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Original research
What can death records tell us about multimorbidity?
  1. Mohammad Reza Baneshi1,
  2. James Eynstone-Hinkins2,
  3. Paul McElwee1,
  4. Gita D Mishra1,
  5. Lauren Moran2,
  6. Michael Waller1,
  7. Annette Dobson1
  1. 1 Australian Women and Girls’ Health Research Centre, School of Public Health, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
  2. 2 Australian Bureau of Statistics, Brisbane, Queensland, Australia
  1. Correspondence to Professor Annette Dobson, Australian Women and Girls’ Health Research Centre, School of Public Health, The University of Queensland Faculty of Medicine, Herston, QLD 4006, Australia; a.dobson{at}sph.uq.edu.au

Abstract

Background Multimorbidity has been measured from many data sources which show that prevalence increases with age and is usually greater among women than men and in more recent periods. Analyses of multiple cause of death data have shown different patterns of multimorbidity associated with demographic and other characteristics.

Methods Deaths in Australia among over 1.7 million decedents aged 55+ were stratified into three types: medically certified deaths, coroner-referred deaths with natural underlying causes and coroner-referred deaths with external underlying causes. Multimorbidity was measured by prevalence of ≥2 causes and analysed over three periods based on administrative changes: 2006–2012, 2013–2016 and 2017–2018. Poisson regression was used to examine the influence of gender, age and period.

Results The prevalence of deaths with multimorbidity was 81.0% for medically certified deaths, 61.1% for coroner-referred deaths with natural underlying causes and 82.4% for coroner-referred deaths with external underlying causes. For medically certified deaths, multimorbidity increased with age: incidence rate ratio (IRR 1.070, 95% CI 1.068, 1.072) was lower for women than men (0.954, 95% CI 0.952, 0.956) and changed little over time. For coroner-referred deaths with natural underlying causes, multimorbidity showed the expected pattern increasing with age (1.066, 95% CI 1.062, 1.070) and being higher for women than men (1.025, 95% CI 1.015, 1.035) and in more recent periods. For coroner-referred deaths with external underlying causes, there were marked increases over time that differed by age group due to changes in coding processes.

Conclusion Death records can be used to examine multimorbidity in national populations but, like other data sources, how the data were collected and coded impacts the conclusions.

  • DEATH CERTIFICATES
  • MORBIDITY
  • DEATH

Data availability statement

Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/jech-2023-220654

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Contributors MRB, AD and GDM contributed to the design of the study. PM prepared the data set. MRB undertook the statistical analyses, and all authors contributed to the interpretation of the results. MRB and AD wrote the first draft of the manuscript. All authors read and revised the manuscript and accepted the final version of the manuscript and were accountable for all aspects of the work. AD is responsible for the overall content as guarantor.

    • Funding GDM is supported by an NHMRC Investigator Grant (APP2009577).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.