ICD-10, Mortality Measurement and Public Policy: Does ICD-10 Influence Policy Decisions?

This is an examination of how the utilization of ICD-10 codes may have an impact on public health policy.

The utilization of ICD-10 (International Classification of Diseases), 10^th Revision is a major milestone in specifying greater precision in diagnostic descriptions. Utilization of ICD-10 in the United States (USA) has been mandated by the Centers for Medicare and Medicaid (CMS) with implementation targeted for the near future. The advantage is that the ‘USA ICD-10 Clinical Modifications (CM) has some 68,000 codes. The USA ICD-10 Procedure Code System (PCS) also has a procedure code system not used by other countries that contains 76,000 codes’.^[1]

Beginning with deaths occurring in January 1999, the United States began using ICD-10 to classify causes of death reported on death certificates. The transition to ICD-10 has improved mortality data, predominantly via increased level of detail offered by the codes, giving statisticians access to richer data. For example NCHS uses coded mortality data to generate national health statistics, which detail the annual leading causes of death, life expectancy, frequency of injury due to specific incidents, and several other statistics. In turn, these mortality profiles are used for public policy initiatives, such as smoking cessation, safe driving habit promotions, baby safety, enhanced vehicle restraint systems, and potentially the most ubiquitous – child inoculation programs. However, not all these programs had their roots in ICD-10; many originated during ICD-9 utilization. The point is that precision in mortality classification has enabled improved understanding of mortality causes, leading to corresponding policy initiatives to reduce mortality levels.

The following are examples of where ICD-10 mortality coding has been directly linked to public health initiatives, be it focused care delivery or population education:

Italy & 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, the analysis focused on just one external causes of mortality (injury deaths), and covered 15 selected categories of injuries.

Canada. In Canada in 2002, there were 1631 chronic disease deaths among adults aged 69 years and younger attributed to alcohol consumption, and these deaths were 2.4% of the deaths in Canada for this age group. The net number of deaths comprised 2577 deaths caused and 947 deaths prevented by alcohol consumption. Moderate drinking was involved in 25% of deaths caused and 85% of deaths prevented by alcohol. There were 42,996 years of life lost prematurely in Canada due to alcohol consumption in 2002, 28,890 for men and 14,106 for women. In Canada in 2002, there were 91,970 net chronic disease hospitalizations attributed to alcohol consumption among individuals aged 69 years and younger. The net numbers were 124,621 hospitalizations caused and 32,651 hospitalizations prevented by alcohol consumption. The conclusion was that with rising rates of alcohol consumption and extensive high-risk drinking, both chronic and acute damage from alcohol are expected to increase. Attention was recommended to 1) create effective policies and interventions; 2) control access to alcohol; 3) reduce high-risk drinking; and 4) provide brief interventions for high-risk drinkers.^[3]

The study examined the potential years of lost life attributable to alcohol. “The sum of residual life expectancies for people dying from alcohol consumption is known as potential years of life lost (PYLL) due to alcohol. PYLL for each sex- and age-group can be estimated by interpolating the observed mean age at death and the standard life expectancies tables for each respective sex– and age–group. This study uses the World Health Organization (WHO) 2000 standard life expectancies table for Canada… PYLL were calculated per 100,000 [of] population”^[4]. In terms of economic impact the results are significant, demonstrating not only a productive economic benefit lost to society, but the potential economic cost due to a likely increase in healthcare delivery. In terms of the lives lost, and diminished longevity, the costs are immeasurable. The results are reflected in the table below:

^aa Standard life expectancy for men at birth is 76.0 years.

^bb Alcohol-attributable years of life lost per 100,000 men is 196.

^cc Standard life expectancy for women at birth is 81.5 years.

^dd Alcohol-attributable years of life lost per 100,000 women is 92.

Mozambique. In 2006 in Mozambique, “ICD-10 was adopted by the system and four pilot projects were implemented to provide facility-based mortality and morbidity data for public health use. Lists of selected diseases, included in paper forms for aggregated data, are used for hospital morbidity and mortality surveillance. The system is highly accepted by practitioners, is easy to use and implementable nationwide. Data are used to improve hospital management and to elaborate health facility profile reports.”^[1]

In summary, ICD-10 mortality coding is enabling greater precision in identifying causes of death, which in turn enables more precise analyses, which can subsequently lead to public health initiatives benefiting society.

Carl C. Jaekel, MS, CPHIMS, ACHE
Strategic Advisory Services
Santa Rosa Consulting
carljaekel@SantaRosaConsulting.com

^[1]Roberta Pastore, Alessandro Campione, Bernardina Gonçalves, Armando Melo, Celia Goncalves, Carla Silva Matos, and Marcelino Mugai – “Use of ICD-10 for morbidity and mortality notification for in-patients, in recourse limited settings. The experience of Mozambique using reduced disease lists.” ANNUAL WHO FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK MEETING, Seoul, Korea 2009 (http://www.who.int/classifications/network/WHOFIC2009_D050p_Pastone.pdf)

^[1]Wikipedia Online Dictionary (http://en.wikipedia.org/wiki/ICD-10)

^[2]Gjertsen F, Bruzzone S, Vollrath ME, Pace M, Ekeberg O. - Comparing ICD-9 and ICD-10: The impact on intentional and unintentional injury mortality statistics in Italy and Norway; Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway; Feb 16., 2012

^[3]Jürgen Rehm, PhD,Norman Giesbrecht, PhD, Jayadeep Patra, MA, and Michael Roerecke, MSc - Estimating Chronic Disease Deaths and Hospitalizations Due to Alcohol Use in Canada in 2002: Implications for Policy and Prevention Strategies; Prev Chronic Dis. 2006 October; 3(4): A121. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779285/)

^[4] Ibid