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Multiple cause of death data have the potential to help point out potential concerns in the accuracy as well as provide a more complete picture of mortality for causes which are frequently not recorded as the underlying cause of death.
Missing death data have little noticeable affect on age-specific mortality rates between the ages of 5 and 60 years where substantial overlap of the lines representing the gold standard estimate and the erroneous estimates can be observed.
At the state level, major linked data resources incorporating hospital separations, ED visits, cancer registrations, mental health service use and fact and cause of death data have been available for nearly two decades via the Western Australian Data Linkage System WADLSS) and the NSW CHeReL since 2006.
Cause of death data have been carefully analysed to take into account incomplete coverage of vital registration in countries and the likely differences in cause of death patterns that would be expected in the uncovered and often poorer sub-populations [ 10].
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Multiple cause of death data has been used to look at trends in certain diseases, e.g. HIV [ 5, 6] and lung disease [ 7], but despite its availability, surprisingly few studies have looked at it broadly.
In 2007, the Lancet "Who Counts?" series confirmed that few countries in greatest need of vital-event and cause-of-death data have the capacity to obtain these (5).
Cancer death certifications data have some limitations in accuracy and completeness that should be made clear.
There have since been legal and educational reforms [ 30], and death certificate data have been audited by the Center for Disease Control and the Office for National Statistics.
Finally, limitations regarding the use of death certificate data have been well described (7, 20, 38), and the presence of multiple end-organ complications is common in individuals with longstanding diabetes (39); for example, CAD is rare in the absence of underlying renal disease in individuals with young-onset diabetes, particularly type 1 (40).
However, the use of national death certificate data has been found to be a reasonably sensitive (≥80%) method compared to more active methods of CJD case ascertainment [45], [46].
This study estimated time trends in the deprivation gap in neonatal mortality by cause of death, for which limited data have been published.
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