Trends in mortality from appendicitis and from gallstone disease in English populations, 1979-2006: study of multiple-cause coding of deaths

Objective To report on trends in mortality from appendicitis and from gallstone disease. Design and setting Analysis of data from death certificates including all certified causes of death, termed 'mentions', not just the underlying cause, using data from Oxford ('mentions' available from 1979 to 2006) and all England ('mentions' available from 1995 to 2006). Outcome measures Mortality rates across all years studied, and in periods defined by changes to national rules in selecting the underlying cause of death. Results In the Oxford region, mortality rates for appendicitis based on underlying cause fluctuated between periods defined by coding rule changes. Those based on mentions were more stable: they were 3.3 per million population in 1979-83 and 3.5 in 2001-6. Nationally, mentions-based rates fell from 3.4 per million in 1995-2000 to 3.1 in 2001-2006, a small but statistically significant decline. For gallstone disease in Oxford, rates fell in the early years but then levelled off. Mortality rates for gallstones in England actually rose slightly between 1995-2000 (15.0 deaths per million) and 2001-6 (15.6 per million). The majority of deaths from appendicitis and gallstone disease were in the elderly. Conclusions Appendicitis and gallstones are considered to be avoidable causes of death. Mortality rates for each cause have not shown any substantial falls in the recent periods covered by this study. It is possible that deaths were not, in fact, avoidable, but audits into the circumstances of deaths from these diseases may be warranted. Mortality data based on underlying cause alone substantially underestimate deaths from these two conditions.