ArticlePopulation health metrics2026
Regional and educational disparities in inaccurately coded deaths in Sweden, 1997-2023: a systematic analysis.
Article in Population health metrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAccurate underlying cause of death (CoD) data is critical for informing public health policy, but inaccurate CoD assignment, here called garbage code (GC) deaths, compromise CoD research and monitoring. Since 1997, GCs have consistently made up over 20% of all underlying CoDs in Sweden, but the distribution of GC deaths by sociodemographic status of the deceased remains poorly understood.
methodsWe used the Swedish Cause of Death Register containing 2.50 million death records from 1997 to 2023. We mapped each record to the Global Burden of Disease (GBD) project cause list and categorized GC deaths by disease groups. We calculated the fraction of deaths that were GCs by individual age, sex, region of death, and highest educational attainment. We performed redistribution of GCs onto well-defined CoDs and assessed the odds of GC assignment with a binomial logistic regression.
resultsSince 1997, Sweden has coded at least 23% of deaths to GCs each year with 25.5% coded to GCs in 2023. The lowest educated consistently received more GC deaths, with 45.8% more GC deaths relative to non-GC deaths between ages 20 and 39 compared to the highest educated, and there were more GC deaths in (1) infections, (2) blood and endocrine diseases, (3) injuries, (4) cancers, and (5) maternal, neonatal, and congenital (MNC) diseases in 2023. GC deaths among the highest educated have continued to increase in infections, injuries, cardiovascular, digestive, and MNC diseases. After redistribution, well-defined death counts among the lowest educated increased by over 20% in 13 of the leading 20 CoDs in Sweden. Our model suggested low education increased the likelihood of having a GC by 12.8% (11.4%-14.2%) compared to the highest educated. This was second to point estimates of standardized age at death (25.2% [24.8%-25.6%]) and exceeded sex (12.1% [11.4%-12.8%] increase for males) and region (at most 7.3% [6.6%-8.1%] decrease for death outside of Stockholm).
conclusionsWe found consistent trends of high GC level in Sweden with doctors assigning more GCs to the lowest educated. Our results reveal stark sociodemographic disparities in CoD coding in Sweden and it is probable that similar disparities would be found elsewhere. This underscores the need for improving procedures and national guidelines in CoD assignment to correctly represent all social groups in research.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.