Forensic mortality in northern Tunisia in 2023: a cross-sectional study comparing ICD-11 and ICD-10 coding.

OBJECTIVES: To classify causes of death in northern Tunisia in 2023 according to the International Classification of Diseases, 11th Revision (ICD-11) and ICD-10, and to compare the two classifications in a forensic context. DESIGN: Descriptive cross-sectional study of causes of death in a forensic setting in 2023. Demographic data and causes of death were retrospectively extracted and coded using ICD-11 and ICD-10, applying ICD-11 post-coordination where relevant. SETTING: A forensic medicine department in a university hospital in Tunis, Tunisia, accounting for eight northern governorates of Tunisia. PARTICIPANTS: All deaths examined or autopsied during 2023 were included. Cases involving aborted fetuses, stillbirths, exhumed remains with death occurring before 2023 and skeletal remains were excluded. RESULTS: A total of 2214 deaths were included, of whom 73.6% were male, with a mean age of 53.3 years. The most frequent ICD-11 chapters were External Causes (41.2%) and Diseases of the Circulatory System (32.8%). ICD-11 identified 216 unique underlying causes, compared with 219 using ICD-10. ICD-11 post-coordination was applied in 88.5% of cases, providing additional details for road traffic accidents, assaults and poisonings. Overall distributions were similar, but ICD-11 allowed a more specific coding of causes of death. CONCLUSIONS: ICD-11 enhances medicolegal mortality reporting by improving specificity, flexibility and the ability to capture multiple circumstances of death. Its adoption will strengthen national mortality statistics.