Pertinence of electronic death certificates for real-time surveillance and alert, France, 2012-2014

In France, the early mortality monitoring, conducted by Santé publique France, the French National Public Health agency (SpFrance) (formerly French Institute for public health surveillance-InVS), is based on the administrative data provided by the National Institute for Statistic and Economic Studies (INSEE) and consequently does not allow analyses on medical causes of death. Since 2007, the physicians can certify deaths electronically. In this electronic system (Electronic Death Registration System; EDRS), the medical causes of death, in free-text format, are directly transmitted to SpFrance. In the future, these data could be used in a real-time surveillance system by medical causes of death. The objective of this study was to evaluate the pertinence of e-death certification using the following assessment criteria: timeliness, representativeness, and completeness of sociodemographic and medical information included in the e-death certificates.

This study consisted of a descriptive analysis of the information collected by e-death certificates recorded between January 1, 2012 and July 31, 2014.

The study quantified the temporal and geographical evolution of the deployment of the EDRS between 2012 and 2014. The timeliness of the system was estimated by calculating the delay between the dates of death and of data availability for analysis. Sociodemographic and death-related characteristics were described. The frequency of missing data was measured for each variable. The number of completed fields per certificate and the number of words per field and per certificate were calculated for the medical causes of death.

Between January 2012 and July 2014, 77,776 e-death certificates were collected. A slight increase in the use of the e-death certification was observed during the study period, reaching 6.1% of the total number of deaths in 2014. Good national coverage was noted. Nearly 79% of e-certificates were submitted to SpFrance on the day of the death. We observed a high completeness of the e-certificates. The rate of missing data did not exceed 2.7% for sociodemographic variables. On average, 10 words, distributed in three fields, were used to describe the medical causes of death.

E-death certificates constitute a reactive source of information on medical causes of death. The deployment of EDRS is of major public health interest for the development of a real-time warning surveillance system of mortality by cause.