Philippines Preliminary Cause of Death (COD) Data as of 31st January 2022.

Ischemic Heart Disease, Cerebral Vascular Disease, Covid-19, and Cancer were the 4 leading COD in 2021. Unexpected decreases in some COD categories may be due to C-19 substitution for other causes.

Philippines Statistics Authority prepares Cause of Death (COD) data from the death certificates for registered deaths following the WHO ICD-10 Classification system (ICD-11 came into effect on Jan 1, 2022). The latest COD, compiling data as of 31st January 2022, was released on 29th March 2022. Cause of death was recorded for 766,126 persons, with the 4 leading causes of Ischemic Heart Diseases, Cerebrovascular diseases, Covid-19, and Neoplasm (cancer) together contributing 45% of the registered deaths out of 51 possible categories.

I compared the total COD provided with the PSA vital statistics (birth, marriage, and death) as of 31st January 2022, released on 22 February 2022, which showed 829,955 registered deaths. Total registered deaths and total COD as of the same date should match. Thus, there are 63,829 COD data points not yet reflected in this COD release, almost 10%; perhaps PSA has a backlog in data entry?

Late registrations of vital events, and late reporting from provincial and municipal centers means that compilation of substantially complete data typically takes 4 - 6 months. For reference, the 2020 Registered Deaths in the Philippines final report was released on 31st January of 2022 (13 months for compilation and finalization).

Here are the top 10 causes (8 causes prior to 2020) of death in the Philippines. Aside from Covid-19 most of these are considered lifestyle-related.

In 2021 Covid-19, virus identified contributed 74,008 deaths while Covid-19, virus not identified contributed 31,715, together accounting for 105,723 reports, or 13.8% of the total COD. Even assuming all of these C-19 attributed deaths are excess deaths is not sufficient to explain the 239,138 additional deaths in 2021.

For reference here is the Philippines 5-year historical all cause mortality data also plotted with 2020 and 2021. Note that 2020 had lower all cause mortality of -1% vs. 2019, whereas 2021 has had a 39% increase vs. 2020 in still preliminary data.

I have set out 7-year trending in COD for the top 3 leading causes, aside from Covid-19 which is a new cause, and also for the “Other Causes” category below for reference. The figures show total cases by year (bar) as well as the year-on-previous-year % change (line). The 2015-2019 years represent typical trending.

Ischemic Heart Disease (IHD) was the 1st leading cause of death being blamed for 17.8% of all deaths and nearly double the next cause Cerebrovascular diseases which contributed to 9.7%. IHD increased by 29.7% in 2021 compared to 2020, 31,294 additional deaths. Historical % year on year increases since 2015 ranged from 5.1 - 13.5%. Even aside from the staggering increase in 2021, the prior steady increase in IHD does not bode well for the country’s overall population health. Note that heart attacks are also one of the common reported Adverse Reactions from Covid-19 Vaccination. Monthly breakdown of COD data is not publicly available to assess possible increases against vaccine uptake.

Cerebrovascular diseases, often referred to as strokes, were next as the 3rd leading cause after Covid-19. Prior year on year changes ranged from -2.4 to 5%. The increase of 15.3% in 2021 is unprecedented.

The neoplasm category, 4th official cause of death, is particularly interesting. Prior to 2020 there was a general upward trend (range -0.7 to 4.7%). However, in 2020 and particularly 2021, there was a very marked drop in cases. Logically, under lockdown, this does not make sense. Lockdowns reduced movement and income for many, both reducing peoples access to medical care. This should have increased not decreased cancer deaths.

Covid-19 has been particularly dangerous for persons with poor health and multiple comorbidities. Likely there was substitution of cause, with cancer patients being recorded as Covid-19 deaths. The same case likely applies for pneumonias and respiratory tuberculosis both of which had lower reported incidence in 2020 and 2021. Notably, there were no influenza deaths recorded for 2020 and 2021.

The “Other” causes of death category, includes deaths that are not readily classified or assigned to any of the other causes. This category has increased by 60% in 2021, and more than double the 2015-2019 averages.

Breakdown of this data by month, if PSA will make this available, should help in clarifying trending and possible correlations with the ongoing public health interventions.

COD data will be updated as further information becomes available.