title: Quantifying cause-related mortality by weighting multiple causes of death.
abstract: OBJECTIVE
  To investigate a new approach to calculating cause-related standardized mortality rates that involves assigning weights to each cause of death reported on death certificates.
  
  
  METHODS
  We derived cause-related standardized mortality rates from death certificate data for France in 2010 using: (i) the classic method, which considered only the underlying cause of death; and (ii) three novel multiple-cause-of-death weighting methods, which assigned weights to multiple causes of death mentioned on death certificates: the first two multiple-cause-of-death methods assigned non-zero weights to all causes mentioned and the third assigned non-zero weights to only the underlying cause and other contributing causes that were not part of the main morbid process. As the sum of the weights for each death certificate was 1, each death had an equal influence on mortality estimates and the total number of deaths was unchanged. Mortality rates derived using the different methods were compared.
  
  
  RESULTS
  On average, 3.4 causes per death were listed on each certificate. The standardized mortality rate calculated using the third multiple-cause-of-death weighting method was more than 20% higher than that calculated using the classic method for five disease categories: skin diseases, mental disorders, endocrine and nutritional diseases, blood diseases and genitourinary diseases. Moreover, this method highlighted the mortality burden associated with certain diseases in specific age groups.
  
  
  CONCLUSIONS
  A multiple-cause-of-death weighting approach to calculating cause-related standardized mortality rates from death certificate data identified conditions that contributed more to mortality than indicated by the classic method. This new approach holds promise for identifying underrecognized contributors to mortality.
authors.affiliation: CépiDc-Inserm, Epidemiology Centre on Medical Causes of Death, 80, rue du Général Leclerc, 94276 le Kremlin-Bicêtre, Cedex, France .
authors.forename: Clara
authors.initials: C
authors.lastname: Piffaretti
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia .
authors.forename: Margarita
authors.initials: M
authors.lastname: Moreno-Betancur
authors.affiliation: CépiDc-Inserm, Epidemiology Centre on Medical Causes of Death, 80, rue du Général Leclerc, 94276 le Kremlin-Bicêtre, Cedex, France .
authors.forename: Agathe
authors.initials: A
authors.lastname: Lamarche-Vadel
authors.affiliation: CépiDc-Inserm, Epidemiology Centre on Medical Causes of Death, 80, rue du Général Leclerc, 94276 le Kremlin-Bicêtre, Cedex, France .
authors.forename: Grégoire
authors.initials: G
authors.lastname: Rey
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends*; D017678:Sex Distribution; D055815:Young Adult