When a death certificate lists more than one cause (around 80 percent of all certificates), one of these is described as the underlying cause of death. ICD-10 defines an underlying cause of death as: (a) the disease or disorder that initiates the causal chain of diseases or disorders leading directly to death (natural death); (b) the circumstances of the accident or violence causing the injury that initiated the causal chain of morbid events leading directly to death (non-natural death). If for example the death certificate lists dementia as the cause of pneumonia, then dementia is identified as underlying cause of death and included in the statistics. In another example, when a fall is indicated as the cause of a hip fracture, then the fall is identified as underlying cause of death and included in the statistics. Statistics on death causes are a form of tabulation for underlying causes of death. Statistics on causes of death are a tabulation of underlying causes of death. For an overall picture of the developments in causes of deaths, the ICD-10 blocks such as cancer or cardiovascular diseases offer general reference (in Statistics Netherlands quarterly figures). At this level, cancer is the leading cause of death. In addition, publications on specific causes of death such as lung cancer, heart attack or dementia (CBS Statline: BELDO or extensive list) offer a detailed account of mortality in the Netherlands to serve as a reference for research and policymaking. At this level, dementia is the leading cause of death in the Netherlands.
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