Competing Causes of Death: Quantifying the Probability of Dying from One Cause Before Another with Multiple Causes of Death

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

Throughout life, individuals are exposed to multiple risks, where the occurrence of one can prevent others. This is known as competing risks. In mortality analysis, this means dying from one cause prevents death from other diseases. Understanding competing risks is essential for assessing disease lethality, guiding clinical treatment decisions, and evaluating disease burden. However, comprehensive documentation of competing risks across multiple morbid conditions remains limited. In this study, we investigate whether multiple causes of death (MCD) data can be used to evaluate mortality competing risks across diseases. We conduct pairwise comparisons among the 10 leading groups of causes of death in Denmark, France, Spain, and the United States. Specifically, we use cumulative incidence functions to estimate the probability that one cause initiated the mortality process before another when both diseases were reported on the death certificate. We then validate this approach by comparing these probabilities with those derived from Danish register data, where exposure to both diseases is known. Analysis of MCD data reveals that individuals with neoplasms or diseases of the digestive system at the end of life are more likely to have these conditions listed as their underlying causes of death compared to other comorbidities present on the death certificate. The estimated probabilities from MCD data showed consistency across countries and aligned with the "true" probabilities from register data in terms of direction, i.e. identifying which cause is most likely to lead to death, but can differ significantly in magnitude.

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 Presented in Session 98. Causes of Death and Multi-Morbidity at Death