Civil Registry System of the Philippines (Birth and Death)

Introduction
The PSA is mandated by law to keep and preserve the birth, marriage and death certificates of a
Filipino citizen. These certificates are the bases for establishing the legal status of each and every
Filipino.
TIME COVERAGE
 Most vital records from before 1889 come from Catholic parish and diocesan archives.
 In 1889, the Spanish government created the Central Office of Statistics, which required
each parish priest to give the government a detailed list of the births, marriages, and deaths in his
area.
 After the Philippine Revolution of 1898, the church and state became separate. Within
the first few years, officials responsible for civil registration were appointed in each municipality.
 In 1930, civil registration became mandatory and, in 1932, the Bureau of Census and
Statistics was created to oversee all civil registration in the Philippines. It was not until 1940 that
most registrations began to be recorded.

CONTENT
o Births: Child’s name, birth date and place; parents’ names, residence, and occupation;
witnesses’ ages, relationships, residences.
o Marriages: Bride and groom names, ages, residences, occupations, marriage date and
place; sometimes ages and/or birth dates and places; parents' names; residences,
occupations; witnesses and officer who performed ceremony; former spouses.
o Death registers: Name of deceased, age, death date and place, occupation, name of
surviving spouse, informant’s name and residence, cause of death, sometimes birth date and
place, parents’ names, children’s names.
o Fetal deaths: Record of all stillbirths, includes information similar to birth and death data

Act No. 3753

Law on Registry of Civil Status

Section 1. Civil Register. – A civil register is established for recording the civil status of persons, in
which shall be entered: (a) births; (b) deaths; (c) marriages; (d) annulments of marriages; (e)
divorces; (f) legitimations; (g) adoptions; (h) acknowledgment of natural children; (i) naturalization;
and (j) changes of name.

Section 2. Civil Registrar-General his duties and powers. – The director of the National Library shall
be Civil Registrar-General and shall enforce the provisions of this Act. The Director of the National
Library, in his capacity as Civil Registrar-General, is hereby authorized to prepare and issue, with the
approval of the Secretary of Justice, regulations for carrying out the purposes of this Act, and to
prepare and order printed the necessary forms for its proper compliance. In the exercise of his
functions as Civil Registrar-General, the Director of the National Library shall have the power to give
orders and instructions to the local Civil registrars with reference to the performance of their duties as
such. It shall be the duty of the Director of the National Library to report any violation of the provisions
of this Act and all irregularities, negligence or incompetency on the part of the officers designated as
local civil registrars to the (Chief of the Executive Bureau or the Director of the Non-Christian Tribes)
Secretary of the Interior, as the case may be, who shall take the proper disciplinary action against the
offenders.

Section 3. Local Civil Registrars. – Except in the City of Manila, where the duties of local civil registrar
shall be performed by the officer of the Philippine Health Service designated by the Director of said
service, the Treasurers of the regular municipalities, municipal districts and cities shall be local civil
registrars of the respective municipalities, municipal districts or cities and shall perform the duties
imposed upon them by this Act without extra compensation, in addition to their ordinary duties. In his
capacity as local civil registrar, the officer designated by the Director of the Health Service as local
civil registrar of Manila and the treasurers above mentioned shall be under the direction and
supervision of the Civil Registrar-General.

Section 4. Civil Register Books. – The local registrars shall keep and preserve in their offices the
following books, in which they shall, respectively make the proper entries concerning the civil status
of persons:

1. Birth and death register;

2. Marriage register, in which shall be entered not only the marriages solemnized but also divorces
and dissolved marriages.
3. Legitimation, acknowledgment, adoption, change of name and naturalization register.
Section 5. Registration and Certification of Birth. – The declaration of the physician or midwife in
attendance at the birth or, in default thereof, the declaration of either parent of the newborn child,
shall be sufficient for the registration of a birth in the civil register. Such declaration shall be exempt
from the documentary stamp tax and shall be sent to the local civil registrar not later than thirty days
after the birth, by the physician, or midwife in attendance at the birth or by either parent of the newly
born child.
In such declaration, the persons above mentioned shall certify to the following facts: (a) date and hour
of birth; (b) sex and nationality of infant; (c) names, citizenship, and religion of parents or, in case the
father is not known, of the mother alone; (d) civil status of parents; (e) place where the infant was
born; (f) and such other data may be required in the regulation to be issued.

In the case of an exposed child, the person who found the same shall report to the local civil registrar
the place, date and hour of finding and other attendant circumstances.
In case of an illegitimate child, the birth certificate shall be signed and sworn to jointly by the parents
of the infant or only the mother if the father refuses. In the latter case, it shall not be permissible to
state or reveal in the document the name of the father who refuses to acknowledge the child, or to
give therein any information by which such father could be identified.
Any fetus having human features which dies after twenty four hours of existence completely
disengaged from the maternal womb shall be entered in the proper registers as having been born and
having died.
Section 6. Death certificate and register. – No human body shall be buried unless the proper death
certificate has been presented and recorded in the office of the local civil registrar. The physician who
attended the deceased or, in his default the health officer concerned, or in default of the latter, any
member of the family of the deceased or any person having knowledge of the death, shall report the
same to the local health authorities, who shall issue a death certificate and shall order the same to be
recorded in the office of the local civil registrar. The death certificate, which shall be issued by the
attending physician of the deceased or, in his default, by the proper health officer, shall contain the
following data be furnished by the person reporting the death; (a) date and place of death; (b) full
name, (c) age, (d) sex, (e) occupation or profession, (f) residence; (g) status as regards marriage, (h)
nationality of the deceased, and (i) probable cause of death.

During epidemics, bodies may be buried provided the proper death certificates have been secured,
which shall be registered not later than five days after the burial of the body.

Section 7. Registration of marriages. – All civil officers and priests or ministers authorized to
solemnize marriages shall send a copy of each marriage contract solemnized by them to the local
civil registrar within the time limit specified in the existing Marriage Law.

In cases of divorce and annulment of marriage, it shall be the duty of the successful petitioner for
divorce or annulment of marriage to send a copy of the final decree of the court to that local civil
registrar of the municipality where the dissolved or annulled marriage was solemnized.
In the marriage register there shall be entered the full name and address of each of the contracting
parties, their ages, the place and date of the solemnization of the marriage, the names and addresses
of the witnesses, the full name, address, and relationship of the minor contracting party or parties or
the person or persons who gave their consent to the marriage, and the full name, title, and address of
the person who solemnized the marriage.
In cases of divorce or annulment of marriages, there shall be recorded the names of the parties
divorced or whose marriage was annulled, the date of the decree of the court, and such other details
as the regulations to be issued may require.

Section 8. Registration of legitimations by subsequent marriage. – The acknowledgment of the

children legitimated by subsequent marriage, referred to in article one hundred and twenty-one of the
Civil Code, may be recorded in the legitimation register, entering: (a) The names of the parents; (b)
that at the time when the children were conceived, the aforesaid parents could have contracted
marriage, and that they actually contracted marriage, stating the date and place when such marriage
was solemnized, the minister who officiated, and the civil register where such marriage was recorded;
(c) the names of the children legitimated with reference to their birth certificates.

Section 9. Registration of acknowledgment by public instrument. – Any voluntary acknowledgment by

the natural parents or by only one of them by public instrument, shall be recorded in the
acknowledgment register of the civil registrar of the municipality where the decree was issued. The
names of the interested parties and such other data as may be required by the regulations to be
issued shall be entered in register.
It shall be the duty of the natural parents whose voluntary acknowledgment was may be means of a
public instrument to send a certified copy thereof to the local civil registrar of the municipality in the
civil register whereof the birth of the acknowledged child was recorded, not later than twenty days
after the execution of such instrument, for the registration thereof.
Section 10. Registrations of adoptions, changes of name, and naturalization. – In cases of adoptions,
changes of name, and naturalization, it shall be the duty of the interested parties or petitioners to
register the same in the local civil registrar of the municipality where the birth of the acknowledged
child was registered setting forth the following data: (a) full name of the natural child acknowledged;
(b) age; (c) date and place of birth; (d) status as to marriage, and residence of the child
acknowledged; (e) full name of the natural father or mother who makes the acknowledgment; (f) full
name of the notary public before whom the document was acknowledged; (g) full names of witnesses
to document; (h) date and place of acknowledgment of said document and entry and page number of
the notarial register in which the name was recorded.

Section 11. Duties of clerks of Court to register certain decisions. – In cases of legitimation,
acknowledgment, adoption, naturalization and change of given or family name, or both, upon the
decree which issued the decree to ascertain whether the same has been registered, and if this has
not been done, to have said decree recorded in the office of the civil registrar of the municipality
where the court is functioning.

Section 12. Duties of local civil registrar. – Local civil registrars shall (a) file registrable certificates and
documents presented to them for entry; (b) complete the same monthly and prepare and send any
information required of them by the Civil Registrar-General; (c) issue certified transcripts or copies of
any certificate or document registered upon payment of proper fees; (d) order the binding, properly
classified, of all certificates or documents registered during the year; (e) send to the Civil Registrar-
General, during the first ten days of each month, a copy of the entries made during the preceding
month for filing; (f) index the same to facilitate search and identification in case any information is
required, and (g) administer oaths, free of charge, for civil register purposes.

Section 13. Documents registered are public documents. – The books making up the civil register and
all documents relating thereto shall be considered public documents and be prima facie evidence of
the truth of the facts therein contained. They shall be open to the public during office hours and shall
be kept in a suitable safe which shall be furnished to the local civil registrar at the expense of the
general fund of the municipality concerned. The local registrar shall not under any circumstances
permit any document entrusted to his care to be removed from his office, except by order of a court,
in which case the proper receipt shall be taken. The local civil registrar may issue certified copies of
any document filed, upon payment of the proper fees required in this Act.

Section 14. Expenses and fees of the office of the civil registrar. – All expenses in connection with the
establishment of local civil registers shall be paid out of municipal funds, and for this purpose,
municipal councils and boards shall make the necessary appropriation out of their available general
funds:

For the registration of documents and for certified copies of documents on file in the local civil
registrar’s office, fees shall be charged in accordance with the following schedule:
For registration of legitimations P2.00
For registration of an adoption 2.00
For registration of an annulment of marriage 10.00
For registration of a divorce 10.00
For registration of naturalization 20.00
For registration of a change of name 2.00
For certified copies of any documents in the register, for each one hundred words 20.00
The Civil Registrar General or any local civil registrar may issue certified copies of documents free of
charge for official use or at the request of a competent court. All fees collected for such purposes
shall accrue to the general fund of the municipality concerned.

Section 15. Preservation of present register books. – All birth, death and marriage registers and other
papers relating thereto at present in the keeping of the municipal secretaries or the clerk of the
Municipal Court of Manila shall be transferred by the same to the officers acting as local civil
registrars in each city or municipality and shall form part of the archives of the latter.

Section 16. False statement. – Any person who shall knowingly make false statement in the forms
furnished and shall present the same for entry in the civil register, shall be punished by imprisonment
for not less than one month nor more than six months, or by a fine of not less than two hundred pesos
nor more than five hundred or both, in the discretion of the court.

Section 17. Failure to report. – Other violations. – Any person whose duty is to report any fact
concerning the civil status of persons and who knowingly fails to perform such duty, and any person
convicted of having violated any of the provisions of this Act shall be punished by a fine of not less
than ten pesos nor more than two hundred.

Section 18. Neglect of duty with reference to the provisions of this Act. – Any local registrar who fails
properly to perform his duties in accordance with the provisions of this Act and of the regulations
issued hereunder, shall be punished for the first offense, by an administrative fine in a sum equal to
his salary for not less than fifteen days nor more than three months, and for a second or repeated
offense, by removal from the service.

Section 19. Application of this Act to the special provinces. – The Director of the National Library, in
his capacity as Civil Registrar-General, is hereby authorized upon recommendation of the (Director of
Bureau of Non-Christian Tribes) Secretary of the Interior, to designate the municipalities in the
specially organized provinces where the provisions of this Act shall be applied.

Section 20. Transitory provisions. – All rights, duties and powers established by Act Numbered thirty-
six hundred and thirteen, entitled the Marriage Law, with the reference to the procedure for the
issuance of the marriage license prior to the solemnization of marriage, the registration, of marriages,
and the filing of the documents in connection therewith, conferred and imposed by said Act upon the
clerk of the Municipal Court of Manila and the municipal secretaries, are hereby transferred to the
officer of the Health Service in accordance with section three of this Act, and to the municipal
treasurers, respectively, in their capacity as local registrars.

All duties and powers established by subsections (d) and (e) of section twenty-one hundred and
twelve of the Administrative Code, imposed and conferred by said section upon the municipal
secretaries, are hereby likewise transferred to the municipal treasurers in their capacity as local civil
registrars.

Section 21. All acts or parts of acts inconsistent herewith are hereby repealed.

Section 22. This Act shall take effect three months after its approval.

Approved, November 26, 1930.

 Requesting for a Civil Registry Document
This section provides information about civil registry documents that can be obtained from the
Philippine Statistics Authority (PSA). These include birth certificate, marriage certificate, death
certificate, and Certificate of No Marriage (CENOMAR). This section further discusses in detail the
requirements and procedures in securing copies of these documents.

EXAMPLE OF BIRTH CERTIFICATE

EXAMPLE OF DEATH CERTIFICATE:
Births in the Philippines, 2018

Reference Number: 
2019-230

Release Date: 
Friday, December 27, 2019

In 2018, a total of 1,668,120 live births were registered, which is equivalent to a crude birth rate
(CBR) of 15.8 or 16 births per thousand population.

The number of registered live births showed a decreasing trend, noticeably from 2012 to 2018. The
decrease in the last six years was 6.8 percent, from 1,790,367 live births in 2012 to 1,668,120
recorded births in 2018. (See Figure 1 and Table 1)

On the average, there were about 4,570 babies born daily or about 190 babies born per hour or
approximately three babies born per minute.

More males born than females

More males (870,832 or 52.2%) were born than females (797,288 or 47.8%), which resulted in a sex
ratio at birth of 109 males per 100 females.
(See Figure 2 and Table 2)
 

Highest occurrence of births in NCR

Of the total live births, 58.4 percent were born in Luzon, 18.5 percent in Visayas and 23.0 percent in
Mindanao. Among the regions of the country, the National Capital Region (NCR) recorded the highest
number of birth occurrences with 14.3 percent. Second in rank was CALABARZON (13.8%) and the
third was Central Luzon (11.3%).
(See Figure 3 and Table 2)

More babies born outside the usual residence of the mother

The difference between the place of birth by occurrence and place of birth by usual residence of the
mother by region is shown in the last column of Table 2. Five out of the 17 regions reported positive
differentials in the number of births by place of occurrence. These positive differentials may be
indicative of expectant mothers giving birth outside of their usual place of residence due to better
health care facilities and social services in the receiving region.  In Luzon, the receiving region was
NCR which accounted for 22,210 births. Notably, expectant mothers from CALABARZON, Central
Luzon and other areas in Luzon preferred to give birth in NCR.
Most number of births in September
In 2018, most births occurred in September with 156,820 (9.4%) of the total births in the country. It
was followed by the months of October (9.3%), November (8.9%), and December (8.8%). The month
of February had the least number of births in 2018 (see Figure 4).

Nine in ten birth deliveries are medically attended

Of the total number of births in the country, 94.3 percent birth deliveries were attended by health
professionals which may either be a physician, a midwife or a nurse.  
(See Figure 5, Tables 3a, 3b and 3c)
The number of births by place of occurrence and by usual residence of mother showed a remarkable
proportion on births attended by health professionals in 16 regions. This is indicative of improving
health services in terms of maternal and child health care. Among regions, only Autonomous Region
in Muslim Mindanao (ARMM) showed a very low proportion of medically attended births. Almost half
of the births that occurred in the region were attended by traditional birth attendants (hilot/unlicensed
midwife). (See Tables 3a, 3b and 3c)

More than half of babies born to unwed mothers

More than half (906,106 or 54.3%) of the total registered live births in 2018 were born out of wedlock.
The three regions that recorded the highest number of illegitimate children based on usual residence
of the mother were CALABARZON (146,366), NCR (142,702), and Central Luzon (102,766). (See
Figure 6 and Table 4)

The proportion of illegitimate babies in 11 regions of the country, were more than half of its total
births. On the other hand, ARMM expectedly had the greatest number of legitimate births.
The customs and traditions, rites and practices on marriage of Muslim communities has contributed to
the high number of legitimate children in ARMM.

Majority of babies born to mothers aged 20-24 years old 

Majority of births were born to mothers aged 20-24 (454,648 or 27.3%) and to fathers aged 25-29
(411,606 or 24.7%). Moreover, babies born to adolescent mothers (183,967) were more than those
babies sired by adolescent fathers (50,194). (See Figure 7 and Table 5)

The median age of mothers was 27 and for fathers was 29 years old. The median age of father
excludes information from births where paternity is not acknowledged.

  

Explanatory Notes
Data on births presented in this release were obtained from the Certificates of Live Birth (Municipal
Form No. 102) that were registered at the Office of the City/Municipal Civil Registrars all throughout
the country and forwarded to the Philippine Statistics Authority. Information presented include
registered births which occurred from January to December 2018. Cumulative figures for 2018 reflect
updated data received from previous months and may differ from preliminary counts previously
published. Births of Filipinos that occurred abroad which were reported to the Philippine Foreign
Service Posts are presented in a separate report.
 Registered Deaths in the Philippines, 2017
Reference Number: 2019-096
Release Date: 10 June 2019
Reported deaths in 2017 reached 579,237, a decrease of 0.5 percent than the previous year’s
582,183 deaths. This is equivalent to a crude death rate (CDR) of 5.5, or about six (6) persons per
thousand population. In 2017, an average of 1,587 persons died daily. This translates to 66 deaths
per hour or one (1) per minute.
The number of deaths from 2008 to 2016 showed an increasing trend but slightly declined in 2017.
The increase during the ten-year period is about a quarter, or 25.5 percent, from 461,581 in 2008 to
579,237 in 2017. (Figure 1 and Table 1).

Highest number of deaths in CALABARZON

The top three regions in terms of number of deaths by usual residence were found in Luzon:
CALABARZON with 84,971 or 14.7 percent, followed by NCR with 75,187 or 13.0 percent then
Central Luzon with 67,980 or 11.7 percent.  The combined share of these three regions was 39.4
percent of the total deaths.
 
On the other hand, the three regions which had the least number of deaths were ARMM (3,036 or
0.5%), CAR (8,176 or 1.4%) and Caraga (14,928 or 2.6%). These numbers accounted for only 4.5
percent of the total deaths in the country (Figure 2 and Table 2).
  
Most number of deaths in August
The month of August recorded the highest number of deaths with 51,154 or 8.8 percent, while
February had the least number with 44,765 or 7.7 percent share of the total deaths. 
Daily Index is the increase/decrease from the overall daily average of event occurrences.  In 2017,
the months of March to July fall below the national daily index of 100.0 (Figure 3 and Table 3).

 
More deaths in males than females
In 2017, the number of deaths in males (332,517) was higher than deaths in females (246,720). This
translates to a sex ratio of 135, which means that there are 135 male deaths for every 100 female
deaths (Table 4).
Figure 4 shows the age and sex pattern of death in 2017. It reflects an inverted pyramid, with fewer
deaths at the younger ages, except for children under one, and progressively increasing as people
age.  As in most parts of the world, males are more likely to die before females at all ages. In the
Philippines, it is clearly shown that males died at a higher rate than females before reaching the age
of 80 years, with the greatest difference observed at ages 60 to 64 years (15,362 deaths). Higher
proportions of female deaths were observed in the older age groups, which is indicative of higher
survival rate of females than males.

 
 Six out of ten deaths not attended
Attendant refers to a medical doctor or any other allied health care provider who provided medical
attendance to the deceased.
Out of 579,237 registered deaths, about half or 292,098 were not attended. Seven regions namely:
NCR (63.4%), CALABARZON (55.4%), CAR (51.7%), Western Visayas (51.5%), Northern Mindanao
(51.0%), ARMM (50.7%) and Caraga (50.1%) had more medically attended deaths than those not
attended by any health care provider (Figure 5 and Table 5).

 
Highest number of infant deaths in CALABARZON
Infant deaths are deaths that occurred before reaching age 1. At the national level, 20,311 infant
deaths were registered in 2017. Six out of ten deaths were males (11,760 or 57.9%). The top three
regions that registered high infant deaths were CALABARZON with 3,546 (17.5%), NCR with 3,357
(16.5%) and Central Luzon with 2,314 (11.4%).
On the other hand, ARMM (193 or 1.0%), CAR (205 or 1.0%) and Caraga (386 or 1.9%) had the least
number of registered infant deaths (Figure 6 and Table 6).

 
High maternal deaths in CALABARZON
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the
pregnancy or its management but not from accidental or incidental causes.  In 2017, there were 1,484
registered maternal deaths in the country.
Among all regions, CALABARZON recorded the biggest number of maternal deaths with 222 or 15.0
percent of the total, followed by NCR with 195 or 13.1 percent, and Central Visayas with 164 or 11.1
percent. On the other hand, CAR recorded the least number of maternal deaths with only 13 or 0.9
percent of the total (Figure 7 and Table 7).

 
Most deaths due to ischemic heart diseases
Figure 8 shows the ten leading causes of death in 2017.  It can be seen that among the total deaths,
ischemic heart diseases were the leading causes of death with 84,120 or 14.5 percent. Second were
neoplasms which are commonly known as “cancer” with 64,125 or 11.1 percent, followed by
cerebrovascular diseases with 59,774 or 10.3 percent (Table 8).
Among males, ischemic heart diseases were also the leading causes of death with 50,503 or 15.2
percent followed by cerebrovascular diseases (33,610 or 10.1%) and neoplasms (30,800 or 9.3%). It
was also observed that assault was included in the 10 leading causes of death with 10,866 or 3.3
percent of the total deaths in males.  On the other hand, similar to males, the top cause of death
among females was also ischemic heart disease (33,617 or 13.6%), followed by neoplasm with
33,325 or 13.5 percent and pneumonia with 28,835 or 11.7 percent of the total deaths in females
(Table 8).
 Explanatory Notes
Data on deaths presented in this release were obtained from the Certificates of Death (Municipal
Form No. 103) that were registered at the Office of the City/Municipal Civil Registrars all throughout
the country and forwarded to the Philippine Statistics Authority. Information presented includes
registered deaths which occurred from January to December 2017. Figures presented are not
adjusted for under registration. 
 
TECHNICAL NOTE
PSA IMPLEMENTATION OF IRIS SOFTWARE: UNDERSTANDING CODING AND PROCESS
IMPROVEMENTS
In 2017 the Philippines Statistical Authority (PSA) implemented Iris, an automated software program
which assigns codes from the International Classification of Diseases 10th Revision (ICD-10) to death
records, and assists in the selection of an underlying cause of death. This replaces the previous
process where mortality coding rules were applied manually.
The implementation of Iris has enabled the PSA to update mortality coding processes and mortality
statistical outputs, bringing the coding of Philippines mortality data up to date with international best
practice.
The Iris implementation project is part of a large-scale initiative the Government of Philippines has
undertaken with the Bloomberg Philanthropies Data for Health/Vital Strategies initiative to improve
civil registration and vital statistics in the Philippines. As part of this project a number of initiatives
have been undertaken which relate directly to death certification, registration and data analytics.
These initiatives include:
• Courses in medical certification for doctors across major hospitals in the Philippines;
• Campaigns to improve death registration rates;
• Training in medical certification for cause of death coders and data analysts; and
• Training in ICD-10 coding rules as governed by the World Health Organization.
The move to Iris, alongside the additional CRVS initiatives being undertaken in the Philippines all
have the potential to impact statistical outputs. It should be noted that updates applied to the ICD-10
are regulated by the World Health Organization (WHO) and are adopted only where they enhance
accuracy or reflect improved medical understanding. To that end the changes in this issue will
improve the quality of the Philippines’ mortality dataset.
The purpose of this Technical Note is to provide a summary of changes that have occurred as a
result of software and coding updates. This technical note provides a resource for data users to
understand where changes have occurred within the dataset and the impact of those changes moving
forward.
PSA INVESTIGATIONS INTO IRIS
PSA investigations into Iris were conducted throughout 2016 and 2017. A key element of these
investigations was a dual coding exercise conducted where records were coded through Iris and
manually. Approximately 200,000 records from the 2016 and 2017 reference year were processed
through both techniques (Iris and manual) with outputs being analyzed thoroughly. Results showed
that Iris would provide a strong platform for future auto coding and enable best practice in mortality
coding and statistical output to be sustained. The Iris software is language independent, and as such
 is being used extensively around the world. Updates made to ICD-10 by the WHO are rapidly
implemented in Iris, meaning that cause of death coding practices and statistical outputs will remain
up to date.
KEY CHANGES IN OUTPUT DUE TO IRIS IMPLEMENTATION
The PSA is committed to communicating to data users how Iris has changed statistical output. This
technical note will assist users in understanding what may be a legitimate change in disease process
as opposed to administrative by-products of recent changes to the death certification, registration and
analytical system.
The PSA annually publishes the leading causes of death in the Philippines, with output based on
Mortality Tabulation List 1 of the ICD-10 of suggested statistical outputs. The following analysis will be
based on this leading cause of death tabulation. For details on other changes to coding and statistical
output please contact the PSA-VSD.
LEADING CAUSES OF DEATH, 2017
The leading cause of death in 2017 in the Philippines was ischemic heart disease, followed by
neoplasms and cerebrovascular diseases (see table below). Although the ischemic heart diseases
were the leading cause of death in 2016, the numerical change is statistically significant.

LEADING CAUSES OF DEATH – TIME SERIES WITH NUMBER

Cause of Death 2013 2014 2015 2016 2017

Ischaemic heart diseases 65,378 65,551 68,572 74,134 84,120

Neoplasms 53,601 55,588 58,715 60,470 64,125

Cerebrovascular diseases 54,578 52,894 58,310 56,938 59,774

Pneumonia 53,101 53,689 49,595 57,809 57,210

Diabetes Mellitus 27,064 31,539 34,050 33,295 30,932

Hypertensive diseases 29,067 34,902 34,506 33,452 26,471

Chronic lower respiratory infections 23,867 24,686 23,760 24,365 24,818

Respiratory Tuberculosis 22,013 23,157 24,644 24,462 22,523

Other heart diseases 33,027 34,141 31,729 28,641 22,134

Remainder of the diseases of the genitourinary system 16,785 17,220 18,061 19,759 15,717

 
 A key coding change with the introduction of Iris has been in regards to ischemic heart disease and
hypertension. Prior practice based on local coding rules was to combine hypertension and ischaemic
heart diseases into a hypertensive heart disease regardless of placement of the two diseases on the
death certificate. With the implementation of Iris, ischaemic heart disease is retained as the
underlying cause of death in many of these cases, meaning the number of deaths coded to I20-I25
(ischemic heart diseases) has increased and the number of deaths coded to hypertensive diseases
(I10-I15) has decreased.
In addition to ischemic heart diseases, hypertensive diseases have also been reallocated to
cerebrovascular diseases with the implementation of Iris. Hypertension is a key risk factor for strokes,
especially those of hemorrhagic etiology, and there has been an increase in these conditions (I60-
I62) under the new coding model.
Tuberculosis has decreased as an underlying cause of death under the implementation of Iris. There
is a tendency to select tuberculosis as the underlying cause of death regardless of position placement
on the death certificate under the former manual coding rules. This has now changed and the
tuberculosis must legitimately have initiated the train of morbid events leading to death to be assigned
as the underlying cause of death. It is also acknowledged that the Department of Health (DOH) have
implemented many prevention and intervention campaigns targeted at tuberculosis in recent years.
This may also have legitimately reduced number of deaths due to tuberculosis. As the administrative
and real-world changes are difficult to separate, caution should be taken when interpreting time series
data for tuberculosis.
 

LEADING CAUSES OF DEATH – TIME SERIES WITH RATES

Cause of Death 2013 2014 2015 2016 2017

Ischaemic heart diseases 66.6 65.6 67.5 71.8 80.2

Neoplasms 54.6 55.7 57.8 58.6 61.1

Cerebrovascular diseases 55.6 53.0 57.4 55.1 57.0

Pneumonia 54.1 53.8 48.8 56.0 54.5

Diabetes Mellitus 27.6 31.6 33.5 32.2 29.5

Hypertensive diseases 29.6 34.9 34.0 32.4 25.2

Chronic lower respiratory infections 24.3 24.7 23.4 23.6 23.7

Respiratory tuberculosis 22.4 23.2 24.3 23.7 21.5

Other heart diseases 33.6 34.2 31.2 27.7 21.1

Remainder of diseases of the genitourinary system  17.1 17.2 17.8 19.1 15.0
 LEADING CAUSES OF DEATH, 2017, BY STANDARDIZED DEATH RATE
The prior analysis of change is based on numerical differences over a time series seen in the PSA
data. To assess the impact of change at a population level data should be presented as a death rate.
A death rate provides a number of deaths as expected per 100,000 density in a population and helps
take into account changes in population numbers and age structure of time. The table below shows
the top 10 causes of death in the Philippines over the last 5 years as standardized death rates.
 
When presented as death rates, we can see that the proportional changes from 2016 to 2017 are not
as large as suggested by numerical changes in the first table. It is recommended that policy makers
and researchers use rates in conjunction with numbers of deaths to provide context to an area of
interest.
OTHER NOTABLE AREAS OF CHANGE WITH THE IRIS IMPLEMENTATION
Although the focus of this technical note has been on the leading causes of death in the Philippines in
2017 there are general areas of change which should be highlighted in order to demonstrate the
higher level of quality in statistical output for causes of death with this release.  Notable changes are
discussed below:
Decrease in specified causes of death considered “direct”: There has been a decrease in deaths due
to cardiac arrest and respiratory failure as the underlying cause of death in Iris. These conditions are
considered ill-defined and do not indicate where health funding and intervention should be targeted.
These deaths are now coded to more specific diseases appearing on the death certificate.
Improved identification of primary and secondary cancers: There has been an increase in cancers of
unknown primary cause with the implementation of Iris. This is due to an improved ability to identify
secondary cancers and code them accordingly. Under previous rules, cancers were generally
assumed to be primary in the majority of cases leading to an over-count of particular cancer types.
More consistent distribution of deaths due to external causes: Under prior coding rules there was a
lack of internal business rules on how to code the intent (i.e. accident, suicide, homicide) of deaths
due to injury where no intent was stated by the certifier. A set of business rules have been
implemented as part of the Iris project and there is greater consistency in the output for external
causes of death.
MOVING FORWARD
The PSA remains committed to maximizing the relevance and usability of mortality data in the
Philippines, ensuring alignment with international best practice for mortality coding and maintaining
international comparability. To that end, this project will also instigate changes and improvements in
statistical output for causes of death in the Philippines.
 

REFERENCES
1. Category:Philippines Vital Records
2. https://psa.gov.ph/civilregistration/requesting-civil-registry-document
3. https://psa.gov.ph/content/births-philippines-2018