Dáil Éireann Debate, Tuesday - 1 December 2020
696. Deputy Michael Fitzmaurice asked the Minister for Health the reason the statistics of his Department on the cause of death in Ireland in the time period March to November 2020 are different to those of the CSO; and if he will make a statement on the matter. [39909/20]
View answerOn 25 November 2020 the Central Statistics Office (CSO) published the ‘Analysis of Underlying Cause of Death Data, Including COVID-19 report ‘as a new publication in their frontier series. (https://www.cso.ie/en/releasesandpublications/fr/fr-ucd2020/analysisofunderlyingcauseofdeathdataincludingcovid-19januarytooctober2020/)
This publication is based on deaths registered with the General Registrar’s Office (GRO) and notified to the CSO for the period of January to October 2020.
The findings of the CSO publication reported that there were 1,462 Covid-19 related deaths in the period January – October 2020 registered with the General Registrar's Office and subsequently notified to the CSO.
As of the 1st of November, the Department of Health had been notified of 1,915 Covid-19 related deaths. This is 453 higher than reported by the CSO for deaths registered by the end of October.
These deaths have been reported to the Department of Health by the Health Protection Surveillance Centre (HPSC). Under Infectious Diseases (Amendment) Regulations 2020, all medical practitioners are required to notify the Medical Officer of Health (MOH)/Director of Public Health (DPH) of certain diseases including Covid-19.
There are several reasons for the difference in these figures:
a. The CSO note that the data in their publication is based on deaths that occurred between 1 Jan 2020 and end October 2020, and that have been registered with the General Registrar's Office and subsequently notified to the Central Statistics Office (CSO). They also note that these figures are provisional.
b. Due to the legal requirement for registration of deaths being within 3 months in Ireland, it can be assumed that deaths for the months August-October registered with the GRO and subsequently notified to the CSO are incomplete.
c. Outside of these months, there are a significant proportion of deaths that are registered after 3 months. The most common reason for a late registration of a death is that a case is referred to the Coroner for further investigation.
d. All unnatural deaths (deaths from accidents, suicides, poisonings etc.) must be referred to the Coroner’s Office for further investigation and these deaths tend to be registered late as a consequence. In addition, all deaths that occur in nursing homes and all COVID-19 deaths must also be reported to the Coroner. The number of late registered deaths is increasing over recent years and the CSO publishes these late registered deaths as an appendix to the annual report.
e. The classification process for deaths related to COVID-19 differs between the HPSC and the CSO. Further detail is provided below on the process.
Further information:
Classification and publication of deaths by the HPSC:
A death reported by the by the Health Protection Surveillance (HPSC) as due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a possible, probable or confirmed COVID-19 case as per the case definition for COVID-19, available on the HPSC website www.hpsc.ie, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death. A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19.
HPSC Procedure for recording and checking COVID-19 deaths
All medical practitioners and coroners have been advised to report all deaths in confirmed, probable and possible COVID-19 cases, in any healthcare setting, to their local Department of Public Health and these are notified to the HPSC.
The case definitions for confirmed, probable and possible COVID-19 are available on the HPSC website. The outcome for cases that have already been notified is then updated to ‘died’ on HPSC’s Computerised Infectious Disease Reporting System (CIDR) and cases newly identified on death are notified.
The following deaths should be notified as COVID-19 deaths:
- Deaths in confirmed COVID-19 case: A death in a person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms (including post mortem).
- Deaths in probable COVID-19 case: A death in a person with probable COVID-19 as per the COVID-19 case definition for surveillance purposes
- Deaths in possible/suspect COVID-19 case: All deaths in patients suspected of having COVID-19 i.e. patients with symptoms clinically compatible with COVID-19 illness. These suspect cases may or may not have been laboratory tested for COVID-19 prior to death. These possible COVID-19 deaths include patients with pending COVID-19 laboratory results. This includes all unexplained deaths/sudden deaths in residential facilities with a confirmed/suspected COVID-19 cluster/outbreak of illness unless the there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma)
- Coroner’s reports of deaths: All COVID-19 deaths reported as such from Coroners should be notified as COVID-19 deaths. The case classification should be assigned as per the COVID-19 case definition.
The HPSC also receives a daily list of deaths from all causes which were registered in Ireland in the previous day from the General Register Office (GRO). All registered deaths with COVID-19 reported in any of the four cause of death fields are reported as COVID-19 deaths. The causes of death on the GRO file are checked for ‘COVID-19’ and cross-checked against the details for the cases of COVID-19 notified to HPSC.
Deaths in patients with COVID-19 due to causes such as accidents, trauma or other causes that could not be related to COVID-19 are recorded as not due to COVID-19. Deaths in COVID-19 cases occurring more than 30 days after the COVID-19 diagnosis are flagged and checked to ascertain if the death should be reported as due to COVID-19 or not due to COVID-19. If there is a period of complete recovery between the COVID-19 related illness and death, the deaths are recorded as not due to COVID-19.
HPSC publications on COVID-19 related deaths
Publication of COVID-19 Related deaths by the HPSC are made on a daily basis on the HPSC website, based on the data held in CIDR at that time. CIDR is a live dataset and data is subject to revision when new information is received.
Classification of COVID-19 related deaths by the CSO:
The CSO classify the information received from the General register Office on the Death Certificate to assign an Underlying Cause of Death (UCOD). This is a complex process as coding rules that are adopted by the World Health Organisation (WHO) are applied to ensure parity between jurisdictions.
CSO Procedure for recording and checking COVID-19 deaths
It is a legal requirement that every death that takes place in the State must be recorded and registered and these records are then held in the General Register Office (GRO). A death within the State can be registered with any Registrar, regardless of where it occurs. Deaths must be registered as soon as possible after the death and no later than three months from the date of death.
Following a death, a registered medical practitioner who attended the deceased will complete and sign Part 1 of a Death Notification Form (DNF), and this will include information on the cause of death.
This form is then given to the spouse/partner or another relative of the deceased who are then the qualified informant for the death. If the deceased has no spouse/partner or other relative, then the form will be provided to another qualified informant.
The qualified informant must then complete Part 2 of this DNF with additional details regarding the deceased person. Once completed, this DNF must then be given to a Registrar (within, as per the above, a maximum of three months) and the qualified informant then signs the register in the presence of the Registrar. You do not need to be the next-of-kin to undertake this requirement.
The Cause of Death is completed by the medical practitioner who attended the deceased and has the following information:
Part 1(a): Disease or condition directly leading to death, (this does not mean the mode of dying e.g. heart failure etc., it means the disease that caused death) due to (or as consequence of)
Part 1(b): Antecedent Causes (morbid conditions, if any, giving rise to the above cause stating the underlying condition last) due to (or as consequence of)
Part 1(c): Further Antecedent Causes
Part 2: Other Significant Conditions (contributing to the death but not related to the disease or condition causing it)
Any death that occurs in the State must be registered in the State, e.g. a death of a US resident holidaying in Ireland must be registered here. An Irish national that dies abroad is not registered in the State.
The registration of a death may be delayed where the death has been referred to a Coroner for investigation or inquiry. In such cases, the Coroner may issue a temporary certification to allow the death to be registered pending final determination of any investigation or inquiry.
CSO Mortality Coders in the Vital Statistics unit use specialised software (IRIS) and defined coding rules on the specified causes of death to assign an appropriate underlying cause of death. The hierarchy in which the causes are written on the death certificate impacts on the assignment of the UCOD. According to the WHO international guidelines, persons with COVID-19 may die due to other conditions such as myocardial infarction.
CSO publications on COVID-19 related deaths;
The ‘Frontier Series’ that this data was published under is a new development from the CSO. The CSO Frontier Series may use new methods which are under development and / or data sources which may be incomplete for example new administrative data sources which may have specific limitations.
The CSO publishes quarterly deaths data together with a summary of the four quarters (when publishing Quarter 4) classified by year of registration. It also publishes annual statistics on deaths by year of occurrence, with a time lag of approximately 22 months.
The CSO published the Vital Statistics Quarter 2 data on 27th November 2020. The CSO will report data for Quarter 3 next year based on the registration data compiled from the General Register Office.
The CSO also releases the “COVID-19 Deaths and Cases Statistics” publication on its website in its fortnightly publication. This publication is based on the HPSC CIDR data extract.
This publication is available at https://www.cso.ie/en/releasesandpublications/ep/p-covid19/covid 19informationhub/health/covid-19deathsandcasesstatistics/
