- Methods and Projects
- Standards and Classifications
Standardised Methodological Report
Deaths according to Cause of Death
- 1Contact
- 1.1Contact organisation
National Statistics Institute of Spain
- 1.5Contact mail address
Avenida de Manoteras 50-52 - 28050 Madrid
- 1.1Contact organisation
- 2Metadata update
- 2.1Metadata last certified
25/06/2024
- 2.2Metadata last posted
19/12/2023
- 2.3Metadata last update
25/06/2024
- 2.1Metadata last certified
- 3Statistical presentation
- 3.1Data description
The Statistics on Causes of Death is one of the most important sources of information in the field of Health.
Deaths are the consequence of a set of biological, economic, health and social causes. Therefore, it is necessary to have information not only on the number of deaths that occur in a country in a given period, but also on all the circumstances surrounding the occurrence in order to facilitate action by the Health Administrations and the rest of the social forces.
This fact, together with the scarce availability of reliable and exhaustive indicators to evaluate the population' s level of health, has led to a continued increase in the demand for this statistic, the main objectives of which are as follows:
1. To provide information on mortality according to the underlying cause of death according to the ICD (International Classification of Diseases), distribution by age groups, sex and other classification variables.
2. Provide information on multiple cause of death.
3. To ascertain stillbirths by cause of death according to the ICD.
4. To measure perinatal mortality, providing the basis for obtaining indicators to evaluate the coverage and quality of health services.
5. To make the construction of a historical series possible in order to study the evolution of the prevalence of certain causes of death, as well as other studies that satisfy the information needs that the Health Administrations have raised.
6. To carry out regional comparisons on the behaviour of mortality by groups of causes of death.
7. To provide the basis for the construction of health indicators recommended by International Agencies.
- 3.2Classification system
- Comunidades y Ciudades Autónomas
01 Andalucía
02 Aragón
03 Asturias, Principado de
04 Balears, Illes
05 Canarias
06 Cantabria
07 Castilla y León
08 Castilla - La Mancha
09 Cataluña
10 Comunitat Valenciana
11 Extremadura
12 Galicia
13 Madrid, Comunidad de
14 Murcia, Región de
15 Navarra, Comunidad Foral de
16 País Vasco
17 Rioja, La
18 Ceuta
19 Melilla - Provincias
02 Albacete
03 Alicante/Alacant
04 Almería
01 Araba/Álava
33 Asturias
05 Ávila
06 Badajoz
07 Balears, Illes
08 Barcelona
48 Bizkaia
09 Burgos
10 Cáceres
11 Cádiz
39 Cantabria
12 Castellón/Castelló
13 Ciudad Real
14 Córdoba
15 Coruña, A
16 Cuenca
20 Gipuzkoa
17 Girona
18 Granada
19 Guadalajara
21 Huelva
22 Huesca
23 Jaén
24 León
25 Lleida
27 Lugo
28 Madrid
29 Málaga
30 Murcia
31 Navarra
32 Ourense
34 Palencia
35 Palmas, Las
36 Pontevedra
26 Rioja, La
37 Salamanca
38 Santa Cruz de Tenerife
40 Segovia
41 Sevilla
42 Soria
43 Tarragona
44 Teruel
45 Toledo
46 Valencia/València
47 Valladolid
49 Zamora
50 Zaragoza
51 Ceuta
52 Melilla
- Comunidades y Ciudades Autónomas
- 3.3Sector coverage
It collects all deaths that occur in Spain, regardless of whether they are of resident or non-resident population.
- 3.4Statistical concepts and definitions
- Age
Age in years refers to the number of birthdays reached by the reference date, in other words, the age last birthday.
- Basic cause of death
Disease or injury that started the chain of pathological events which directly led to death, or the circumstances of the accident or violence which produced the fatal injury.
- Death
The statistical concept death used traditionally in Spain comprised the deaths of all persons that had lived for more than 24 hours. As of 1975, this concept has been broadened to include live births that die during the first 24 hours.
- Late foetal death
This is death prior to the complete expulsion or extraction from its mother of a product of viable conception. This viability is precisely what serves to differentiate between late foetal deaths and abortions. Currently, the World Health Organisation (WHO) has identified the viability of the foetus with those born dead that weigh at least 500 grammes, and should this data not be available, with a gestational age of at least 22 weeks.
- Multiple cause of death
The set of all diseases, morbid states or injuries that caused death or contributed to death, and the circumstances of the accident or the violence that caused said injuries.
- Sex
Sex refers to the biological sex of the person. According to the WHO, "sex" refers to biological and physiological features defining to men and women, whereas "gender" refers to the roles, behaviour, activities and attributes constructed socially that a specific culture regards as appropriate for men and women. In accordance with this description, the WHO regards "man" and "woman" as sex categories, whereas "male" and "female" are gender categories.
- Usual residence
Place where a person normally spends rest periods, not taking into account temporary absences due to leisure trips, holidays, visits to family and friends, business, visiting friends or relatives or religious pilgrimages. Nevertheless, it is important to highlight that only usual residents in a region will be considered:
- Those who, according to the previous definition, would usually have lived therein for a continuous period of at least 12 months.
- Those who, according to the previous definition, would have established their usual residence therein less than 12 months ago, but with the intention of remaining therein for at least one year.
Where the above circumstances cannot be established, "usual residence" shall mean the place of registered residence.
- Age
- 3.5Statistical unit
The statistical unit is the deceased person
- 3.6Statistical population
The target population of the statistic is the set of people who die in Spain
- 3.7Reference area
The statistic covers the entire national territory.
- 3.8Time coverage
The statistics are carried out annually.
There are results available in paper publication since 1900 and in computerised microdata files since the reference year 1975.
- 3.9Base period
1999 is considered the base year, the first year when version 10 of the ICD was applied.
- 3.1Data description
- 4Unit of measure
- 4.1Unit of measure
Data is published in absolute numbers (number of deaths), in gross rates and standardised rates (deaths per 100,000 inhabitants).
Until 2021 mortality rates were calculated using the population on 1 July of that year. From 2022 onwards mortality rates are calculated with the average population between 1 January of the study year and 1 January of the following year.
- 4.1Unit of measure
- 5Reference period
- 5.1Reference period
The data refers to the calendar year covered by the statistics, regardless of whether the data is published by the month when the deaths occurred
Data referred to the period: Anual A: 2023
- 5.1Reference period
- 6Institutional mandate
- 6.1Legal acts and other agreements
The compilation and dissemination of the data are governed by the Statistical Law No. 12/1989 "Public Statistical Function" of May 9, 1989, and Law No. 4/1990 of June 29 on “National Budget of State for the year 1990" amended by Law No. 13/1996 "Fiscal, administrative and social measures" of December 30, 1996, makes compulsory all statistics included in the National Statistics Plan. The National Statistical Plan 2009-2012 was approved by the Royal Decree 1663/2008. It contains the statistics that must be developed in the four year period by the State General Administration's services or any other entity dependent on it. All statistics included in the National Statistics Plan are statistics for state purposes and are obligatory. The National Statistics Plan 2021-2024, approved by Royal Decree 1110/2020, of 15 December, is the Plan currently implemented. This statistical operation has governmental purposes, and it is included in the National Statistics Plan 2021-2024. (Statistics of the State Administration).
The Statistics on Causes of Death is subject to the Regulation (EU) no. 328 \2011 of the Commission of 5 April 2011 implementing Regulation (EC) no.1338/2008 of the European Parliament and Council on EU statistics on public health and health and safety at work, concerning statistics on the causes of death.
The Spanish version of this European Union standard is accessible at www.ine.es/normativa/leyes/UE/minine.htm#30417
For the preparation of this statistic, collaboration agreements have been established with the communities and its health ministries.
- 6.2Data sharing
The exchanges of information needed to elaborate statistics between the INE and the rest of the State statistical offices (Ministerial Departments, independent bodies and administrative bodies depending on the State General Administration), or between these offices and the Autonomic statistical offices, are regulated in the LFEP (Law of the Public Statistic Function). This law also regulates the mechanisms of statistical coordination, and concludes cooperation agreements between the different offices when necessary.
It is carried out in collaboration with the Autonomous Communities.
- 6.1Legal acts and other agreements
- 7Confidentiality
- 7.1Confidentiality - policy
The Statistical Law No. 12/1989 specifies that the INE cannot publish, or make otherwise available, individual data or statistics that would enable the identification of data for any individual person or entity. Regulation (EC) No 223/2009 on European statistics stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society
- 7.2Confidentiality - data treatment
INE provides information on the protection of confidentiality at all stages of the statistical process: INE questionnaires for the operations in the national statistical plan include a legal clause protecting data under statistical confidentiality. Notices prior to data collection announcing a statistical operation notify respondents that data are subject to statistical confidentiality at all stages. For data processing, INE employees have available the INE data protection handbook, which specifies the steps that should be taken at each stage of processing to ensure reporting units' individual data are protected. The microdata files provided to users are anonymised.
The Medical Death Certificate - Statistical Death Bulletin indicates that personal data obtained by the statistical services both directly from the respondents and through administrative sources will be subject to protection and will be covered by statistical secrecy (Article 13.1 of the Law on Public Statistical Function [LFEP, for its acronym in Spanish] of May 9, 1989). All statistical personnel will have the obligation to preserve statistical secrecy (article 17.1 of the LFEP).
- 7.1Confidentiality - policy
- 8Release policy
- 8.1Release calendar
The advance release calendar that shows the precise release dates for the coming year is disseminated in the last quarter of each year.
- 8.2Release calendar access
The calendar is disseminated on the INEs Internet website (Publications Calendar)
- 8.3User access
The data are released simultaneously according to the advance release calendar to all interested parties by issuing the press release. At the same time, the data are posted on the INE's Internet website (www.ine.es/en) almost immediately after the press release is issued. Also some predefined tailor-made requests are sent to registered users. Some users could receive partial information under embargo as it is publicly described in the European Statistics Code of Practice
- 8.1Release calendar
- 9Frequency of dissemination
- 9.1Frequency of dissemination
Provisional mortality data by cause of death for the year 2023 are released in June 2024.
Definitive data for 2023 and provisional data for the first half of 2024 are released in December 2023.
- 9.1Frequency of dissemination
- 10Accessibility and clarity
- 10.1News release
The results of the statistical operations are normally disseminated by using press releases that can be accessed via both the corresponding menu and the Press Releases Section in the web
- 10.2Publications
The results of the statistic are published on the INE website and some results are included in publications such as the Anuario Estadistico (Statistical Yearbook), Cifras INE (INE Figures), etc.
- 10.3On-line database
INEbase is the system the INE uses to store statistical information on the Internet. It contains all the information the INE produces in electronic formats. The primary organisation of the information follows the theme-based classification of the Inventory of Statistical Operations of the State General Administration . The basic unit of INEbase is the statistical operation, defined as the set of activities that lead to obtaining statistical results on a determined sector or subject based on the individually collected data. Also included in the scope of this definition are synthesis preparation.
Access to the tables and time series on INEbase within the section Society/Health:
- 10.4Micro-data access
A lot of statistical operations disseminate public domain anonymized files, available free of charge for downloading in the INE website Microdata Section
Microdata from this statistic can be accessed under specific conditions. These files are anonymised to preserve statistical confidentiality. No information is provided on the following variables:
- Name, surname, identity document, address of the deceased
- Registration data of the death in the civil registry
- Day variable on all dates
- Codes of municipalities with less than 10,000 inhabitants. The size of the municipalities is provided
- Country codes with a frequency less than that established
. - 10.5Other
Interested users can request, through the Information Area, specific use of information, which are carried out preserving the confidentiality of the data and signing the corresponding agreement or document. More information at
- 10.6Documentation on methodology
A detailed description is available at:
- 10.7Quality documentation
The fields mentioned below (items 10.6 to 17) form the user-oriented quality report for this operation.
- 10.1News release
- 11Quality management
- 11.1Quality assurance
Quality assurance framework for the INE statistics is based on the ESSCoP, the European Statistics Code of Practice made by EUROSTAT. The ESSCoP is made up of 16 principles, gathered in three areas: Institutional Environment, Processes and Products. Each principle is associated with some indicators which make possible to measure it. In order to evaluate quality, EUROSTAT provides different tools: the indicators mentioned above, Self-assessment based on the DESAP model, peer review, user satisfaction surveys and other proceedings for evaluation.
The statistics are based on the collection of information from the Medical Death Certificates of the deaths registered in the Civil Registry. Legally, there is an obligation to register the death of any live birth, which ensures the possibility of accessing all deaths.
The coverage control is carried out in the Provincial Delegations of the INE from cross-checking the correlative registration volume and page. It is also compared with the computerised part of the Civil Registry.
In relation to the information obtained, the information capture application contains an error filter that guarantees a minimum quality level by not allowing data to be entered into the process with inconsistencies, especially causes of death in relation to the variables sex and age.
The participation of the Autonomous Communities' Death Registries in the coding of the cause of death allows a closer look at the source of information that can provide data to complete the quality of the death certificate, such as medical records or judicial proceedings.
Finally, during the process of preparing the statistic, warning controls have been established to filter those bulletins with information suspected to be erroneous.
- 11.2Quality assessment
Since civil registries are the first source of information and there is a legal obligation to register the death, the almost total coverage of the statistic is guaranteed.
Regarding the reliability of the information, this is increased by the cooperation established through collaboration agreements (recently renewed) with all the Autonomous Communities in terms of proximity and access to the health systems of each Autonomous Community, which allows additional information to be obtained, if necessary, from the medical professionals who certify the death.
The introduction of ICT tools for the capture of information (optical character recognition reading) and for the exchange of information between the Autonomous Community teams and the INE, in addition to the implementation of an automatic encoder (IRIS), have facilitated data processing and has allowed a reduction in the processing times of the statistic, moving the publication date forward.
From 2020, the Institutes of Forensic Medicine and Forensic Sciences (IMLCF) are part of the information circuit providing the causes of death according to ICD-10 in case of deaths with judicial intervention and improving the quality of these data.
The INE is currently one of the first statistics offices of the EU countries to publish Statistics on Causes of Death each year, one year ahead of the deadline set by the European regulation governing such statistics.
- 11.1Quality assurance
- 12Relevance
- 12.1User needs
Users of the statistic include:
- Ministries and other public agencies.
- Territorial administrations (Autonomous Communities, City Councils,...).
- Companies and non-profit institutions.
- Researchers and universities.
- Individuals.
Each one of these users has different needs according to the destination and utility of the information they need.
Some examples of the studies carried out:
People affected by toxic oil syndrome (colza)
European study on nutrition and cancer
European study on prostate cancer
Study on diet and cardiovascular disease risk in Spain,... - 12.2User satisfaction
The INE has carried out general user satisfaction surveys in 2007, 2010, 2013, 2016 and 2019 and it plans to continue doing so every three years. The purpose of these surveys is to find out what users think about the quality of the information of the INE statistics and the extent to which their needs of information are covered. In addition, additional surveys are carried out in order to acknowledge better other fields such as dissemination of the information, quality of some publications...
On the INE website, in its section Methods and Projects / Quality and Code of Practice / INE quality management / User surveys are available surveys conducted to date.(Click next link)
The content of the Medical Death Certificate conforms to the recommendations from the World Health Organisation and to the information requirements determined by the EU Regulation, so that all requests for information from international agencies can be met.
On the other hand, the statistic receives numerous requests for tailored information which can be met in practice, except for those that may affect confidentiality and statistical secrecy.
- 12.3Completeness
The information that is collected allows all the requests for the variables required by the EU Regulation to be met. 100% of the results requested by the EU regulation are provided.
R1=100%
- 12.1User needs
- 13Accuracy and reliability
- 13.1Overall accuracy
As mentioned in point 12, the collection procedures, coverage control and error filtering make it possible to obtain a high degree of statistical reliability.
- 13.2Sampling error
As it is an exhaustive statistic, it has no sampling errors.
- 13.3Non-sampling error
Coverage is almost exhaustive due to the legal obligation to register deaths and as civil registries are the source of information. The subsequent cross-checking with the computerised records of the Civil Register shows a collection lag of less than 0.1%. Once these records are identified, they are incorporated into the process.
As for the lack of information for determining the cause of death, the statistics provide a figure of 0.79% of bulletins in which the underlying cause could not be determined because the bulletin was not sufficiently completed.
Overcoverage rate (A2)= 0%
Non-response rate per unit (A4)= 0.79%
Imputation rate (A7) = 0%
- 13.1Overall accuracy
- 14Timeliness and punctuality
- 14.1Timeliness
The definitive data of the statistic for year 2022 are published 12 months after the end of the reference year for the information, i.e. in December 2023.
TP2=12
The deadline for publication according to the EU Regulation is 24 months after the year t.
Generally, definitive data for the year t are published in December t+1.
Dissemination of provisional cause of death data is done on a six-monthly basis. Provisional data for year t are published in June t+1 and provisional data for the first half of the year t+1 are published in December t+1.
- 14.2Punctuality
Data dissemination is carried out according to the structural statistics availability calendar that INE prepares and publishes each year.
- 14.1Timeliness
- 15Coherence and Comparability
- 15.1Comparability - geographical
The statistical processing is the same for the whole territory in all phases. In this way, the results are perfectly comparable for any geographical disaggregation. Likewise, they are comparable with the rest of the countries in the European Union as they comply with the provisions of the Regulation.
- 15.2Comparability - over time
The results of the Statistics on Causes of Death are comparable over time for the underlying cause of death variable as long as it refers to the same version of the International Classification of Diseases.
The INE has data from 1900 that refers to internationally comparable classifications of diseases. For certain diseases, the length of the series is 123 annual records.
However, since that date, several reviews of the classification of diseases have been carried out. All statistical publications mention the classification used.
The versions of the International Classification of Diseases (ICD) used for the latest data were:
From 1968 to 1979 with ICD 8
From 1980 to 1998 with ICD 9
From 1999 with ICD 10
Therefore, the comparability of all the latest data has a length of 24 in annual series and 288 in monthly series.
CC2=24
In addition to the publication of detailed data, the information of aggregated deaths is published according to the three shortlists of diseases (see item 3.2). There is an equivalence between versions 9 and 10 of the ICD for these short lists so that comparable series can be made at this level since 1980.
Equivalence between versions 9 and 10:
www.ine.es/daco/daco42/sanitarias/listas_02.doc
.
- 15.3Coherence - cross domain
This statistic is the main reference for information on the causes of death.
The partial information obtained from the following sources is analysed: hospital morbidity survey, statistics of deceased victims from the Directorate General for Traffic and the periodic reports from the National Centre of Epidemiology.
- 15.4Coherence - internal
The coherence between the variables is compared in all phases of the statistical process.
Data consistency: the latest version of the ICD is used with the partial revisions of each year according to the WHO. In order to maintain data coherence at the Autonomous Community level, there is a forum for the exchange of opinions between the different Autonomous Communities in order to agree on the interpretation and application of the ICD revisions in order to homogenise the coding rules in each Autonomous Community team.
- 15.1Comparability - geographical
- 16Cost and burden
- 16.1Cost and burden
So that doctors who certify a death do not need to complete the medical death certificate as well as the statistical death bulletin, in 2009 the questionnaire was modified to collect the information from this statistic by designing a single form called the medical death certificate / statistical death bulletin in which all the information required in both documents is collected.
As a statistic based on an administrative register, there is no burden on respondents.
The software designed used by the forensics in order to provide the information of the causes of death according with the ICD-10 in case of judicial intervencion is as simple as possible to reduce the burden.
The estimate of the budgetary appropriation necessary to finance this statistic foreseen in the 2023 Annual Programme is 340,75 thousand euros.
- 16.1Cost and burden
- 17Data revision
- 17.1Data revision - policy
The INE of Spain has a policy which regulates the basic aspects of statistical data revision, seeking to ensure process transparency and product quality. This policy is laid out in the document approved by the INE board of directors on 13 March of 2015, which is available on the INE website, in the section "Methods and projects/Quality and Code of Practice/INE’s Quality management/INE’s Revision policy" (link).
This general policy sets the criteria that the different type of revisions should follow: routine revision- it is the case of statistics whose production process includes regular revisions-; more extensive revision- when methodological or basic reference source changes take place-; and exceptional revision- for instance, when an error appears in a published statistic-.
- 17.2Data revision - practice
Provisional statistical data 2023 are published in June 2024 and will be updated with the publication December 2024, which publishes provisional data for the first half of 2024.
- 17.1Data revision - policy
- 18Statistical processing
- 18.1Source data
Statistical data is obtained from information completed by doctors, courts, relatives and the Civil Registry to register a death.
Two questionnaire models have been designed
1.-Medical Death Certificate/Statistical Death Bulletin (MDC/SDB) for deaths in which there are no special circumstances
2.- In the case of deaths in which, due to the circumstances, a court must intervene, the information is collected in a death questionnaire with judicial intervention that is filled out by the court via an internet questionnaire.
The information collected in both documents is virtually the same. Information is obtained from the personal data of the deceased, the place of death, the causes of death, the circumstances of the death in the case of deaths with judicial intervention and the registration in the Civil Registry
In 2019 forensic start to take part in the statistical circuit of information, providing the causes of death in case of deaths with judicial intervention using a software developped by INE.
Information on stillbirths is obtained from the Statistical Birth Bulletin .
- 18.2Frequency of data collection
Data collection takes place monthly.
- 18.3Data collection
The first sheet of the MDC/SDB (pages 1 and 2) corresponding to the Medical Certificate is completed by the certifying doctor when a death occurs without the need for a court to intervene (in most cases). The second sheet (pages 3 and 4) which corresponds to the Statistical Bulletin, is completed by the declarant or failing that by the Civil Registry clerk (page 3) and the registration data by the Civil Registry clerk (page 4).
When the doctor certifying the death completes the part corresponding to the Medical Certificate, the person in charge of the registration of the death delivers the MDC/SDB to the civil registry of the municipality where the death occurred.
The civil registry sends the MDC/SDBs recorded that month to the INE on a monthly basis.
The Provincial Delegation of the INE receives the documentation from the Civil Registry, scanned by Optical Character Recognition (OCR) and the fields of the demographic variables are validated.
In cases of death with judicial intervention, the court must complete a web-based questionnaire. This information is transmitted directly to the INE database.
- 18.4Data validation
The data is processed and validated in three phases:
Provincial delegations: with the information obtained in the optical capture of the MDC/SDB data, a first validation of valid values and the absence of inconsistencies in the provincial delegations is carried out (for example, death dates prior to the date of birth, records of standardised municipalities, etc.). The resulting files are made available to the Autonomous Community teams.
Autonomous Community Phase: the Autonomous Community teams select the underlying cause of death among the causes certified in the MDC and recover partial lack of information. The coded deaths are sent to a central INE database, where they are incorporated after successfully passing error-free validations (lack of variables, incoherence between cause of death and other variables, etc.)
Central services phase: once the files from the Autonomous Communities have been received in the central INE services, a revision process is carried out based on warnings of possible errors in the coding (codes that did not exist in previous years, rare codes at certain ages...) that guarantees homogeneous processing among the 17 coding teams from the Autonomous Communities (the data from Ceuta and Melilla is coded in the central INE services).
- 18.5Data compilation
Statistical microdata is grouped for publication by:
Detailed list (list that includes the underlying cause code without grouping) at national level by age and sex.
Short lists (see item 3.2) at the National, Autonomous Communities, provinces and provincial capitals level.
- 18.6Adjustment
No calibration or weighting adjustment is required as this is a statistic with complete coverage.
On the other hand, by following international recommendations (WHO) and applying the updated version of ICD-10 and other classification standards, data is published and transmitted without any adjustment for use by other agencies.
- 18.1Source data
- 19Comment
- 19.1Comment
- 19.1Comment