The data
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This analysis is based on the Multiple Cause of Death file. All causes entered on a death certificate are routinely coded, and those codes yield raw multiple-cause data.Note6 To produce multiple-cause-of-death data, computing software (Automated Classification of Medical Entities ― ACME) assigned the underlying cause based on the World Health Organization rules for selection and modification and the causal relationships among diseases. Another system (TRANSAX) converted death codes to a form amenable to person-based analysis of multiple causes. This software eliminates redundant causes within death certificates and, where appropriate, combines pairs of codes into a third code.Note6
Multiple-cause-of-death data were obtained from all provinces and territories from 2000 to 2008―a total of 1,811,406 records. Because the data for some provinces and territories were incomplete for earlier years, this analysis was limited to the 2004-to-2008 period.
To produce data at the national level, the multiple-cause information was merged with the Canadian Vital Statistics Death database maintained by Statistics Canada. The merge was based on the death registration number, province, and year of occurrence. Because of mismatches between the two datasets, 3.3% of all deaths (2.5% of diabetes-mellitus-related deaths) were excluded from the analysis.
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