Changes in the Proportion of Deaths Attributable to Ill-defined Causes in Bahrain from 2000 to 2020.

Background: 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. Objectives: 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. Methods: 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's method. Results: 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 "undetermined" or "others"). Males and those aged ≥65 years were more likely to have IDCODs. There was a strong negative correlation between IDCODs and mortality from circulatory disorders ( Conclusion: 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' and medical students' proficiency in completing death certificates and to ensure regular audits of the coding process.