Mortality from cancer in Tunisia in 2020 and death certification quality

##plugins.themes.academic_pro.article.sidebar##

Published Apr 1, 2026
https://doi.org/10.62438/tunismed.v104i02.5876
Download
PDF
Vol. 104 No. 02 (2026): Tunis Med Fev 2026

##plugins.themes.academic_pro.article.main##

Mohamed Amine Bennour
National Institute of Public Health, Tunis-Tunisia
Salsabil Rejaibi
Basic Health Care Directorate,Faculty of Medicine of Tunis, University of Tunis El Manar , Tunis,Tunisia 
Hajer Aounallah Skhiri
National Institute of Public Health,Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Faculty of Medicine of Tunis, University of Tunis El Manar , Tunis,Tunisia

Abstract

Introduction-Aim: According to the World Health Organization, cardiovascular disease and cancer figure among leading causes of death worldwide.
This aim of our study was to identify the deadliest cancers in Tunisia and to assess the quality of medical certification related to cancer deaths.
Methods: We led a descriptive observational study based on data from the national information system on causes of deaths in 2020. Were included
all medical death certificates received by the National Institute of Health and related to deaths occurring in 2020. Causes of death were coded
according to the International Classification of Diseases (ICD-10). The share of Garbage codes was determined by ANACONDA software. Data entry
and analysis, were performed by SPSS software.
Results: In total, 45420 deaths were enrolled, including 7001 deaths from cancer, representing 15.1% of all deaths. The sex ratio (Male/Female)
was to 1.7 with median age was 67 years ±0.2. The deadliest cancers were the following cancers: bronchopulmonary (22.8%), colorectal (7.9%),
breast (7.4%), prostate (5.9%), liver (4.9%) and pancreas (4.8%). The share of garbage codes was 12%, dominated by cancers with "unspecified
primary location" (6.1%), "primary cancers with multiple independent locations" (1.6%), uterine cancer of undefined location (1.3%), “cancer of the
digestive tract of undefined location” (1.2%).
Conclusion: Our study highlighted the important place of cancer among all deaths in Tunisia. We recommend training of certifying doctors on
the rules of good quality certification, and the strengthening of primary prevention by fighting against risk factors and secondary prevention by
screening and early diagnosis of cancers.

Keywords:

Cancer, Epidemiology, Tunisia, Mortality

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. World health organization. Cancer worldwide in 2020. WHO; 2022.
  2. Pierre A, Bernard-Alex G. cancer in developing countries: updates of 2019. Tropical Medecine. 2020
  3. López-Gómez M, Malmierca E, de Górgolas M, Casado E. Cancer in developing countries: the next most preventable pandemic. The global problem of cancer. Crit Rev Oncol Hematol. 2013 Oct;88(1):117-22.
  4. World Health Organization.The Global Cancer Observatory. The cancer in Tunisia in 2020 [Internet]. 2021 p. 2. Available on: https:// gco.iarc.fr/today/data/factsheets/populations/788-tunisia-fact-sheets.pdf
  5. Institut National de Santé. Statistiques nationales sur les causes des décès en Tunisie en 2020. Tunis: INSP;2021.
  6. Organisation Mondiale de la Santé. Classification internationale des maladies de 2010. Genève: OMS; 2008.
  7. Foreman K, Naghavi M, Ezzati M. Improving the usefulness of US mortality data: New methods for reclassification of underlying cause of death. Popul Health Metr.2016;14.
  8. Flagg LA, Anderson RN. Unsuitable Underlying Causes of Death for Assessing the Quality of Cause-of-death Reporting. Natl Vital Stat Rep. 2021;69(14):1-25.
  9. University of Melbourne. Guidance for assessing and interpreting the quality of mortality data using Anaconda. Melbourne: UM; 2020.
  10. Mikkelsen L, Moesgaard K, Hegnauer M, Lopez AD. ANACONDA: a new tool to improve mortality and cause of death data. BMC Med. 2020;18(1):1 13.
  11. Ishitani L, Teixeira R, Abreu D, Paixão L, França E. Garbage codes as causes of death and quality of mortality statistics in Brazil. Eur J Public Health. 2020;30(5):165 53.
  12. Lima R, Frederes A, Marinho MD, Cunha C, Adair T, et al. Investigation of garbage code deaths to improve the quality of cause-of-death in Brazil: results from a pilot study. Rev Bras Epidemiol. 2019;22(3):190 4.
  13. Institut National de Santé. Statistiques nationales sur les causes des décès en Tunisie en 2017. Tunis: INSP;2020.
  14. Department of social and economic affairs. Demographic and Social statistics. United Nations: DESA;2021.
  15. Hugo J. La mortalité du cancer à travers le monde [En ligne]. Sciences et avenir [cité le 05/03/2014] ; [environ 6 écrans]. Disponible à l’URL : https://www.sciencesetavenir.fr/sante/infographie-la- mortalite-du-cancer-a-travers-le-monde_19672.
  16. Institute for Health Metrics and Evaluation. Global Burden Disease Compare. Washington: IHME; 2022.
  17. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209 49.
  18. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374 403.
  19. Cancer Research of United Kingdom. Children’s cancer statistics. United Kingdom: Cancer Research UK;2019.
  20. Iburg KM, Mikkelsen L, Adair T, Lopez AD, Brecht. Are cause of death data fit for purpose? evidence from 20 countries at different levels of socio-economic development. PLOS ONE. 2020;15(8):237 9.
  21. Ellingsen CL, Alfsen GC, Ebbing M, Pedersen AG, Sulo G, et al. Garbage codes in the Norwegian Cause of Death Registry 1996– 2019. BMC public health. 2022; 22(1), 1-15.
  22. Houssin D, Bréchot C. Certificats de décès : passage à la certification électronique. BEH. 2007;7(5):12.
  23. Hart JD, Sorchik R, Bo KS, Chowdhury HR, Gamage S, Joshi R, et al. Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative. BMC Med. 2020;18:52.
  24. França E, Ishitani LH, Teixeira R, Duncan BB, Marinho F, Naghavi M. Changes in the quality of cause-of-death statistics in Brazil: garbage codes among registered deaths in 1996–2016. Popul Health Metr. 2020;18(1):20.