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Sudden increases in diagnostic code density were observed at certain sites when changes in coding policies or data inclusion criteria took place.
Changes in official cause of death coding policies must be accounted for when describing time trends of cause-specific absolute mortality rates.
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For example, assess the value achieved by a certain coding policy compared to an uncoded one.
In order to minimize arbitrariness, the process of coding policy content was guided by the five following rules: 1.
For suicide in males almost no impact of official cause of death coding policy change was observed.
Items were added or deleted, and decisions and clarification of specific items were recorded in a coding policy manual.
Changes in coding, policy, or public awareness may have played a part in the decreased number of ED admissions documented with our selected codes during 2007 2010.
Through 1994 the SFSO official cause of death coding policy used ICD-8 combined with internal rules giving priority to some causes (accident, poisoning or trauma; influenza; cancer).
The rates for prostate and breast cancer dropped substantially between 1994 and 1995 with the change in cause of death coding policy.
In conclusion, unlinked death records and changes in official cause of death coding policy pose methodological challenges in large population-based linkage studies with follow-up over decades.
We showed that correction for both unlinked deaths and changes in coding policy over time is required for an accurate description time trends of absolute mortality rates.
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