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Finn Gjertsen, Silvia Bruzzone, Margarete E Vollrath, Monica Pace, Oivind Ekeberg
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Injury. 2013 Jan;44(1):132-8. doi: 10.1016/j.injury.2012.01.010. Epub 2012 Feb 16.
The international classification of diseases (ICD) provides guidelines for the collection, classification and dissemination of official cause-of-death statistics. New revisions of the ICD can potentially disrupt time trends of cause-of-death statistics and affect between-country comparisons. The aim of this study was to measure how switching from ICD-9 to ICD-10 affected mortality statistics for external causes of death, i.e. intentional and unintentional injuries, in Italy and Norway.
A sample of death certificates (N=454,897) were selected in Italy from the first year the ICD-10 was implemented (2003) and reclassified from ICD-10 to ICD-9 by the Italian National Institute of Statistics. A sample of death certificates was also selected in Norway (N=10,706) from the last year the ICD-9 was used (1995) and reclassified according to ICD-10 by Statistics Norway. The reclassification (double-coding) was performed by special trained personal in governmental offices responsible for official mortality statistics. Although the reclassification covered all causes of death (diseases and injuries) in the sample, our analysis focused on just one ICD chapter XX. This was external causes of mortality (injury deaths), and covered 15 selected categories of injuries.
The switch from ICD-9 to ICD-10 had a significant net impact on 8 of the 15 selected categories. In Italy, accidental falls decreased by 76%; traffic accidents decreased by 9%; suicide by hanging decreased by 3%; events of undetermined intent decreased by 69%; and overall injury deaths decreased by 4%. These net decreases reflect the moving of death records from injury categories in ICD-9 to other injury or disease categories in ICD-10. In Norway, the number of records in three categories decreased significantly: transport accidents, 9%; traffic accidents, 13%; and suicide by self-poisoning, 18%. No statistically significant differences (net changes) were observed in the total number of accidents, suicides and homicides in either country.
Switching to ICD-10 did not change the overall trends for accidents, homicides and suicides in either country. However, the number of records in some injury subcategories e.g. accidental falls and traffic accidents, decreased. Changing classification can thus affect the ranking of causes of injury mortality, with consequences for public health policy.
国际疾病分类（ICD）为官方死因统计数据的收集、分类和传播提供了指导。ICD 的新修订版可能会破坏死因统计数据的时间趋势，并影响国家间的比较。本研究旨在衡量从 ICD-9 切换到 ICD-10 如何影响意大利和挪威的外部原因（即故意和非故意伤害）死亡统计数据。
从意大利实施 ICD-10 的第一年（2003 年）选择了一份死亡证明样本（N=454897），并由意大利国家统计局从 ICD-10 重新分类为 ICD-9。还从挪威选择了 ICD-9 最后一年（1995 年）的一份死亡证明样本（N=10706），并由挪威统计局根据 ICD-10 重新分类。重新分类（双重编码）由负责官方死亡率统计的政府办公室的专门培训人员进行。尽管重新分类涵盖了样本中所有死因（疾病和伤害），但我们的分析仅关注 ICD 第 XX 章。这是外部原因的死亡率（伤害死亡），涵盖了 15 个选定的伤害类别。
从 ICD-9 切换到 ICD-10 对 15 个选定类别中的 8 个产生了重大的净影响。在意大利，意外跌倒减少了 76%；交通事故减少了 9%；自杀挂绳减少了 3%；意图不明的事件减少了 69%；整体伤害死亡减少了 4%。这些净减少反映了死亡记录从 ICD-9 的伤害类别转移到 ICD-10 的其他伤害或疾病类别。在挪威，三个类别的记录数量显著减少：运输事故减少了 9%；交通事故减少了 13%；自杀服毒减少了 18%。在这两个国家，事故、自杀和杀人的总数都没有观察到统计学上显著的差异（净变化）。
切换到 ICD-10 并没有改变这两个国家的事故、杀人或自杀的总体趋势。然而，一些伤害子类别（例如意外跌倒和交通事故）的记录数量减少了。因此，分类的变化会影响伤害死亡率的原因排名，对公共卫生政策产生影响。
