Chronic Disease Death MICA - Documentation

Death records are compiled from death certificates which are filed with the Department of Health and Senior Services under Missouri Revised Statutes (Chapter 193, RSMo). The death certificate system has been in place in Missouri continuously since 1911, although changes in data items and definitions have taken place over the years.

Through the Interjurisdictional Exchange Agreement supported by the National Association of Public Health Statistics and Information Systems, Missouri cooperates with other states in the exchange of death records. Therefore, data concerning deaths of Missouri residents include virtually all Missouri resident Need link to “Resident” page deaths regardless of where the death took place.

Selecting Cause for Each Death

When several diseases or factors lead to a death, the National Center for Health Statistics provides rules for choosing which one will be used statistically as the underlying cause of death. This underlying cause of death is what appears in this MICA. It is defined as the disease or injury which initiated the chain of events which led directly to the death, or the event which caused the fatal injury.

Causes of Death

Some causes of death are subdivisions of larger groups. That is, they are “Intermediate Items” within a “Major Item.” Major items which have subdivisions are shown in blue type with a plus symbol to their left. To view the subdivisions click the plus symbol. For example, clicking on the plus symbol next to "Chronic lower respiratory diseases" reveals the subdivisions asthma, emphysema, and other lower respiratory diseases. To see all the subdivisions, leave “Select All Major Items” checked and click on “Expand Major Items.” The following link provides more detailed information on causes, subcategories, and ICD-10 codes page used in this MICA.

This MICA does not include all chronic conditions. The focus is on conditions which cause a large number of deaths and those most subject to prevention efforts. Data on some other chronic diseases can be found elsewhere in MoPHIMS. For example, Parkinson’s disease is in the Death MICA, and Arthritis/lupus is an indicator in the Priorities MICA.


There are two types of rates available: crude and age-adjusted. Age-adjusted rates allow the selection of the population standard to which the adjustment is made. Confidence intervals around the rates are also available to test the statistical significance of apparent differences between rates.

Rates by Race

“Basic” race includes only white and African-American races. “Expanded” race includes three additional groups: 1) Asian/Native Hawaiian and Other Pacific Islander, 2) American Indian and Alaska Native, and 3) Some Other Race. Rates are not available for the expanded race option.

Rates by Ethnicity

In Missouri, Hispanic origin is underreported on Missouri death certificates. Due to the unreliability of data by ethnicity, rates for ethnicity are available only statewide. Counts are available for all geographies. For more information about the reporting of Hispanic ethnicity on Missouri death certificates, please see page 36 of the Missouri Foundation for Health’s report on Hispanic Health Disparities in Missouri.

Comparability with Earlier Data

Comparisons of data in this Death MICA with data from earlier years should be made with caution, since causes of deaths prior to 1999 were classified using a different system. The underlying cause for each death in this MICA was selected using the Tenth Revision of the International Classification of Diseases (ICD-10). The ninth revision, in effect in the United States from 1979through 1998, used somewhat different categories and rules. Therefore, for certain causes, an apparent change in trends may be misleading: it may reflect the ICD-9 / ICD-10 transition rather than a real change in the pattern of causes of death. Some causes are affected much more than others. For example, Alzheimer’s disease counts are much larger than they would have been under ICD-9, while cancers were relatively unaffected.  For more detail on the effect of the transition on national statistics, see "Comparability of Cause of Death between ICD-9 and ICD-10: Preliminary Estimates."

Also, it is not appropriate to compare age-adjusted rates calculated using different standards. This MICA’s age-adjusted rates use the US 2000 standard by default, but the 1940 and 1970 standards are also available. When comparing age-adjusted rates, be sure to choose matching standards.