Background
Collider bias
Reporting bias
Aim and organisation of the paper
Analyses of cause of death associations in death certificates
Mortality data obtained from death certificates
Framework for the assessment of associations between causes of death and the biases involved
Assessment of collider bias
Assessment of reporting bias
Illustrative example: association between cancer and suicide in death certificates in France
Methods
French mortality data
Simulation scheme
Statistical analyses
Results
French mortality data
Gender | Cause of death | Number (%) | Age at death, median [IQR] | |
---|---|---|---|---|
Men | Overall | 3,685,024 (100) | 76 [64–84] | |
Suicide | Bladder cancer | 150 (0) | 78 [69–83] | |
CNS cancer | 20 (0) | 56 [45–64] | ||
Colorectal cancer | 331 (0) | 75 [68–81] | ||
Cutaneous melanoma | 13 (0) | 76 [58–80] | ||
Head and neck cancer | 157 (0) | 65 [55–75] | ||
Kidney cancer | 77 (0) | 71 [65–77] | ||
Larynx cancer | 103 (0) | 67 [57–75] | ||
Liver cancer | 82 (0) | 72 [63–76] | ||
Lung cancer | 448 (0) | 70 [62–77] | ||
Oesophageal cancer | 104 (0) | 71 [61–79] | ||
Pancreatic cancer | 110 (0) | 73 [65–80] | ||
Prostate cancer | 643 (0) | 79 [72–84] | ||
Stomach cancer | 100 (0) | 75 [65–81] | ||
Testis cancer | 9 (0) | 52 [44–55] | ||
Thyroid gland cancer | 6 (0) | 76 [47–78] | ||
Other or no cancera | 104,888 (2.9) | 50 [39–66] | ||
Other cause | Bladder cancer | 53,867 (1.5) | 77 [69–84] | |
CNS cancer | 24,204 (0.7) | 64 [53–73] | ||
Colorectal cancer | 130,632 (3.5) | 76 [67–82] | ||
Cutaneous melanoma | 12,298 (0.3) | 68 [56–78] | ||
Head and neck cancer | 46,689 (1.3) | 62 [54–71] | ||
Kidney cancer | 30,515 (0.8) | 73 [63–81] | ||
Larynx cancer | 19,431 (0.5) | 66 [57–76] | ||
Liver cancer | 80,578 (2.2) | 71 [63–78] | ||
Lung cancer | 309,349 (8.4) | 68 [59–77] | ||
Oesophageal cancer | 45,215 (1.2) | 68 [58–77] | ||
Pancreatic cancer | 61,217 (1.7) | 71 [62–79] | ||
Prostate cancer | 154,378 (4.2) | 82 [75–87] | ||
Stomach cancer | 43,501 (1.2) | 74 [64–81] | ||
Testis cancer | 1503 (0) | 45 [33–63] | ||
Thyroid gland cancer | 2227 (0.1) | 72 [62–80] | ||
Other or no cancera | 2,562,179 (70) | 78 [67–86] | ||
Women | Overall | 3,553,707 (100) | 84 [76–90] | |
Suicide | Bladder cancer | 10 (0) | 76 [57–87] | |
Breast cancer | 264 (0) | 63 [52–74] | ||
CNS cancer | 4 (0) | 62 [50–77] | ||
Colorectal cancer | 53 (0) | 73 [63–83] | ||
Corpus uteri cancer | 7 (0) | 70 [62–77] | ||
Cutaneous melanoma | 6 (0) | 77 [74–79] | ||
Head and neck cancer | 17 (0) | 61 [57–76] | ||
Kidney cancer | 11 (0) | 73 [62–81] | ||
Larynx cancer | 4 (0) | 54 [50–59] | ||
Liver cancer | 4 (0) | 68 [63–72] | ||
Lung cancer | 37 (0) | 67 [56–78] | ||
Oesophageal cancer | 10 (0) | 73 [51–80] | ||
Ovary cancer | 8 (0) | 66 [58–70] | ||
Pancreatic cancer | 19 (0) | 71 [68–81] | ||
Stomach cancer | 9 (0) | 64 [53–70] | ||
Thyroid gland cancer | 5 (0) | 79 [67–81] | ||
Other or no cancera | 37,829 (1.1) | 53 [42–68] | ||
Other cause | Bladder cancer | 16,694 (0.5) | 82 [75–88] | |
Breast cancer | 180,821 (5.1) | 74 [60–84] | ||
CNS cancer | 18,831 (0.5) | 68 [57–77] | ||
Colorectal cancer | 116,793 (3.3) | 80 [71–87] | ||
Corpus uteri cancer | 10,105 (0.3) | 75 [67–82] | ||
Cutaneous melanoma | 10,472 (0.3) | 73 [57–83] | ||
Head and neck cancer | 9,737 (0.3) | 67 [56–80] | ||
Kidney cancer | 17,161 (0.5) | 78 [69–85] | ||
Larynx cancer | 2,125 (0.1) | 67 [57–79] | ||
Liver cancer | 28,184 (0.8) | 77 [69–84] | ||
Lung cancer | 89,479 (2.5) | 69 [57–79] | ||
Oesophageal cancer | 10,597 (0.3) | 75 [63–83] | ||
Ovary cancer | 47,964 (1.4) | 73 [63–81] | ||
Pancreatic cancer | 57,766 (1.6) | 78 [69–84] | ||
Stomach cancer | 25,717 (0.7) | 80 [70–87] | ||
Thyroid gland cancer | 3,896 (0.1) | 79 [71–86] | ||
Other or no cancera | 2,869,068 (81) | 86 [79–91] |
Cancer site | French mortality data | Simulation #1: independence | Simulation #2: RR from Fang et al. [4] | Fang et al. study[4] | Collider biasb | Reporting biasc | |||
---|---|---|---|---|---|---|---|---|---|
OR | [95% CI] | OR | [95% CI] | OR | [95% CI] | RR | |||
No cancera | 1.00 | 1.00 | 1.00 | 1.0 | 1.0 | 1.0 | |||
Prostate | 0.24 | [0.22;0.26] | 0.71 | [0.68;0.75] | 1.14 | [1.10;1.18] | 1.9 | 1.7 | 4.7 |
Cutaneous melanoma | 0.01 | [0.01;0.02] | 0.61 | [0.53;0.70] | 0.77 | [0.68;0.86] | 1.4 | 1.8 | 64 |
Breast | 0.04 | [0.03;0.04] | 0.58 | [0.52;0.64] | 0.85 | [0.78;0.92] | 1.6 | 1.9 | 24 |
Colorectal | 0.05 | [0.05;0.06] | 0.35 | [0.33;0.37] | 0.50 | [0.48;0.52] | 1.6 | 3.2 | 9.4 |
Oesophageal, liver, pancreatic | 0.03 | [0.03;0.03] | 0.17 | [0.16;0.19] | 0.55 | [0.53;0.58] | 4.5 | 8.1 | 20 |
Lung | 0.02 | [0.02;0.02] | 0.14 | [0.13;0.15] | 0.36 | [0.35;0.38] | 3.3 | 9.1 | 17 |
Central nervous system | 0.01 | [0.01;0.01] | 0.11 | [0.09;0.14] | 0.25 | [0.22;0.28] | 2.3 | 9.3 | 35 |