Causes of Death Data in the Global Burden of Disease Estimates for Ischemic and Hemorrhagic Stroke.
BACKGROUND
Stroke mortality estimates in the Global Burden of Disease (GBD) study are based on routine mortality statistics and redistribution of ill-defined codes that cannot be a cause of death, the so-called 'garbage codes' (GCs). This study describes the contribution of these codes to stroke mortality estimates.


METHODS
All available mortality data were compiled and non-specific cause codes were redistributed based on literature review and statistical methods. Ill-defined codes were redistributed to their specific cause of disease by age, sex, country and year. The reassignment was done based on the International Classification of Diseases and the pathology behind each code by checking multiple causes of death and literature review.


RESULTS
Unspecified stroke and primary and secondary hypertension are leading contributing 'GCs' to stroke mortality estimates for hemorrhagic stroke (HS) and ischemic stroke (IS). There were marked differences in the fraction of death assigned to IS and HS for unspecified stroke and hypertension between GBD regions and between age groups.


CONCLUSIONS
A large proportion of stroke fatalities are derived from the redistribution of 'unspecified stroke' and 'hypertension' with marked regional differences. Future advancements in stroke certification, data collections and statistical analyses may improve the estimation of the global stroke burden.
Department of Neurology, University of Copenhagen Rigshospitalet, Copenhagen, Denmark.
Thomas
T
Truelsen
Lars-Henrik
LH
Krarup
Helle K
HK
Iversen
George A
GA
Mensah
Valery L
VL
Feigin
Luciano A
LA
Sposato
Mohsen
M
Naghavi
D002423:Cause of Death; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D020300:Intracranial Hemorrhages / Q000401:mortality*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*