Multi-morbidity and frailty at death: a new classification of death records for an aging world
Résumé
We present a new classification of death records based on the multiple causes of death. Our aim is to summarize the information on the death certificates according to two main criteria: multi-morbidity and frailty. With increased life expectancy, an ever-growing share of the population is living with several diseases. Multimorbid patients represent a major challenge for caregivers. Interactions between diseases make clinical care more complex, while polypharmacy increases the risk for adverse drug events and non-adherence to treatments. Epidemiologic studies have demonstrated that these patients are at higher risk of dying. As a consequence, mortality analysis needs to extend to the description and the monitoring of the importance of multi-morbidity at death.
Identifying multimorbidity at death is not a simple count of the cases where part 2 of the death certificate is not empty. In particular, the certifying physician may have reported more than one causal process on part 1. We developed decision rules that account for this situation. In addition to multimorbidity, our classification also takes into account the presence of frailty at death, which is another symptom of aging populations. We were able to automatize these rules in a SAS procedure that can be applied to all deaths of a given country. In this study data are for Italy and France in 2014. We present results for deaths at age 50 and over, and discuss the potential and the limitations of this new approach.