Cause-specific mortality analysis: Is the underlying cause of death sufficient?

Cause-specific mortality analysis is based predominantly on examination of the underlying cause of death. Our view is that this single-cause approach is not sufficient. With increasing data availability and technical developments in favor of better data quality, the time has come to consider all items of information reported by certifying physicians on death certificates (i. e. the multiple causes). These data can be used in two main ways: either to reassess the role played by a given cause in mortality, or to examine how causes combine with one another. In this paper, we rely on our experience of multiple cause-of-death (MCOD) analysis in the framework of a French-Italian comparative project to provide information on data quality, and to show that, especially in the context of population aging, MCOD analysis is a very relevant tool for public health policy.