The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.Letter from Karen Dunnell, dated April 2009:"As National Statistician, I have been asked to reply to your recent questions asking:""(1) How many death certificates mentioning thrombosis have been issued in each of the last five years. (271404)""(2) How many death certificates mentioning arteriosclerosis have been issued in each of the last five years. (271405)""(3) How many death certificates mentioning gout have been issued in each of the last five years. (271406)""(4) How many death certificates mentioning prostate cancer have been issued in each of the last five years. (271407)""(5) How many death certificates mentioning osteoarthritis have been issued in each of the last five years. (271408)""(6) How many death certificates mentioning sleep apnoea have been issued in each of the last five years. (271409)""(7) How many death certificates mentioning (a) Type 1 diabetes and (b) Type 2 diabetes have been issued in each of the last five years. (271410)""(8) How many death certificates mentioning high blood pressure have been issued in each of the last five years. (271411)""Internationally accepted guidance from the World Health Organisation requires only those conditions that contributed directly to death to be recorded on the death certificate. Medical practitioners and coroners are not supposed to record all of the diseases or conditions present at or before death. Whether a condition contributed is a matter for their clinical judgement.""The table attached provides the number of deaths where the International Classification of Diseases, Tenth Revision (ICD-10) codes recorded indicate whether any of the following conditions were mentioned anywhere on the death certificate, either as the underlying cause or as a contributory factor, in England and Wales, for 2003 to 2007 (the latest year available).""(1) Thrombosis""(a) Myocardial infarction and coronary thrombosis""(b) Thrombotic Strokes""(c) Pulmonary embolism and deep vein thrombosis""(d) Arterial embolism and thrombosis""(2) Arteriosclerosis""(a) Strokes specifying embolism, thrombosis or and narrowing or occlusion of arteries""(b) Other and unspecified strokes""(c) Ischaemic heart diseases""(d) Atherosclerosis""(3) Gout""(4) Prostate cancer""(5) Arthrosis (osteoarthritis)""(6) Sleep apnoea""(7) Diabetes""(a) Type I diabetes""(b) Type II diabetes""(c) Unspecified diabetes""8) Hypertensive diseases""It is not possible from death certificate data to separate thrombotic, embolic and atherosclerotic conditions affecting the arteries to the brain. Atherosclerosis of arteries in the neck and inside the skull can lead to strokes through thrombosis, embolism or sometimes haemorrhage. The table therefore includes a single category of deaths with mention of one or more ICD codes in the range that includes thrombotic, embolic and atherosclerotic cerebrovascular diseases. Pulmonary embolism and venous thrombosis have been combined, because when one is part of the sequence leading to death, the other nearly always is as well, whether it is mentioned on the certificate or not.""Arteriosclerosis can affect any artery in the body, including those supplying the brain, the heart and all other vital organs. Whether the term used is arteriosclerosis, coronary or ischaemic heart disease, the medical condition is virtually the same - lack of oxygenated blood (ischaemia) to the heart muscle because of atherosclerosis (narrowing and stiffening) of the coronary arteries. This clinical category is represented by the ICD-10 code range 120-125. The whole range has been used to count deaths with any mention of atherosclerotic/ischaemic/coronary heart disease in the attached table.""Type I and Type II diabetes are distinct clinical entities, which are easily identified and tabulated from death certificates using ICD codes. However, the type of diabetes is not always accurately recorded on the death certificate. Therefore, ICD codes have been used to tabulate death certificate mentions of diabetes specified as Type I or Type II, and also those where the type has not been specified.""When interpreting the data in these tables, it is important to be aware that many deaths will have more than one of the requested conditions mentioned. Thrombosis of the coronary arteries in the heart is one of the steps in a heart attack; thrombosis of cerebral arteries may cause a stroke. In both these cases, atherosclerotic narrowing of the arteries will usually have led to the thrombosis. Therefore, many deaths will be represented in more than one of the causes listed." Table 1. Deaths where certain named causes were mentioned on the death certificate¹, England and Wales², 2003 to 2007³ Deaths (persons) Cause of death 2003 2004 2005 2006 2007 Thrombosis Myocardial infarction and coronary thrombosis 48,569 44,283 41,446 38,159 36,152 Thrombotic strokes 598 505 457 385 301 Pulmonary embolism and deep vein thrombosis 18,496 17,016 16,720 17,188 16,670 Arterial embolism and thrombosis 532 517 518 517 501 Arteriosclerosis Strokes specifying embolism, thrombosis or and narrowing or occlusion of arteries 8,182 7,440 7,240 7,002 6,628 Other and unspecified strokes 63,198 58,468 56,530 54,560 53,081 Ischaemic heart diseases 133,350 126,161 122,837 117,475 115,586 Atherosclerosis 7,649 6,944 6,471 6,238 5,874 Gout 140 132 153 119 112 Prostate cancer 12,397 12,425 12,296 12,474 12,860 Arthrosis (osteoarthritis) 1,079 996 930 958 1,013 Sleep apnoea 111 116 152 142 167 Diabetes Type I 1,496 1,314 1,193 1,193 1,184 Type II 6,180 6,424 7,090 7,949 9,954 Unspecified 19,466 19,018 19,765 19,730 19,368 Hypertensive diseases 26,098 26,692 28,837 30,796 33,054 ¹ Cause of death was defined using the International Classification of Diseases, Tenth Revision (ICD-10). The specific causes of death categorised in Table 1, and their corresponding ICD-10 codes, are shown in the following box. Deaths were included where one of these causes was mentioned anywhere on the death certificate. ² Figures for England and Wales include deaths of non-residents. ³ Figures are for deaths registered in each calendar year. Box 1, Causes of death codes used—International Classification of Diseases, Tenth Revision (ICD-10) Cause of death ICD-10 code(s) Thrombosis Myocardial infarction and coronary thrombosis 121-124.0 Thrombotic strokes 163.0, 163.3, 163.6, 165-166 Pulmonary embolism and deep vein thrombosis 180.1-180.3, 180.9, 182.9, 126.0, 126.9 Arterial embolism and thrombosis 174 Arteriosclerosis Strokes specifying embolism, thrombosis or and narrowing or occlusion of arteries 163, 165-166 Other and unspecified strokes 164, 167-169 Ischaemic heart diseases 120-125 Atherosclerosis 170 Gout M10 Prostate cancer C61 Arthrosis (osteoarthritis) M15-M19 Sleep apnoea G47.3 Diabetes Type I E10 Type II E11 Unspecified E14 Hypertensive diseases 110-115