{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:33:33Z","timestamp":1786649613134,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Mortality data are used to assess the development and implementation of health policies, set public health priorities, and evaluate population health. The proportions of ill-defined causes of death (IDCODs) and garbage codes (GCs) impact the accuracy of mortality data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aimed to analyze the temporal evolution of the proportional mortality ratio (PMR) of IDCODs in Bahrain between 2000 and 2020 and to examine variations by age, sex, and nationality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed mortality statistics from 2000 to 2020 from official Bahrain data platforms. The PMR of the IDCODs was computed and examined for correlations with various causes of death (CODs). IDCODs were then redistributed to well-defined CODs using Ledermann\u2019s method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      IDCODs were among the top three CODs in Bahrain until 2014, with the highest PMR (28.8%) in 2009. In 2015, their PMR decreased significantly, and by 2017, it had fallen to 1.9%. Over several years, the ranking of GCs was affected by the inclusion of non-ICD codes (deaths listed as \u201cundetermined\u201d or \u201cothers\u201d). Males and those aged \u226565 years were more likely to have IDCODs. There was a strong negative correlation between IDCODs and mortality from circulatory disorders (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = \u22120.958) and neoplasms (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = \u22120.893). The redistribution of IDCODs primarily led to an increase in circulatory diseases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Although Bahrain has made significant strides in reducing IDCODs, the use of non-ICD codes remains a concern. Mandatory training should be implemented to improve physicians\u2019 and medical students\u2019 proficiency in completing death certificates and to ensure regular audits of the coding process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sjmms.sjmms_742_25","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:00:09Z","timestamp":1777366809000},"page":"159-167","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Changes in the Proportion of Deaths Attributable to Ill-defined Causes in Bahrain from 2000 to 2020"],"prefix":"10.4103","volume":"14","author":[{"given":"Randah R.","family":"Hamadeh","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enjy","family":"Khedr","sequence":"additional","affiliation":[{"name":"Medical Skills and Simulation Centre, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain"},{"name":"Public Health Department, Faculty of Medicine, Benha University, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"issue":"Suppl 3","key":"R1-20260429","doi-asserted-by":"crossref","DOI":"10.1590\/1980-549720190002.supl.3","article-title":"Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015","volume":"22","author":"Teixeira","year":"2019","journal-title":"Rev Bras Epidemiol"},{"key":"R2-20260429","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Roth","year":"2018","journal-title":"Lancet"},{"key":"R5-20260429","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1186\/1471-2458-14-1295","article-title":"Socioeconomic differences in the use of ill-defined causes of death in 16 European countries","volume":"14","author":"Kulh\u00e1nov\u00e1","year":"2014","journal-title":"BMC Public Health"},{"key":"R7-20260429","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1478-7954-8-9","article-title":"Algorithms for enhancing public health utility of national causes-of-death data","volume":"8","author":"Naghavi","year":"2010","journal-title":"Popul Health Metr"},{"key":"R8-20260429","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1016\/S0140-6736(24)00367-2","article-title":"Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"Naghavi","year":"2024","journal-title":"Lancet"},{"key":"R9-20260429","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"Naghavi","year":"2017","journal-title":"Lancet"},{"key":"R10-20260429","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13690-021-00535-1","article-title":"Redistributing ill-defined causes of death \u2013A case study from the BURDEN, 2020-project in Germany","volume":"79","author":"Wengler","year":"2021","journal-title":"Arch Public Health"},{"key":"R11-20260429","doi-asserted-by":"crossref","first-page":"150","DOI":"10.33314\/jnhrc.v22i01.4941","article-title":"Evaluation of errors on death certificates","volume":"22","author":"Atreya","year":"2024","journal-title":"J Nepal Health Res Counc"},{"key":"R12-20260429","first-page":"171","article-title":"Counting the dead and what they died from: An assessment of the global status of cause of death data","volume":"83","author":"Mathers","year":"2005","journal-title":"Bull World Health Organ"},{"key":"R14-20260429","doi-asserted-by":"crossref","first-page":"545","DOI":"10.15537\/1658-3175.5030","article-title":"A study of ill-defined causes of death in Bahrain. 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