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# Electronic death certificates cut garbage codes in Norway's Cause of Death Registry
- URL: https://www.coios.me/electronic-death-certificates-cut-garbage-codes-in-norway-s/
- Published: 2026-10-31T11:21:43.000Z
- Updated: 2026-11-01T07:06:38.000Z
- Description: In Norwegian deaths, 2018-2023, electronic certificates were 21% less likely than paper ones to record a garbage code.
- Author: Daniel Ryan
- Tags: Data, models and systems, Revisions and new sources, Norway, #peer-reviewed, #new, #item, #source-2026-10, #score-85

The study applied modified Poisson regression to all 248 225 deaths with a registered underlying cause in Norway, 2018-2023\. Garbage codes are causes too vague or intermediate to inform prevention, defined here by the Global Burden of Disease list. Overall, 22.6% of deaths had one: 25.6% on paper and 20.1% on electronic certificates. After adjusting for sex, age and place of death, the relative risk was 0.79 (95% CI 0.78-0.80). Unspecified pneumonia (J18) and unspecified stroke (I64) fell most, while heart failure (I50) held a similar share. Results would differ under the shorter WHO list of ill-defined causes that the registry itself uses.

*Why it is interesting: Heart failure, unspecified pneumonia and unspecified stroke were among the five commonest garbage codes in Norway. Garbage codes fell from 25.6% of deaths in 2018 to 21.5% in 2023.*

Source

[BMC Public Health, 30 October 2026](https://doi.org/10.1186/s12889-026-28607-3?ref=coios.me)

Paper

The impact of transition from paper to electronic death records on garbage codes in the Norwegian Cause of Death Registry 2018-2023

Authors

Forthun I, Ellingsen CL, Baravelli CM, Sveen KA, Pedersen AG, Júlíusson PB et al.

DOI

10.1186/s12889-026-28607-3

Full text

[Open copy](https://pmc.ncbi.nlm.nih.gov/articles/PMC13721235/?ref=coios.me) (open-access copy, PubMed Central)

Type

Peer-reviewed article

Design

Register-based analysis of all deaths with a registered underlying cause in the Norwegian Cause of Death Registry, 2018-2023 (n=248,225), modified Poisson regression comparing paper vs electronic certificates adjusted for sex, age and place of death

Verdict

New finding

Driver

[Revisions and new sources](https://www.coios.me/d-data-sources/)

Free full text

[Free to read at the publisher](https://doi.org/10.1186/s12889-026-28607-3?ref=coios.me)

Abstract — the authors' own words, CC BY

Background

In 2018, electronic death certification was gradually introduced in the Norwegian Cause of Death Registry (NCoDR). Electronic certification was made mandatory from 2022\. This may have affected the use and pattern of ill-defined death codes, so-called "garbage codes", reported as the underlying cause of death. This study aimed to assess whether the transition from paper to electronic certification changed the magnitude and pattern of garbage codes in NCoDR. Methods

The analyses included all deaths with a registered underlying cause of death in the period 2018-2023 (n = 248 225). A garbage code was defined according to the definition used by the Global Burden of Disease study. Trends and patterns of garbage codes were assessed and its association with type of certificate (paper/electronic) estimated using a modified Poisson regression model estimating relative risks with 95% confidence interval (CI) adjusting for sex, age at death and place of death. Results

In the complete study period, 22.6% of the deaths were registered with a garbage code as the underlying cause of death. The probability of a garbage code was 21% lower in electronic compared to paper certificates (adjusted relative risk 0.79, 95% CI 0.78-0.80). This difference was stable over time and led to an overall decrease in the proportion of garbage codes with increasing use of electronic certifications. The decrease in garbage codes over time was mainly driven by more specific coding. The five most common garbage codes were I50 (Heart failure), J18 (Pneumonia, organism unspecified), I64 (Unspecified stroke), R96 (Other sudden death, cause unknown) and X59 (Accidental exposure to unspecified factor), accounting for more than one third of the garbage codes in the study period. The proportion of all of these, except for I50, were significantly lower in electronic compared to paper certificates, most notably so for J18 and I64\. Conclusion

The transition from paper to electronic certification led to an improvement in cause of death registration through a reduction in garbage codes, although garbage codes remain a considerable problem. An electronic system can provide guidance and feedback to the certifying physician, thereby providing opportunities for further improvement in data quality.