortic and mitral valves

M 1 0 0 0 0 0 0 0 0 0 0 1

F 0 0 0 0 0 0 0 0 0 0 0 0

Q33 Congenital malformations of lung

M 1 0 0 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

Q60 Renal agenesis and other reduction defects of kidney

M 1 0 0 0 0 0 0 0 0 0 0 1

F 0 0 0 0 0 0 0 0 0 0 0 0

Q61 Cystic kidney disease M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0


70


Q77 Osteochondrodysplasia with defects of growth of tubular bones and spine

M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

Q85 Phakomatoses, not elsewhere classified

M 0 0 0 0 1 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

Q87 Other specified congenital malformation syndromes affecting multiple systems

M 0 0 0 0 0 0 0 0 0 0 0 0 F 1 0 0 0 0 0 0 0 0 0 0 1

Q89 Other congenital malformations, not elsewhere classified

M 2 0 0 0 0 0 0 0 0 0 0 2 F 1 0 0 0 0 0 0 0 0 0 0 1

Q90 Down syndrome M 0 0 0 0 0 0 2 0 0 0 0 2 F 1 0 0 0 0 0 2 0 0 0 0 3

Q93 Monosomies and deletions from the autosomes, not elsewhere classified

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 1 0 0 0 0 0 0 0 0 0 1

R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

M 0 0 0 0 0 1 0 1 0 3 0 5 F 0 0 0 0 0 0 0 0 2 3 2 7

R02 Gangrene, not

elsewhere classified M 0 0 0 0 0 0 0 1 0 0 0 1

F 0 0 0 0 0 0 0 0 1 0 0 1

R26 Abnormalities of gait and mobility

M 0 0 0 0 0 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 0 1 0 1 2

R54 Senility M 0 0 0 0 0 0 0 0 0 2 0 2 F 0 0 0 0 0 0 0 0 0 1 1 2

R57 Shock, not elsewhere classified

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

R58 Haemorrhage, not elsewhere classified

M 0 0 0 0 0 1 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

R68 Other general symptoms and signs

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0 1 0 1

V01-Y98 External causes of morbidity and mortality

M 0 0 9 10 11 9 10 7 11 7 0 74

F 0 0 1 3 2 1 1 3 3 9 1 24

V03 Pedestrian injured in collision with car, pick-up truck or van

M 0 0 1 0 1 0 2 0 1 0 0 5

F 0 0 1 0 0 0 0 1 0 0 0 2


71


V04 Pedestrian injured in collision with heavy transport vehicle or bus

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

V13 Pedal cyclist injured in collision with car, pick-up truck or van

M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

V23 Motorcycle rider injured in collision with car, pick-up truck or van

M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

V27 Motorcycle rider injured in collision with fixed or stationary object

M 0 0 0 1 2 0 0 0 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

V29 Motorcycle rider injured in other and unspecified transport accidents

M 0 0 0 0 1 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

V43 Car occupant injured in collision with car, pick-up truck or van

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 1 0 0 0 0 0 0 0 1

V47 Car occupant injured in collision with fixed or stationary object

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 1 0 0 0 0 0 0 1

V48 Car occupant injured in noncollision transport accident

M 0 0 0 1 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

V86 Occupant of special all-terrain or other motor vehicle designed primarily for off-road use, injured in transport accident

M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

V89 Motor- or nonmotor-vehicle accident, type of vehicle unspecified

M 0 0 0 0 1 0 0 0 0 0 0 1 F 0 0 0 0 0 0 1 0 0 0 0 1

W01 Fall on same level from slipping, tripping and stumbling

M 0 0 0 0 0 0 0 0 1 2 0 3 F 0 0 0 0 0 0 0 0 0 1 0 1

W06 Fall involving bed M 0 0 0 0 0 0 0 0 1 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

W10 Fall on and from stairs and steps

M 0 0 0 0 0 0 1 2 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

W13 Fall from, out of or through building or structure

M 0 0 0 0 0 0 0 0 1 0 0 1

F 0 0 0 0 0 0 0 0 0 0 0 0


72


W18 Other fall on same level

M 0 0 0 0 0 0 0 2 0 1 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

W19 Unspecified fall M 0 0 0 0 0 0 1 1 2 4 0 8 F 0 0 0 0 0 0 0 0 3 8 1 12

W30 Contact with agricultural machinery

M 0 0 0 1 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

W69 Drowning and submersion while in natural water

M 0 0 1 1 1 0 1 1 0 0 0 5

F 0 0 0 0 0 1 0 0 0 0 0 1

W74 Unspecified drowning and submersion

M 0 0 0 0 0 0 0 0 2 0 0 2 F 0 0 0 0 0 0 0 0 0 0 0 0

W79 Inhalation and ingestion of food causing obstruction of respiratory tract

M 0 0 0 1 0 1 0 0 1 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

W84 Unspecified threat to breathing

M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

X47 Accidental poisoning by and exposure to other gases and vapours

M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

X61 Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified

M 0 0 1 0 0 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

X70 Intentional self-harm by hanging, strangulation and suffocation

M 0 0 1 0 2 4 2 0 0 0 0 9 F 0 0 0 0 0 0 0 0 0 0 0 0

X72 Intentional self-harm by handgun discharge

M 0 0 0 0 0 1 1 0 0 0 0 2 F 0 0 0 0 0 0 0 0 0 0 0 0

X80 Intentional self-harm by jumping from a high place

M 0 0 1 4 1 1 1 0 0 0 0 8

F 0 0 0 0 0 0 0 0 0 0 0 0

X91 Assault by hanging, strangulation and suffocation

M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 1 0 0 0 0 0 0 0 1

X99 Assault by sharp object M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 1 0 0 0 0 0 0 1


73


Y11 Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent

M 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 1 0 0 0 0 0 0 0 1

Y12 Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent

M 0 0 0 1 1 1 0 0 0 0 0 3 F 0 0 0 0 0 0 0 0 0 0 0 0

Y21 Drowning and submersion, undetermined intent

M 0 0 0 0 0 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0 1 0 0 0 1

Y29 Contact with blunt object, undetermined intent

M 0 0 0 0 0 1 0 0 0 0 0 1

F 0 0 0 0 0 0 0 0 0 0 0 0

Y30 Falling, jumping or pushed from a high place, undetermined intent

M 0 0 0 0 0 0 1 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

Y34 Unspecified event, undetermined intent

M 0 0 0 0 1 0 0 0 0 0 0 1 F 0 0 0 0 0 0 0 0 0 0 0 0

Y60 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care

M 0 0 0 0 0 0 0 1 0 0 0 1 F 0 0 0 0 0 0 0 1 0 0 0 1


74

Annex

national mortality registry

Documents