This dataset presents the age-adjusted death rates for the 10 leading causes of death in the United States beginning in 1999. Data are based on information from all resident death certificates filed in the 50 states and the District of Columbia using demographic and medical characteristics. Age-adjusted death rates (per 100,000 population) are based on the 2000 U.S. standard population. Populations used for computing death rates after 2010 are postcensal estimates based on the 2010 census, estimated as of July 1, 2010. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for non-census years before 2010 are revised using updated intercensal population estimates and may differ from rates previously published. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause of death statistics are based on the underlying cause of death. SOURCES CDC/NCHS, National Vital Statistics System, mortality data (see http://www.cdc.gov/nchs/deaths.htm); and CDC WONDER (see http://wonder.cdc.gov). REFERENCES National Center for Health Statistics. Vital statistics data available. Mortality multiple cause files. Hyattsville, MD: National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. Murphy SL, Xu JQ, Kochanek KD, Curtin SC, and Arias E. Deaths: Final data for 2015. National vital statistics reports; vol 66. no. 6. Hyattsville, MD: National Center for Health Statistics. 2017. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_06.pdf.

This dataset contains information on the number of deaths and age-adjusted death rates for the five leading causes of death in 1900, 1950, and 2000. Age-adjusted death rates (deaths per 100,000) after 1998 are calculated based on the 2000 U.S. standard population. Populations used for computing death rates for 2011–2017 are postcensal estimates based on the 2010 census, estimated as of July 1, 2010. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for noncensus years between 2000 and 2010 are revised using updated intercensal population estimates and may differ from rates previously published. Data on age-adjusted death rates prior to 1999 are taken from historical data (see References below). SOURCES CDC/NCHS, National Vital Statistics System, historical data, 1900-1998 (see https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm); CDC/NCHS, National Vital Statistics System, mortality data (see http://www.cdc.gov/nchs/deaths.htm); and CDC WONDER (see http://wonder.cdc.gov). REFERENCES National Center for Health Statistics, Data Warehouse. Comparability of cause-of-death between ICD revisions. 2008. Available from: http://www.cdc.gov/nchs/nvss/mortality/comparability_icd.htm. National Center for Health Statistics. Vital statistics data available. Mortality multiple cause files. Hyattsville, MD: National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. Kochanek KD, Murphy SL, Xu JQ, Arias E. Deaths: Final data for 2017. National Vital Statistics Reports; vol 68 no 9. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf. Arias E, Xu JQ. United States life tables, 2017. National Vital Statistics Reports; vol 68 no 7. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf. National Center for Health Statistics. Historical Data, 1900-1998. 2009. Available from: https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm.

The leading causes of death by sex and ethnicity in New York City in since 2007.

Every year the CDC releases the country’s most detailed report on death in the United States under the National Vital Statistics Systems. This mortality dataset is a record of every death in the country for 2005 through 2015, including detailed information about causes of death and the demographic background of the deceased.

It's been said that "statistics are human beings with the tears wiped off." This is especially true with this dataset. Each death record represents somebody's loved one, often connected with a lifetime of memories and sometimes tragically too short.

Putting the sensitive nature of the topic aside, analyzing mortality data is essential to understanding the complex circumstances of death across the country. The US Government uses this data to determine life expectancy and understand how death in the U.S. differs from the rest of the world. Whether you’re looking for macro trends or analyzing unique circumstances, we challenge you to use this dataset to find your own answers to one of life’s great mysteries.

Overview

This dataset is a collection of CSV files each containing one year's worth of data and paired JSON files containing the code mappings, plus an ICD 10 code set. The CSVs were reformatted from their original fixed-width file formats using information extracted from the CDC's PDF manuals using this script. Please note that this process may have introduced errors as the text extracted from the pdf is not a perfect match. If you have any questions or find errors in the preparation process, please leave a note in the forums. We hope to publish additional years of data using this method soon.

A more detailed overview of the data can be found here. You'll find that the fields are consistent within this time window, but some of data codes change every few years. For example, the 113_cause_recode entry 069 only covers ICD codes (I10,I12) in 2005, but by 2015 it covers (I10,I12,I15). When I post data from years prior to 2005, expect some of the fields themselves to change as well.

All data comes from the CDC’s National Vital Statistics Systems, with the exception of the Icd10Code, which are sourced from the World Health Organization.

Project ideas

• The CDC's mortality data was the basis of a widely publicized paper, by Anne Case and Nobel prize winner Angus Deaton, arguing that middle-aged whites are dying at elevated rates. One of the criticisms against the paper is that it failed to properly account for the exact ages within the broad bins available through the CDC's WONDER tool. What do these results look like with exact/not-binned age data?
• Similarly, how sensitive are the mortality trends being discussed in the news to the choice of bin-widths?
• As noted above, the data preparation process could have introduced errors. Can you find any discrepancies compared to the aggregate metrics on WONDER? If so, please let me know in the forums!
• WONDER is cited in numerous economics, sociology, and public health research papers. Can you find any papers whose conclusions would be altered if they used the exact data available here rather than binned data from Wonder?

Differences from the first version of the dataset

• This version of the dataset was prepared in a completely different many. This has allowed us to provide a much larger volume of data and ensure that codes are available for every field.
• We've replaced the batch of sql files with a single JSON per year. Kaggle's platform currently offer's better support for JSON files, and this keeps the number of files manageable.
• A tutorial kernel providing a quick introduction to the new format is available here.
• Lastly, I apologize if the transition has interrupted anyone's work! If need be, you can still download v1.

Effective September 27, 2023, this dataset will no longer be updated. Similar data are accessible from wonder.cdc.gov.

Provisional counts of deaths by the month the death occurred and by select causes of death for 2020-2023.

Health, United States is an annual report on trends in health statistics, find more information at http://www.cdc.gov/nchs/hus.htm.

Rank, number of deaths, percentage of deaths, and age-specific mortality rates for the leading causes of death, by age group and sex, 2000 to most recent year.

Heart disease is currently the leading cause of death in the United States. In 2022, COVID-19 was the fourth leading cause of death in the United States, accounting for almost six percent of all deaths that year. The leading causes of death worldwide are similar to those in the United States. However, diarrheal diseases and neonatal conditions are major causes of death worldwide, but are not among the leading causes in the United States. Instead, accidents and chronic liver disease have a larger impact in the United States.

Racial differences

In the United States, there exist slight differences in leading causes of death depending on race and ethnicity. For example, assault, or homicide, accounts for around three percent of all deaths among the Black population but is not even among the leading causes of death for other races and ethnicities. However, heart disease and cancer are still the leading causes of death for all races and ethnicities.

Leading causes of death among men vs women

Similarly, there are also differences in the leading causes of death in the U.S. between men and women. For example, among men, intentional self-harm accounts for around two percent of all deaths but is not among the leading causes of death among women. On the other hand, influenza and pneumonia account for more deaths among women than men.

The Detailed Mortality - Underlying Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the years 1999-2009. Data are based on death certificates for U.S. residents. Each death certificate contains a single underlying cause of death, and demographic data. The number of deaths, crude death rates, age-adjusted death rates, standard errors and 95% confidence intervals for death rates can be obtained by place of residence (total U.S., region, state, and county), age group (including infants and single-year-of-age cohorts), race (4 groups), Hispanic ethnicity, sex, year of death, and cause-of-death (4-digit ICD-10 code or group of codes, injury intent and mechanism categories, or drug and alcohol related causes), year, month and week day of death, place of death and whether an autopsy was performed. The data are produced by the National Center for Health Statistics.

Note: DPH is updating and streamlining the COVID-19 cases, deaths, and testing data. As of 6/27/2022, the data will be published in four tables instead of twelve. The COVID-19 Cases, Deaths, and Tests by Day dataset contains cases and test data by date of sample submission. The death data are by date of death. This dataset is updated daily and contains information back to the beginning of the pandemic. The data can be found at https://data.ct.gov/Health-and-Human-Services/COVID-19-Cases-Deaths-and-Tests-by-Day/g9vi-2ahj. The COVID-19 State Metrics dataset contains over 93 columns of data. This dataset is updated daily and currently contains information starting June 21, 2022 to the present. The data can be found at https://data.ct.gov/Health-and-Human-Services/COVID-19-State-Level-Data/qmgw-5kp6 . The COVID-19 County Metrics dataset contains 25 columns of data. This dataset is updated daily and currently contains information starting June 16, 2022 to the present. The data can be found at https://data.ct.gov/Health-and-Human-Services/COVID-19-County-Level-Data/ujiq-dy22 . The COVID-19 Town Metrics dataset contains 16 columns of data. This dataset is updated daily and currently contains information starting June 16, 2022 to the present. The data can be found at https://data.ct.gov/Health-and-Human-Services/COVID-19-Town-Level-Data/icxw-cada . To protect confidentiality, if a town has fewer than 5 cases or positive NAAT tests over the past 7 days, those data will be suppressed. COVID-19 cases and associated deaths that have been reported among Connecticut residents, broken down by race and ethnicity. All data in this report are preliminary; data for previous dates will be updated as new reports are received and data errors are corrected. Deaths reported to the either the Office of the Chief Medical Examiner (OCME) or Department of Public Health (DPH) are included in the COVID-19 update. The following data show the number of COVID-19 cases and associated deaths per 100,000 population by race and ethnicity. Crude rates represent the total cases or deaths per 100,000 people. Age-adjusted rates consider the age of the person at diagnosis or death when estimating the rate and use a standardized population to provide a fair comparison between population groups with different age distributions. Age-adjustment is important in Connecticut as the median age of among the non-Hispanic white population is 47 years, whereas it is 34 years among non-Hispanic blacks, and 29 years among Hispanics. Because most non-Hispanic white residents who died were over 75 years of age, the age-adjusted rates are lower than the unadjusted rates. In contrast, Hispanic residents who died tend to be younger than 75 years of age which results in higher age-adjusted rates. The population data used to calculate rates is based on the CT DPH population statistics for 2019, which is available online here: https://portal.ct.gov/DPH/Health-Information-Systems--Reporting/Population/Population-Statistics. Prior to 5/10/2021, the population estimates from 2018 were used. Rates are standardized to the 2000 US Millions Standard population (data available here: https://seer.cancer.gov/stdpopulations/). Standardization was done using 19 age groups (0, 1-4, 5-9, 10-14, ..., 80-84, 85 years and older). More information about direct standardization for age adjustment is available here: https://www.cdc.gov/nchs/data/statnt/statnt06rv.pdf Categories are mutually exclusive. The category “multiracial” includes people who answered ‘yes’ to more than one race category. Counts may not add up to total case counts as data on race and ethnicity may be missing. Age adjusted rates calculated only for groups with more than 20 deaths. Abbreviation: NH=Non-Hispanic. Data on Connecticut deaths were obtained from the Connecticut Deaths Registry maintained by the DPH Office of Vital Records. Cause of death was determined by a death certifier (e.g., physician, APRN, medical

This dataset contains counts of deaths for California as a whole based on information entered on death certificates. Final counts are derived from static data and include out-of-state deaths to California residents, whereas provisional counts are derived from incomplete and dynamic data. Provisional counts are based on the records available when the data was retrieved and may not represent all deaths that occurred during the time period. Deaths involving injuries from external or environmental forces, such as accidents, homicide and suicide, often require additional investigation that tends to delay certification of the cause and manner of death. This can result in significant under-reporting of these deaths in provisional data.

The final data tables include both deaths that occurred in California regardless of the place of residence (by occurrence) and deaths to California residents (by residence), whereas the provisional data table only includes deaths that occurred in California regardless of the place of residence (by occurrence). The data are reported as totals, as well as stratified by age, gender, race-ethnicity, and death place type. Deaths due to all causes (ALL) and selected underlying cause of death categories are provided. See temporal coverage for more information on which combinations are available for which years.

The cause of death categories are based solely on the underlying cause of death as coded by the International Classification of Diseases. The underlying cause of death is defined by the World Health Organization (WHO) as "the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury." It is a single value assigned to each death based on the details as entered on the death certificate. When more than one cause is listed, the order in which they are listed can affect which cause is coded as the underlying cause. This means that similar events could be coded with different underlying causes of death depending on variations in how they were entered. Consequently, while underlying cause of death provides a convenient comparison between cause of death categories, it may not capture the full impact of each cause of death as it does not always take into account all conditions contributing to the death.

Analysis of ‘TABLE III. Deaths in 122 U.S. cities’ provided by Analyst-2 (analyst-2.ai), based on source dataset retrieved from https://catalog.data.gov/dataset/2098dc92-30dd-461a-b7c4-636ba6f0b101 on 26 January 2022.

--- Dataset description provided by original source is as follows ---

TABLE III. Deaths in 122 U.S. cities – 2016. 122 Cities Mortality Reporting System — Each week, the vital statistics offices of 122 cities across the United States report the total number of death certificates processed and the number of those for which pneumonia or influenza was listed as the underlying or contributing cause of death by age group (Under 28 days, 28 days –1 year, 1-14 years, 15-24 years, 25-44 years, 45-64 years, 65-74 years, 75-84 years, and ≥ 85 years).

FOOTNOTE: U: Unavailable. —: No reported cases. * Mortality data in this table are voluntarily reported from 122 cities in the United States, most of which have populations of 100,000 or more. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included.

† Pneumonia and influenza.

§ Total includes unknown ages.

--- Original source retains full ownership of the source dataset ---

Abstract (en): This data collection includes information about the cause of all recorded deaths occurring in the United States, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas during 2000, 2001, and 2002. Data are provided concerning underlying causes of death, multiple conditions that caused the death, place of death, residence of the deceased (e.g., region, division, state, county), whether an autopsy was performed, and the month and day of the week of the death. In addition, data are supplied on the sex, race, age, marital status, education, usual occupation, and origin or descent of the deceased. Mortality detail data can be extracted from this file. The mortality detail records are contained in the first 159 positions of these multiple cause records. In addition to the combined Territory Public-Use file for each year, a subset based on state of occurrence has been created for Puerto Rico, Virgin Islands, American Samoa, Guam, and Northern Marianas. The multiple cause of death fields were coded from the MANUAL OF THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS, TENTH REVISION (ICD-10), VOLUMES 1, 2, AND 3. Information regarding the use of ICD-10 codes may be found at http://www.cdc.gov/nchs/icd9.htm. All recorded deaths occurring in the United States, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas during 2000-2002. Effective with 1999 data, cause of death information is classified according to the MANUAL OF THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS, TENTH REVISION (ICD-10), VOLUMES 1, 2, AND 3.

MMWR Surveillance Summary 66 (No. SS-1):1-8 found that nonmetropolitan areas have significant numbers of potentially excess deaths from the five leading causes of death. These figures accompany this report by presenting information on potentially excess deaths in nonmetropolitan and metropolitan areas at the state level. They also add additional years of data and options for selecting different age ranges and benchmarks. Potentially excess deaths are defined in MMWR Surveillance Summary 66(No. SS-1):1-8 as deaths that exceed the numbers that would be expected if the death rates of states with the lowest rates (benchmarks) occurred across all states. They are calculated by subtracting expected deaths for specific benchmarks from observed deaths. Not all potentially excess deaths can be prevented; some areas might have characteristics that predispose them to higher rates of death. However, many potentially excess deaths might represent deaths that could be prevented through improved public health programs that support healthier behaviors and neighborhoods or better access to health care services. Mortality data for U.S. residents come from the National Vital Statistics System. Estimates based on fewer than 10 observed deaths are not shown and shaded yellow on the map. Underlying cause of death is based on the International Classification of Diseases, 10th Revision (ICD-10) Heart disease (I00-I09, I11, I13, and I20–I51) Cancer (C00–C97) Unintentional injury (V01–X59 and Y85–Y86) Chronic lower respiratory disease (J40–J47) Stroke (I60–I69) Locality (nonmetropolitan vs. metropolitan) is based on the Office of Management and Budget’s 2013 county-based classification scheme. Benchmarks are based on the three states with the lowest age and cause-specific mortality rates. Potentially excess deaths for each state are calculated by subtracting deaths at the benchmark rates (expected deaths) from observed deaths. Users can explore three benchmarks: “2010 Fixed” is a fixed benchmark based on the best performing States in 2010. “2005 Fixed” is a fixed benchmark based on the best performing States in 2005. “Floating” is based on the best performing States in each year so change from year to year. SOURCES CDC/NCHS, National Vital Statistics System, mortality data (see http://www.cdc.gov/nchs/deaths.htm); and CDC WONDER (see http://wonder.cdc.gov). REFERENCES Moy E, Garcia MC, Bastian B, Rossen LM, Ingram DD, Faul M, Massetti GM, Thomas CC, Hong Y, Yoon PW, Iademarco MF. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas – United States, 1999-2014. MMWR Surveillance Summary 2017; 66(No. SS-1):1-8. Garcia MC, Faul M, Massetti G, Thomas CC, Hong Y, Bauer UE, Iademarco MF. Reducing Potentially Excess Deaths from the Five Leading Causes of Death in the Rural United States. MMWR Surveillance Summary 2017; 66(No. SS-2):1–7.

In the United States in 2021, the death rate was highest among those aged 85 and over, with about 17,190.5 men and 14,914.5 women per 100,000 of the population passing away. For all ages, the death rate was at 1,118.2 per 100,000 of the population for males, and 970.8 per 100,000 of the population for women. The death rate Death rates generally are counted as the number of deaths per 1,000 or 100,000 of the population and include both deaths of natural and unnatural causes. The death rate in the United States had pretty much held steady since 1990 until it started to increase over the last decade, with the highest death rates recorded in recent years. While the birth rate in the United States has been decreasing, it is still currently higher than the death rate. Causes of death There are a myriad number of causes of death in the United States, but the most recent data shows the top three leading causes of death to be heart disease, cancers, and accidents. Heart disease was also the leading cause of death worldwide.

United States US: Completeness of Death Registration with Cause-of-Death Information data was reported at 98.000 % in 2009. This records an increase from the previous number of 97.400 % for 2002. United States US: Completeness of Death Registration with Cause-of-Death Information data is updated yearly, averaging 98.000 % from Dec 1992 (Median) to 2009, with 4 observations. The data reached an all-time high of 98.400 % in 1992 and a record low of 97.400 % in 2002. United States US: Completeness of Death Registration with Cause-of-Death Information data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s United States – Table US.World Bank.WDI: Population and Urbanization Statistics. Completeness of death registration is the estimated percentage of deaths that are registered with their cause of death information in the vital registration system of a country.; ; World Health Organization, Global Health Observatory Data Repository/World Health Statistics (http://apps.who.int/gho/data/node.main.1?lang=en).; Weighted average;

The Mortality - Multiple Cause of Death data on CDC WONDER are county-level national mortality and population data spanning the yehttps://healthdata.gov/d/2sz9-6c59ars 1999-2006. These data are available in two separate data sets: one data set for years 1999-2004 with 3 race groups, and another data set for years 2005-2006 with 4 race groups and 3 Hispanic origin categories. Data are based on death certificates for U.S. residents. Each death certificate contains a single underlying cause of death, up to twenty additional multiple causes, and demographic data. The number of deaths, crude death rates, age-adjusted death rates, standard errors and 95% confidence intervals for death rates can be obtained by place of residence (total U.S., state, and county), age group (including infants), race, Hispanic ethnicity (years 2005-2006 only), sex, year of death, and cause-of-death (4-digit ICD-10 code or group of codes). The data are produced by the National Center for Health Statistics.

United States Excess Deaths: Above Expected: Alabama data was reported at 0.000 Number in 30 Oct 2021. This stayed constant from the previous number of 0.000 Number for 23 Oct 2021. United States Excess Deaths: Above Expected: Alabama data is updated weekly, averaging 0.000 Number from Jan 2017 (Median) to 30 Oct 2021, with 251 observations. The data reached an all-time high of 679.000 Number in 11 Sep 2021 and a record low of 0.000 Number in 30 Oct 2021. United States Excess Deaths: Above Expected: Alabama data remains active status in CEIC and is reported by Centers for Disease Control and Prevention. The data is categorized under Global Database’s United States – Table US.G010: Number of Excess Deaths: by States: All Causes (Discontinued).

Project Tycho datasets contain case counts for reported disease conditions for countries around the world. The Project Tycho data curation team extracts these case counts from various reputable sources, typically from national or international health authorities, such as the US Centers for Disease Control or the World Health Organization. These original data sources include both open- and restricted-access sources. For restricted-access sources, the Project Tycho team has obtained permission for redistribution from data contributors. All datasets contain case count data that are identical to counts published in the original source and no counts have been modified in any way by the Project Tycho team. The Project Tycho team has pre-processed datasets by adding new variables, such as standard disease and location identifiers, that improve data interpretabilty. We also formatted the data into a standard data format.

Each Project Tycho dataset contains case counts for a specific condition (e.g. measles) and for a specific country (e.g. The United States). Case counts are reported per time interval. In addition to case counts, datsets include information about these counts (attributes), such as the location, age group, subpopulation, diagnostic certainty, place of aquisition, and the source from which we extracted case counts. One dataset can include many series of case count time intervals, such as "US measles cases as reported by CDC", or "US measles cases reported by WHO", or "US measles cases that originated abroad", etc.

Depending on the intended use of a dataset, we recommend a few data processing steps before analysis:

• Analyze missing data: Project Tycho datasets do not inlcude time intervals for which no case count was reported (for many datasets, time series of case counts are incomplete, due to incompleteness of source documents) and users will need to add time intervals for which no count value is available. Project Tycho datasets do include time intervals for which a case count value of zero was reported.
• Separate cumulative from non-cumulative time interval series. Case count time series in Project Tycho datasets can be "cumulative" or "fixed-intervals". Cumulative case count time series consist of overlapping case count intervals starting on the same date, but ending on different dates. For example, each interval in a cumulative count time series can start on January 1st, but end on January 7th, 14th, 21st, etc. It is common practice among public health agencies to report cases for cumulative time intervals. Case count series with fixed time intervals consist of mutually exxclusive time intervals that all start and end on different dates and all have identical length (day, week, month, year). Given the different nature of these two types of case count data, we indicated this with an attribute for each count value, named "PartOfCumulativeCountSeries".

Effective September 27, 2023, this dataset will no longer be updated. Similar data are accessible from wonder.cdc.gov.

This visualization provides weekly data on the number of deaths by jurisdiction of occurrence and cause of death. Counts of deaths in more recent weeks can be compared with counts from earlier years to determine if the number is higher than expected. Selected causes of death are shown, based on analyses of the most prevalent comorbid conditions reported on death certificates where COVID-19 was listed as a cause of death (see https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Comorbidities). Cause of death counts are based on the underlying cause of death, and presented for Respiratory diseases, Circulatory diseases, Malignant neoplasms, and Alzheimer disease and dementia. Estimated numbers of deaths due to these other causes of death could represent misclassified COVID-19 deaths, or potentially could be indirectly related to COVID-19 (e.g., deaths from other causes occurring in the context of health care shortages or overburdened health care systems). Deaths with an underlying cause of death of COVID-19 are not included in these estimates of deaths due to other causes. Deaths due to external causes (i.e. injuries) or unknown causes are excluded. For more detail, see the Technical Notes.