Understanding end-of-life multimorbidity: An analysis of Multiple Causes of Death in Denmark

Cosmo Strozza , CPop, University of Southern Denmark
Elizabet Ukolova, Interdisciplinary center for population dynamics
Marie-Pier Bergeron-Boucher, University of Southern Denmark

Multiple Causes of Death (MCoD) data capture all reported conditions on death certificates and can enhance understanding of mortality risks. However, it remains unclear whether MCoD data reflect the true multimorbidity burden at death or rather the causal chain of events leading to it. Using Danish registry data, we investigate this question for selected diseases, focusing here on Chronic Obstructive Pulmonary Disease (COPD). By linking the Population, Death, Diseases, and Education registers from 2010–2019, we trace diagnosed COPD cases among Danes aged 50+. We analyse (1) how often and where COPD is reported on death certificates, (2) individual and contextual factors influencing its reporting through logistic regression, (3) mortality profiles of those with and without COPD on the death certificate using multiple decrement life tables, and (4) disease co-occurrence with COPD through the Cause of Death Association Indicator (CDAI). Preliminary results show that COPD is reported on 35% of death certificates of diagnosed individuals, half of the times in each part of the certificate. Women are more likely to have COPD reported, while older age at diagnosis and higher education reduce reporting odds. Multiple decrement life tables reveal distinct mortality profiles: over half of deaths with COPD reported involve other respiratory diseases, compared with fewer than 5% when COPD is unreported, where ill-defined causes are more common. CDAI results indicate strong associations between COPD and heart, digestive system, and external causes, suggesting that MCoD data capture meaningful disease interactions without reflecting the true burden of chronic conditions at death.

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 Presented in Session 33. Aging, Frailty and the Dynamics of Later-Life Health