Documentation

Death records are compiled from death certificates which are filed with the Department of Health and Senior Services by state law (Mo Revised Statutes, Chapter 193). 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 National Center for Health Statistics, Missouri cooperates with other states in the exchange of death records. Therefore, data concerning deaths of Missouri residents include virtually all Missouri resident deaths regardless of where the death took place.

Before January 1, 1999, causes of death in the United States were selected and classified using the Ninth Revision of the International Classification of Diseases (ICD-9). Since then we have been using ICD-10. This change in procedures affects the counts you see in MICA.

Selecting cause for each death: When several diseases or factors lead to a death, the ICD provides rules for choosing which one will be used statistically as the underlying cause of death - the disease or injury which initiated the chain of events which resulted in death. The Tenth Revision changed some of those rules. Some causes are affected much more than others. Nationally, there was little effect on cancer, homicide and suicide. But pneumonia death counts using ICD-10 were about 70 percent of what they would have been under ICD-9. Benign/unspecified neoplasms and Alzheimer's disease were about 50 percent larger than they would have been using ICD-9, and nephritis/nephrosis was about 20 percent higher. However, we cannot know how these changes may affect a subpopulation of the United States; that is, for a certain state, county, race, or sex, the effect of the ICD transition may be different than it was for the nation.

Classifying specific causes into categories: For the years prior to 1999, MICA will give numbers of deaths for certain causes which are slightly different from numbers published earlier for those same years, because MICA definitions have been changed to agree with the ICD-10 list of causes included in those categories. For most of the affected causes, the new MICA number will be slightly smaller than the earlier ones. For example, the former "Homicide and legal intervention" now includes only homicide, and the count for accidents other than motor vehicle crashes will be smaller because medical misadventures are now counted separately. "Stroke," "Chronic lower respiratory disease," and "Ulcer of stomach" may also be slightly smaller. On the other hand, "Ischemic heart disease" will include about 700 more deaths per year statewide because of the inclusion of "unspecified cardiovascular disease."

If you notice a sudden change in a certain cause at the 1998-to-1999 point, follow up further to see whether the change is likely to be explained by the ICD-9/ICD-10 transition rather than by a real change in the pattern of causes of death.

A fuller explanation of this transition and its effects on Missouri data can be found at http://health.mo.gov/data/focus/index.php. This article includes a table showing the estimated effect of this transition on each of 38 of the causes in this MICA.

For more detail on the calculation of the national statistics, see "Comparability of Cause of Death Between ICD-9 and ICD-10: Preliminary Estimates."

Trends and combining years: Counts by cause for 1999 and later may not be comparable to counts 1998 and earlier, because of changes in the system for selecting and classifying causes of death. For certain causes, apparent changes in trends may be misleading. Before using any data spanning 1998-1999, please read the above.

Causes of death: If you would like to study a subdivision of one of the causes listed, create a table with that cause as a row, column or selection variable, and then click on the name of that cause in your table. Causes which have subdivisions are displayed as clickable (in blue and underscored). For example, if a cause in your table is "Chronic lower respiratory diseases," you can click on that title to see asthma, emphysema, and other lower respiratory diseases. The following table/link provides more information on causes, subcategories, and ICD-9 and/or ICD-10 codes used within this MICA.

Pound sign (#): The pound sign (#) marks causes designated by the National Center for Health Statistics as rankable in choosing leading causes of death. Two pound signs (##) mark pairs of causes which together constitute one rankable cause.

Rates: You may choose crude or age-adjusted rates, and if you choose age-adjusted, you may select the standard to which the adjustment is made. Confidence intervals around the rates are also available, so that you can test the statistical significance of apparent differences between rates.

Rates by race: Rates for white and African-American may be obtained only for counties and cities in which there is a substantial African-American population. The counties and cities with substantial population are: Missouri (statewide), Boone County, Greene County, Jackson County, Mississippi County, New Madrid County, Pemiscot County, St. Charles County, St. Louis County, St. Louis City, Scott County and Kansas City. Rates are not available for other minority race.

Rates by ethnicity: Rates for ethnicity are only available statewide.