All-cause mortality
Crude and standardised views
Crude results describe the observed population directly. Where age-sex standardisation is defined for the indicator, Standardised results use direct standardisation to the OECD 2015 standard population. The same supported age-sex strata are retained across participating centres and follow-up years and the OECD weights are renormalised over that common support.
Federated NeuBIRO execution
CHIEF INDICATORS uses the same indicator definitions in the NeuBIRO local and central execution contexts. At a local node, authorised patient-level analytical data remain at the centre and are transformed into aggregate sufficient statistics. At central level, multiple local aggregate outputs are supplied through the NeuBIRO central interface and combined without transferring patient-level records.
The local portal displays only the corresponding centre. The central portal can display participating centres together with the overall result calculated from the combined aggregate inputs.
Quality and completeness
The Quality check view reports the indicator-specific risk set, observed denominator, missing observations and completeness by centre and year. Completeness is calculated from the same sufficient statistics used for the indicator and is therefore recomputed consistently when diabetes-type filters are applied.
Aggregate output must not be assumed to be disclosure-safe solely because it is aggregate. Minimum-cell rules, suppression and any additional disclosure-control requirements remain subject to the agreed governance and DPO assessment.
Interactive diabetes-type stratification
The static portal contains aggregate sufficient statistics stratified by centre, year, diabetes type, sex and age band. The diabetes-type selector recombines these aggregate cells in the browser. It does not average displayed percentages and it does not embed patient-level records.
Full CHIEF INDICATORS User Guide
References
CHIEF — Federated analytics
Carinci F, Nicholson N (2025). Linking registries to deliver standardized NCD indicators in the European Health Data Space: Why do we need a Collaborative Health Information European Framework (CHIEF). Frontiers in Public Health, 13, 1684947. doi:10.3389/fpubh.2025.1684947.
Carinci F, Poljičanin T, Cunningham S, Fava S, Štotl I, Lepiksone J, Nicholson N, Massi Benedetti M, Klazinga N (2025). A taxonomy of indicators for non-communicable diseases: agreement, definition, and contextual description using diabetes as a case study. Frontiers in Public Health, 13, 1685731. doi:10.3389/fpubh.2025.1685731.
Carinci F, Fava S, Štotl I, Nicholson N (2026). Federated analytics for non-communicable disease surveillance in the European Health Data Space: a scoping review and conceptual framework. Frontiers in Public Health, 14, 1911992. doi:10.3389/fpubh.2026.1911992.
Štotl I, Carinci F, Fava S, Lavens A, Lepiksone J, Massi Benedetti M, Poljičanin T, Cunningham S, Sándor J, Nicholson N (2025). FAIR foundations of a novel indicator vault for non-communicable diseases in the European Union: feasibility study for effective contextualisation of indicators. Frontiers in Digital Health, 7, 1685733. doi:10.3389/fdgth.2025.1685733. PMID: 41477523; PMCID: PMC12750770.
Contextualisation / SOLICIT
Nicholson N, Štotl I (2024). A generic framework for the semantic contextualization of indicators. Frontiers in Computer Science, 6, 1463989. doi:10.3389/fcomp.2024.1463989. This paper introduces SOLICIT (Semantic Ontology-Labelled Indicator Contextualisation Integrative Taxonomy).
Nicholson N, Štotl I (2024). Indicator description framework. European Commission, Joint Research Centre, JRC137845. JRC publication.
European Commission, Joint Research Centre (2026). SOLICIT Indicator Ontology. JRC Data Catalogue. doi:10.2905/JRC.XMAN7Y8.
NeuBIRO and EUBIROD
EUBIROD Network. European Best Information through Regional Outcomes in Diabetes (EUBIROD Network). EUBIROD Network website.
Gualdi S, Carinci F. NeuBIRO software. EUBIROD Network. Open-source repository, EUPL licence. NeuBIRO GitHub repository.
BIRO Consortium (2012). The BIRO Monograph: Best Information through Regional Outcomes. European BIRO Project. BIRO Monograph PDF.
Carinci F, Rossi L, Massi Benedetti M, BIRO Consortium (2009). An open source statistical engine for the automatic production of standardized diabetes indicators within and across regions: results of the BIRO project. link IDF World Diabetes Congress, Montreal, P-1604.
Carinci F, Azzopardi J, Baglioni V, Beck P, Cunningham S, Skeie S, Olympios G, Pruna S, Traynor V, Massi Benedetti M, BIRO Consortium (2009). A novel standard to support information delivery for the fulfilment of IDF policy in Europe: results of the EU DG SANCO funded BIRO project. link IDF World Diabetes Congress, Montreal, O-0402.
Cunningham SG, Carinci F, Brillante M, Leese GP, McAlpine RR, Azzopardi J, Beck P, Bratina N, Bocquet V, Doggen K, Jarosz-Chobot PK, Jecht M, Lindblad U, Moulton T, Metelko Ž, Nagy A, Olympios G, Pruna S, Skeie S, Storms F, Di Iorio CT, Massi Benedetti M (2016). Core Standards of the EUBIROD Project. Defining a European Diabetes Data Dictionary for Clinical Audit and Healthcare Delivery. Methods of Information in Medicine, 55(2), 166–176. doi:10.3414/ME15-01-0016.
Carinci F, Štotl I, Cunningham SG, et al. (2021). Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe. Frontiers in Clinical Diabetes and Healthcare, 2, 744516. doi:10.3389/fcdhc.2021.744516.
SCORE2-Diabetes Working Group and the ESC Cardiovascular Risk Collaboration (2023). SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. European Heart Journal, 44(28), 2544–2556. doi:10.1093/eurheartj/ehad260. PubMed. PMC.
REWINDER
Carinci F, Messina R, Michelini M, Bici A, Berardo A, Dei Cas A, Iezzi E, Di Iorio CT, Gualdi S, Aldigeri R, Fantini MP, Bonadonna RC, Massi Benedetti M, Di Bartolo P (2025). Real-world data and patient-reported outcomes in diabetes in Emilia–Romagna (REWINDER): protocol of a federated cohort study for the regional evaluation of quality of care during and after COVID-19. BMJ Open, 15, e102401. doi:10.1136/bmjopen-2025-102401.
Carinci F, Messina R, Mencarelli M, Michelini MM, Bici A, Berardo A, Cas AD, Iezzi E, Aldigeri R, Di Iorio CT, Gualdi S, Fantini MP, Bonadonna R, Nicholson N, Benedetti MM, Di Bartolo P (2026). Implementing a federated regional diabetes register in a decentralized health system: implications for healthcare organization and the European Health Data Space. Frontiers in Public Health, 14, 1864673. doi:10.3389/fpubh.2026.1864673.
Privacy
Di Iorio CT, Carinci F, Azzopardi J, Baglioni V, Beck P, Cunningham S, Evripidou A, Leese G, Løvaas KF, Olympios G, Orsini Federici M, Palladino P, Pruna S, Skeie S, Taverner P, Traynor V, Massi Benedetti M (2009). Privacy impact assessment in the design of transnational public health information systems: the BIRO project. Journal of Medical Ethics, 35(12), 753–761. doi:10.1136/jme.2009.029918.
Di Iorio CT, Carinci F, Oderkirk J (2014). Health research and systems’ governance are at risk: should the right to data protection override health? Journal of Medical Ethics, 40(7), 488–492. doi:10.1136/medethics-2013-101603.
Di Iorio CT, Carinci F, Oderkirk J, Smith D, Siano M, de Marco DA, de Lusignan S, Hamalainen P, Massi Benedetti M (2021). Assessing data protection and governance in health information systems: a novel methodology of Privacy and Ethics Impact and Performance Assessment (PEIPA). Journal of Medical Ethics, 47(12), e23. doi:10.1136/medethics-2019-105948.
Di Iorio CT, Carinci F, Brillante M, Azzopardi J, Beck P, Bratina N, Cunningham SG, de Beaufort C, Debacker N, Jarosz-Chobot P, Jecht M, Lindblad U, Moulton T, Metelko Ž, Nagy A, Olympios G, Pruna S, Røder M, Skeie S, Storms F, Massi Benedetti M (2013). Cross-border flow of health information: is ‘privacy by design’ enough? Privacy performance assessment in EUBIROD. European Journal of Public Health, 23(2), 247–253. doi:10.1093/eurpub/cks043. PubMed.
Di Iorio CT, Ronchi E, Pristas I, Buble T, Nicholson N, Carinci F (2025). Data protection, interoperability and governance assessment tool: results from a proof-of-concept survey. Frontiers in Digital Health, 7, 1685774. doi:10.3389/fdgth.2025.1685774. PubMed. PMC. JRC record.