One of the main tasks of our network is to compare official Italian data with the corresponding estimates generated by the GBD study. This comparison is not always easy. GBD estimates of causes of death in Italy, for example, show several differences when compared with official data. These differences, however, have a reason to exist. Italy, despite being among the countries with the best current data and, specifically, the best data on causes of death, nevertheless produces about 25 percent of misidentified causes of death. The cause of death must always identify the primary cause. Often, however, it identifies a generic cause, from which a specific one cannot be traced (e.g., stroke, without specification of hemorrhagic or ischemic; diabetes without specification of type 1 or 2; tumor, without identification of the site of the primary), or it indicates a cause that may never be a primary cause (e.g., sepsis; cardiac arrest; senility). The GBD, based on scientific evidence, redistributes these causes, called “Garbage Codes” (GCs), to primary causes of death. Thus, the 25% redistribution of causes generates differences when we compare official data with GBD estimates. On the other hand, we cannot reason about causes of death, ignoring the 25% of misattributed causes, and focusing only on those correctly attributed. The analysis carried out for Italy, and its regions, and the comparison with major European countries showed that Italy is above the European average, but that there is great heterogeneity among Italian regions in the quality of the data. The Province of Bolzano has 20 percent of GCs, a lower proportion than the best European country considered (the United Kingdom), while Campania has 32 percent, slightly lower than the proportion of the worst countries considered (France, Portugal, Greece). We believe that Italy has the capacity to improve widely, and the duty to reduce the existing differences between regions.

Monasta L, Alicandro G, Pasovic M, et al. Redistribution of garbage codes to underlying causes of death: a systematic analysis on Italy and a comparison with most populous Western European countries based on the Global Burden of Disease Study 2019 [published online ahead of print, 2022 Jan 21]. Eur J Public Health. 2022;ckab194. doi:10.1093/eurpub/ckab194