Reported deaths in 2017 reached 579,237, a decrease of 0.5 percent than the previous year’s 582,183 deaths. This is equivalent to a crude death rate (CDR) of 5.5, or about six (6) persons per thousand population. In 2017, an average of 1,587 persons died daily. This translates to 66 deaths per hour or one (1) per minute.
The number of deaths from 2008 to 2016 showed an increasing trend but slightly declined in 2017. The increase during the ten-year period is about a quarter, or 25.5 percent, from 461,581 in 2008 to 579,237 in 2017. (Figure 1 and Table 1).
Highest number of deaths in CALABARZON
The top three regions in terms of number of deaths by usual residence were found in Luzon: CALABARZON with 84,971 or 14.7 percent, followed by NCR with 75,187 or 13.0 percent then Central Luzon with 67,980 or 11.7 percent. The combined share of these three regions was 39.4 percent of the total deaths.
On the other hand, the three regions which had the least number of deaths were ARMM (3,036 or 0.5%), CAR (8,176 or 1.4%) and Caraga (14,928 or 2.6%). These numbers accounted for only 4.5 percent of the total deaths in the country (Figure 2 and Table 2).
Most number of deaths in August
The month of August recorded the highest number of deaths with 51,154 or 8.8 percent, while February had the least number with 44,765 or 7.7 percent share of the total deaths.
Daily Index is the increase/decrease from the overall daily average of event occurrences. In 2017, the months of March to July fall below the national daily index of 100.0 (Figure 3 and Table 3).
More deaths in males than females
In 2017, the number of deaths in males (332,517) was higher than deaths in females (246,720). This translates to a sex ratio of 135, which means that there are 135 male deaths for every 100 female deaths (Table 4).
Figure 4 shows the age and sex pattern of death in 2017. It reflects an inverted pyramid, with fewer deaths at the younger ages, except for children under one, and progressively increasing as people age. As in most parts of the world, males are more likely to die before females at all ages. In the Philippines, it is clearly shown that males died at a higher rate than females before reaching the age of 80 years, with the greatest difference observed at ages 60 to 64 years (15,362 deaths). Higher proportions of female deaths were observed in the older age groups, which is indicative of higher survival rate of females than males.
Six out of ten deaths not attended
Attendant refers to a medical doctor or any other allied health care provider who provided medical attendance to the deceased.
Out of 579,237 registered deaths, about half or 292,098 were not attended. Seven regions namely: NCR (63.4%), CALABARZON (55.4%), CAR (51.7%), Western Visayas (51.5%), Northern Mindanao (51.0%), ARMM (50.7%) and Caraga (50.1%) had more medically attended deaths than those not attended by any health care provider (Figure 5 and Table 5).
Highest number of infant deaths in CALABARZON
Infant deaths are deaths that occurred before reaching age 1. At the national level, 20,311 infant deaths were registered in 2017. Six out of ten deaths were males (11,760 or 57.9%). The top three regions that registered high infant deaths were CALABARZON with 3,546 (17.5%), NCR with 3,357 (16.5%) and Central Luzon with 2,314 (11.4%).
On the other hand, ARMM (193 or 1.0%), CAR (205 or 1.0%) and Caraga (386 or 1.9%) had the least number of registered infant deaths (Figure 6 and Table 6).
High maternal deaths in CALABARZON
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. In 2017, there were 1,484 registered maternal deaths in the country.
Among all regions, CALABARZON recorded the biggest number of maternal deaths with 222 or 15.0 percent of the total, followed by NCR with 195 or 13.1 percent, and Central Visayas with 164 or 11.1 percent. On the other hand, CAR recorded the least number of maternal deaths with only 13 or 0.9 percent of the total (Figure 7 and Table 7).
Most deaths due to ischaemic heart diseases
Figure 8 shows the ten leading causes of death in 2017. It can be seen that among the total deaths, ischaemic heart diseases were the leading causes of death with 84,120 or 14.5 percent. Second were neoplasms which are commonly known as “cancer” with 64,125 or 11.1 percent, followed by cerebrovascular diseases with 59,774 or 10.3 percent (Table 8).
Among males, ischaemic heart diseases were also the leading causes of death with 50,503 or 15.2 percent followed by cerebrovascular diseases (33,610 or 10.1%) and neoplasms (30,800 or 9.3%). It was also observed that assault was included in the 10 leading causes of death with 10,866 or 3.3 percent of the total deaths in males. On the other hand, similar to males, the top cause of death among females was also ischaemic heart disease (33,617 or 13.6%), followed by neoplasm with 33,325 or 13.5 percent and pneumonia with 28,835 or 11.7 percent of the total deaths in females (Table 8).
Data on deaths presented in this release were obtained from the Certificates of Death (Municipal Form No. 103) that were registered at the Office of the City/Municipal Civil Registrars all throughout the country and forwarded to the Philippine Statistics Authority. Information presented includes registered deaths which occurred from January to December 2017. Figures presented are not adjusted for under registration.
CLAIRE DENNIS S. MAPA, Ph.D.
National Statistician and Civil Registrar General
See more at the Vital Statistics Main page.
PSA IMPLEMENTATION OF IRIS SOFTWARE: UNDERSTANDING CODING AND PROCESS IMPROVEMENTS
In 2017 the Philippines Statistical Authority (PSA) implemented Iris, an automated software program which assigns codes from the International Classification of Diseases 10th Revision (ICD-10) to death records, and assists in the selection of an underlying cause of death. This replaces the previous process where mortality coding rules were applied manually.
The implementation of Iris has enabled the PSA to update mortality coding processes and mortality statistical outputs, bringing the coding of Philippines mortality data up to date with international best practice.
The Iris implementation project is part of a large scale initiative the Government of Philippines has undertaken with the Bloomberg Philanthropies Data for Health/Vital Strategies initiative to improve civil registration and vital statistics in the Philippines. As part of this project a number of initiatives have been undertaken which relate directly to death certification, registration and data analytics. These initiatives include:
• Courses in medical certification for doctors across major hospitals in the Philippines;
• Campaigns to improve death registration rates;
• Training in medical certification for cause of death coders and data analysts; and
• Training in ICD-10 coding rules as governed by the World Health Organization.
The move to Iris, alongside the additional CRVS initiatives being undertaken in the Philippines all have the potential to impact statistical outputs. It should be noted that updates applied to the ICD-10 are regulated by the World Health Organization (WHO) and are adopted only where they enhance accuracy or reflect improved medical understanding. To that end the changes in this issue will improve the quality of the Philippines’ mortality dataset.
The purpose of this Technical Note is to provide a summary of changes that have occurred as a result of software and coding updates. This technical note provides a resource for data users to understand where changes have occurred within the dataset and the impact of those changes moving forward.
PSA INVESTIGATIONS INTO IRIS
PSA investigations into Iris were conducted throughout 2016 and 2017. A key element of these investigations was a dual coding exercise conducted where records were coded through Iris and manually. Approximately 200,000 records from the 2016 and 2017 reference year were processed through both techniques (Iris and manual) with outputs being analysed thoroughly. Results showed that Iris would provide a strong platform for future autocoding and enable best practice in mortality coding and statistical output to be sustained. The Iris software is language independent, and as such is being used extensively around the world. Updates made to ICD-10 by the WHO are rapidly implemented in Iris, meaning that cause of death coding practices and statistical outputs will remain up to date.
KEY CHANGES IN OUTPUT DUE TO IRIS IMPLEMENTATION
The PSA is committed to communicating to data users how Iris has changed statistical output. This technical note will assist users in understanding what may be a legitimate change in disease process as opposed to administrative by-products of recent changes to the death certification, registration and analytical system.
The PSA annually publishes the leading causes of death in the Philippines, with output based on Mortality Tabulation List 1 of the ICD-10 of suggested statistical outputs. The following analysis will be based on this leading cause of death tabulation. For details on other changes to coding and statistical output please contact the PSA-VSD.
LEADING CAUSES OF DEATH, 2017
The leading cause of death in 2017 in the Philippines was ischaemic heart disease, followed by neoplasms and cerebrovascular diseases (see table below). Although the ischaemic heart diseases were the leading cause of death in 2016, the numerical change is statistically significant.
|Cause of Death||2013||2014||2015||2016||2017|
|Ischaemic heart diseases||65,378||65,551||68,572||74,134||84,120|
|Chronic lower respiratory infections||23,867||24,686||23,760||24,365||24,818|
|Other heart diseases||33,027||34,141||31,729||28,641||22,134|
|Remainder of the diseases of the genitourinary system||16,785||17,220||18,061||19,759||15,717|
A key coding change with the introduction of Iris has been in regards to ischaemic heart disease and hypertension. Prior practice based on local coding rules was to combine hypertension and ischaemic heart diseases into a hypertensive heart disease regardless of placement of the two diseases on the death certificate. With the implementation of Iris, ischaemic heart disease is retained as the underlying cause of death in many of these cases, meaning the number of deaths coded to I20-I25 (ischaemic heart diseases) has increased and the number of deaths coded to hypertensive diseases (I10-I15) has decreased.
In addition to ischaemic heart diseases, hypertensive diseases have also been reallocated to cerebrovascular diseases with the implementation of Iris. Hypertension is a key risk factor for strokes, especially those of haemorrhagic aetiology, and there has been an increase in these conditions (I60-I62) under the new coding model.
Tuberculosis has decreased as an underlying cause of death under the implementation of Iris. There is a tendency to select tuberculosis as the underlying cause of death regardless of position placement on the death certificate under the former manual coding rules. This has now changed and the tuberculosis must legitimately have initiated the train of morbid events leading to death to be assigned as the underlying cause of death. It is also acknowledged that the Department of Health (DOH) have implemented many prevention and intervention campaigns targeted at tuberculosis in recent years. This may also have legitimately reduced number of deaths due to tuberculosis. As the administrative and real world changes are difficult to separate, caution should be taken when interpreting time series data for tuberculosis.
LEADING CAUSES OF DEATH, 2017, BY STANDARDIZED DEATH RATE
The prior analysis of change is based on numerical differences over a time series seen in the PSA data. To assess the impact of change at a population level data should be presented as a death rate. A death rate provides a number of deaths as expected per 100,000 density in a population and helps take into account changes in population numbers and age structure of time. The table below shows the top 10 causes of death in the Philippines over the last 5 years as standardized death rates.
|Cause of Death||2013||2014||2015||2016||2017|
|Ischaemic heart diseases||66.6||65.6||67.5||71.8||80.2|
|Chronic lower respiratory infections||24.3||24.7||23.4||23.6||23.7|
|Other heart diseases||33.6||34.2||31.2||27.7||21.1|
|Remainder of diseases of the genitourinary system||17.1||17.2||17.8||19.1||15.0|
When presented as death rates, we can see that the proportional changes from 2016 to 2017 are not as large as suggested by numerical changes in the first table. It is recommended that policy makers and researchers use rates in conjunction with numbers of deaths to provide context to an area of interest.
OTHER NOTABLE AREAS OF CHANGE WITH THE IRIS IMPLEMENTATION
Although the focus of this technical note has been on the leading causes of death in the Philippines in 2017 there are general areas of change which should be highlighted in order to demonstrate the higher level of quality in statistical output for causes of death with this release. Notable changes are discussed below:
Decrease in specified causes of death considered “direct”: There has been a decrease in deaths due to cardiac arrest and respiratory failure as the underlying cause of death in Iris. These conditions are considered ill-defined and do not indicate where health funding and intervention should be targeted. These deaths are now coded to more specific diseases appearing on the death certificate.
Improved identification of primary and secondary cancers: There has been an increase in cancers of unknown primary cause with the implementation of Iris. This is due to an improved ability to identify secondary cancers and code them accordingly. Under previous rules, cancers were generally assumed to be primary in the majority of cases leading to an over-count of particular cancer types.
More consistent distribution of deaths due to external causes: Under prior coding rules there was a lack of internal business rules on how to code the intent (i.e. accident, suicide, homicide) of deaths due to injury where no intent was stated by the certifier. A set of business rules have been implemented as part of the Iris project and there is greater consistency in the output for external causes of death.
The PSA remains committed to maximising the relevance and useability of mortality data in the Philippines, ensuring alignment with international best practice for mortality coding and maintaining international comparability. To that end, this project will also instigate changes and improvements in statistical output for causes of death in the Philippines.