Multiple cause of death approach to analyze mortality patterns

Luisa Frova, Michele Antonio Salvatore, Marilena Pappagallo, Viviana Egidi


The mortality analysis normally refers to the underlying cause of death but often death can be caused by a variety of factors, especially at older ages. Multiple cause of death approach allows to take into account all the information reported on the death certificate.

This approach was utilized for analyzing the mortality of  70 years and over old people in Italy in 2001.

A descriptive analysis was carried out and several indicators widely used in literature were computed: for example the average number of causes per death or the cause-specific ratio of the frequency of the cause as underlying and its frequency as multiple cause (underlying or associated).

A cluster analysis was done to explore the existence of some particular morbid contexts, individuating eight clusters that presented particular profiles regarding underlying and associated causes of death. Multivariate odds ratios were then computed to evaluate the associations between morbidity patterns and underlying cause by means of different logistic regression models.

The conclusion is that multiple cause of death data represent a very useful instrument to study the interaction of diseases leading to death, also if much still need to be done to increase the quality of death certificate completion.


multiple cause, patterns, mortality

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ISSN: 2035-5556

Reg. Tribunale di Roma n. 3321/54