Description of a new all cause mortality surveillance system in Sweden as a warning system using threshold detection algorithms.

A warning system has been set up to detect unusual weekly clusters of deaths by age group and municipality using all-cause Swedish death registry data. The technique for monitoring deaths by age group (<1, 1-24, 25-44, 45-64 and 65 plus) and week uses a compound smoothing technique, which calculates a baseline of expected events from retrospective data. Due to insufficient baseline data for the geographical component of the system a different algorithm, based on the Poisson distribution, was chosen to calculate expected weekly number of deaths per municipality, adjusting for municipalities with inherently higher mortality rates. This system was designed and tested during 2004 and implemented from the beginning of 2005. Threshold settings have been adjusted to provide a realistic number of weekly alerts. An evaluation of the system will be performed prospectively from the beginning of 2005 due to the lack of a gold standard for retrospective performance evaluation.