Prospects for a nationwide mortality registry: lessons learned from the Bremen Mortality Index

The time of death and the diseases leading to death provide important information for health research and disease registries. They facilitate conclusions about the state of health of a population and contribute to the assessment of health promotion measures as well as disease prevention and care. In many countries, these data are provided through mortality registries. In Germany, these data are available on death certificates, which must be filled out by physicians with all information available for each death. However, use of these data for research is very difficult as there is no central registry. Instead, regional health authorities archive the respective death certificates locally. Furthermore, the data provided on death certificates are partly uncoded or only available in paper form. Bremen is the only federal state that has more than 20 years of expertise with a regional mortality registry that demonstrates how health research can benefit from an efficient processing and provision cause of death (CoD) data and how this may also improve the quality of cancer registration. Currently, automatic coding of the CoD by the statistical offices is being implemented on a national level. As a consequence, the free-text information from death certificates will have to be recorded electronically. This requires organizational restructuring that offers a unique opportunity to make all the necessary provisions that are needed for the establishment of mortality registries at the federal state level. This would be an important step towards the establishment of a long overdue national mortality registry - a research data infrastructure guaranteeing international competitiveness.