MONICA Manual, Part II, Section 1
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Annual Demographic and Mortality data ANNUAL POPULATION MORTALITY REPORTING FORM (ICD-9) Form: E Version: 2 2.6.87 |
FOR MDC USE ONLY Seq.no: Received: |
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Please print carefully or type the requested information. Please complete all blanks in accordance with the instructions provided. Complete one form for each MONICA Reporting Unit for each sex each year.
| 1. | MONICA Collaborating Centre name: | Code:|___|___| |
| 2. | MONICA Reporting Unit name: | Code:|___|___| |
| 3. | Calendar year for which information is being provided: | |___|___|___|___| |
| 4. | The following table gives the official statistics for: | 1. Males, 2. Females |___| |
| ICD-9 category | Number of deaths for the selected ICD categories in these age groups |
Total of the row |
|||||||||
| 25-29 | 30-34 | 35-39 | 40-44 | 45-49 | 50-54 | 55-59 | 60-64 | 65-69 | 70-74 | ||
| Total deaths | |||||||||||
| 001-139, 320-322, 480-487 | |||||||||||
| 140-208 | |||||||||||
| 151 | |||||||||||
| 153 | |||||||||||
| 154 | |||||||||||
| 162 | |||||||||||
| 174 | |||||||||||
| 180 | |||||||||||
| 204-208 | |||||||||||
| 250 | |||||||||||
| 390-459 | |||||||||||
| 401-405 | |||||||||||
| 410-414 | |||||||||||
| 420-429 | |||||||||||
| 430-438 | |||||||||||
| 440-448 | |||||||||||
| 490-493 | |||||||||||
| 571 | |||||||||||
| 780-799 | |||||||||||
| 798 | |||||||||||
| E800-E999 | |||||||||||
| E800-E848 | |||||||||||
| E950-E959 | |||||||||||
| Total of the column | |||||||||||
| 5. | If you recorded the numbers in item 4 by hand, please write above each number printed to the right the numbers as used for item 4 | 0 1 2 3 4 5 6 7 8 9 | ||
| 6. | Source of information: | 1. Local registry 3. National registry |
2. Regional registry 4. Other (explain in item 8) |
Code:|___| |
| 7. | Person providing information: | ___________________ (Please type or print) |
___________________ Signature |
Date: _____/_____/_____ day month year |
| 8. | Comments or reservations about data provided: | |||
The purpose of this form is to provide a convenient and common format for reporting annually the official statistics of the total number of deaths and the number of deaths from selected causes among residents of each official MONICA Reporting Unit. The numbers provided on this form are an essential component in the investigation of cardiovascular disease mortality trends.
This form replaces the old Annual Population Mortality Reporting Form (ICD-9): Form E, Version 1, which was used to report only the total mortality and mortality from cardiovascular diseases.
This form is to be completed once each year and reported to the MONICA Data Centre (MDC), so that it is received there by 31 December each year. The information should be provided for the calendar year two years before the year of reporting the data. For example, the data for 1993 should be reported by 31 December 1995. Please inform the MDC and the MONICA Management Centre - Geneva (MMC) if there is any difficulty in meeting this schedule.
The first year for which the mortality data requested on this form should be provided by every MCC is 1987. However, the MCCs are strongly recommended to report the data already for 1986, and if possible, from 1983 onwards. If the cardiovascular disease mortality for a particular year has already been reported to the MDC using version 1 of form E, the rows for cardiovascular diseases can be left blank when reporting the data requested on version 2 of form E for that year. In addition to the yearly reporting, the information should be reported whenever requested by the MMC.
The time period for which information is to be reported is the calendar year (1 January through 31 December) as stated on the form. The data provided are to be the best available estimates of the number of deaths occurring among MONICA Reporting Unit residents during this calendar year.
The information is to be provided separately for males and females for deaths of residents of each official MONICA Reporting Unit. See Part I, Appendix 2 for a list of these Reporting Units and code numbers.
This form is to be used for those death registration systems using the International Classification of Diseases 1975 Revision (ICD-9). If the source of information for the numbers of deaths reported here uses ICD-9 codes, then this form should be used. If the source uses the International Classification of Diseases 1965 Revision (ICD-8) then the ICD-8 form should be used. If neither of these systems of coding causes of death are used, please contact the MDC for instructions.
This form is to be completed by the MCC Principal Investigator or by someone officially designated to perform this task.
This form can be completed either by typewriter or by hand. For the table of mortality figures, a computer printout can also be pasted on the form, as described in more detail in the specific instructions. The recorded information should be examined carefully for both correctness and legibility. Further, since it may be necessary to photocopy the form, perhaps several times, as a routine part of processing and providing reserve copies it is essential that the recorded information be clear and dark. Hence, please use a dark ribbon if a typewriter is used or a dark ball-point pen if the form is completed by hand.
This form includes blank spaces where you are to record the requested information. None of these spaces should be left blank (except the cells for cardiovascular diseases in the case the cardiovascular mortality data have already been reported to the MDC using version 1 of form E). If you have no information to provide for a specific item, then so indicate according to the instructions for that item.
If a mistake is made in entering information on an item other than the mortality table, please draw a single line through the erroneous entry and provide the correct information in the immediate neighbourhood. If an error is made in the mortality table, draw a single line through the erroneous entry and write and circle a capital letter in the cell of the erroneous entry. In the right side of the table, print or type and circle the same letter followed by the correct number. Use different letters for different corrections. If the number of corrections required has made the form difficult to read or perhaps confusing, please re-enter the information on a new copy and send this new copy of the form to the MDC. If this step is required, please check the final copy carefully to make sure that no new errors were made in the process of re-copying the numbers onto the new form.
A completed form with error corrections is enclosed at the end of the specific instructions.
These instructions should be followed carefully when completing the indicated version of the Annual Population Mortality Reporting Form (ICD-9). Please ensure that the instructions are for the version of the form being completed. Specific instructions are listed by item below:
| 1. | MONICA Collaborating Centre name: | Code:|___|___| |
Print or type the official MONICA Collaborating Centre name and code number in the spaces provided. Use the name and code number as they appear in Part I, Appendix 2: MONICA Collaborating Centres and Reporting Units.
| 2. | MONICA Reporting Unit name: | Code:|___|___| |
Print or type the official MONICA Reporting Unit name and code number in the space provided. Use the name and code number as they appear in Part I, Appendix 2. Even if your centre has only one Reporting Unit, please enter the appropriate name and code number here. Do not leave this item blank. If your centre has more than one Reporting Unit, then complete one form for each sex for each Reporting Unit and record the appropriate name and code number for the Reporting Unit in this space.
| 3. | Calendar year for which information is being provided: | |___|___|___|___| |
Print or type the calendar year (1 January through 31 December) for which data are being provided. Please contact the MDC for instructions and note in item 8 if the reporting period does not correspond to a calendar year as described above. Include all four digits of the year as described in the completed example form at the end of these instructions.
| 4. | The following table gives the official statistics for: | 1. Males, 2. Females |___| |
| ICD-9 category | Number of deaths for the selected ICD categories in these age groups | Total of the row |
|||||||||
| 25-29 | 30-34 | 35-39 | 40-44 | 45-49 | 50-54 | 55-59 | 60-64 | 65-69 | 70-74 | ||
| Total deaths | |||||||||||
| 001-139, 320-322, 480-487 | |||||||||||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... |
| E800-E848 | |||||||||||
| E950-E959 | |||||||||||
| Total of the column | |||||||||||
Note that separate forms are to be completed for males and females. For each form print or type the appropriate number in the coding box to the right.
Print or type the official number of deaths among residents of the official MONICA Reporting Unit for each age group - ICD-9 code combination in the appropriate cell. Alternatively, paste a computer printout on top of the table on the form. Such a computer printout must have the title and the total columns included, and the age groups and the ICD-9 code categories must be in the same order as in the original form. However, it is not necessary to include the vertical and horizontal lines in the printout. An example of such a computer printout is given at the end of these instructions.
Note: If you have decided to exclude some people living in the Reporting Unit area (e.g. those who are not citizens of the country) from the survey sample and event monitoring, such population groups are excluded from the MONICA study population. Hence, such people must not be counted here.
The ICD-9 categories for which data are to be reported: Most of the ICD-9 categories of this form can be extracted from the Abbreviated Mortality List (so called AM classification), which is used on the following annual publication: United Nations, Department of International Economic and Social Affairs. Demographic Yearbook. New York, UN.
Specific instruction for completing each disease group, with the relation to a possible AM class, are listed below. If data for some disease group are not available for your Reporting Unit, please print N.A. in the corresponding row of item 4 and explain in item 8 the reason for not being able provide the data.
| * | The rows for the categories marked with an asterisk can be left blank if the data have already been reported to the MDC on version 1 of form E. In such a case, please write in the blank area "Data have been sent earlier to the MDC on version 1 of form E". |
| ICD-9 category | AM category | Explanations |
|---|---|---|
| 001-E999 (Total deaths) | Give here the total number of deaths from ALL CAUSES among the residents of the Reporting Unit. | |
| 001-139, 320-322, 480-487 | 1-12, 25, 34-35 | Give here the total number of deaths from INFECTIOUS AND PARASITIC DISEASES, MENINGITIS, PNEUMONIA AND INFLUENZA. |
| 140-208 | 13-20 | Give here the total number of deaths from MALIGNANT NEOPLASMS, including the specific neoplasms reported on the following lines. |
| 151 | 13 | Give here the number of deaths from malignant neoplasm of stomach. |
| 153 | 14 | Malignant neoplasm of colon. |
| 154 | 15 | Malignant neoplasm of rectum, rectosigmoid junction and anus. |
| 162 | 16 | Malignant neoplasm of trachea, bronchus and lung. |
| 174 | 17 | Malignant neoplasm of female breast. |
| 180 | 18 | Malignant neoplasm of cervix uteri. |
| 204-208 | 19 | Leukaemia. |
| 250 | 21 | Diabetes mellitus. |
| 390-459* | 26-33 | Give here the total number of deaths from DISEASES OF THE CIRCULATORY SYSTEM, including the specific causes reported in the following lines. |
| 401-405* | 28 | Give here the number of deaths from hypertensive disease. |
| 410-414* | 29-30 | Ischaemic heart diseases. |
| 420-429* | not an AM class | Other forms of heart disease. |
| 430-438* | 31 | Cerebrovascular disease. |
| 440-448* | not an AM class | Diseases of arteries, arterioles and capillaries. |
| 490-493 | 36 | BRONCHITIS, EMPHYSEMA AND ASTHMA. |
| 571 | 39 | CHRONIC LIVER DISEASE AND CIRRHOSIS. |
| 780-799 | 48 | SIGNS, SYMPTOMS AND ILL-DEFINED CONDITIONS, including sudden death (ICD-9 code 798). |
| 798 | not an AM class | Sudden death, cause unknown. |
| E800-E999 | 50-55 | Give here the number of deaths from EXTERNAL CAUSES OF INJURY AND POISONING, including the more specific causes reported on the following lines. |
| E800-E848 | not an AM class | Give here the number of deaths from transport accidents. |
| E950-E959 | 53 | Suicide and self-inflicted injury. |
| Total of the column | Calculate here the sum of all entries of the table. These totals have no scientific interpretation, but they are important for data management purposes. Do not leave these totals blank. |
If the MCC includes only ages 25-64 in the event registration activities, then it is not necessary to report these mortality statistics for the age groups 65-69 and 70-74. In such a case "NA" should appear in the respective columns of the "Total deaths" row of the table.
| 5. | If you recorded the numbers in item 4 by hand, please write above each number printed to the right the numbers as used for item 4 | 0 1 2 3 4 5 6 7 8 9 |
This item was added as an attempt to help read hand-written entries that may appear elsewhere on this form. If you are entering data on this form by typewriter, leave this item blank. If you are completing the form by hand, please write, in your handwriting, each number above the digits as shown in the example below. Then compare the entries in the table and elsewhere on the form with those as written for this item and change those that may be confusing or unclear.
| 6. | Source of information: | 1. Local registry 3. National registry |
2. Regional registry 4. Other (explain in item 8) |
Code:|___| |
Print or type the appropriate number in the box for the code number. If the source of the information is not the same as reported for the previous year, please indicate the reason for the change in item 8.
Use codes as follows:
| 1 | Local registry: use this code if the numbers of deaths by cause were obtained directly from a local registration system with the area covered by this system corresponding exactly with the area of the MONICA Reporting Unit. |
| 2 | Regional registry: use this code if the numbers of deaths by cause were obtained directly from a regional registration system which covers a broader area than the MONICA Reporting Unit area, but which does not cover the entire country. Clearly, if such a registry is used, the deaths occurring among residents of the MONICA Reporting Unit must be identifiable as having occurred in that Reporting Unit. |
| 3 | National registry: use this code if the numbers of deaths by cause were obtained from a national registration system. |
| 4 | Other: use this code if none of the other codes are applicable. Please describe clearly in item 8 the source of information if "other" is coded. |
| 7. | Person providing information: | ___________________ (Please type or print) |
___________________ Signature |
Date: _____/_____/_____ day month year |
Type or print the name of the person completing this form and the date completed in the spaces provided. Note that this form is to be completed by the Principal Investigator of the MCC or his or her designate.
| 8. | Comments or reservations about data provided: |
Type or print any reservations or comments about the data that may be helpful to the MDC in using the data or preparing summary reports. Note especially the instructions for items 3 and 6. If necessary, attach additional sheets.
An example of a manually completed form with error corrections:

An example of a completed form where the mortality table has been printed by a computer: