METHODS: This study analyzed death records from January 2017 to June 2022, sourced from Malaysia's Health Informatics Centre, coded into ICD-10. Data anonymization adhered to ethical standards, with 387,650 death registrations included after quality checks. The dataset, limited to three-digit ICD-10 codes, underwent cleaning and an 80:20 training-testing split. Preprocessing involved HTML tag removal and tokenization. ML approaches, including BERT (Bidirectional Encoder Representations from Transformers), Gzip+KNN (K-Nearest Neighbors), XGBoost (Extreme Gradient Boosting), TensorFlow, SVM (Support Vector Machine), and Naive Bayes, were evaluated for automated ICD-10 coding. Models were fine-tuned and assessed across accuracy, F1-score, precision, recall, specificity, and precision-recall curves using Amazon SageMaker (Amazon Web Services, Seattle, WA). Sensitivity analysis addressed unbalanced data scenarios, enhancing model robustness.

RESULTS: In assessing ICD-10 coding with ML, Gzip+KNN had the longest training time at 10 hours, with BERT leading in memory use. BERT performed best for the F1-score (0.71) and accuracy (0.82), closely followed by Gzip+KNN. TensorFlow excelled in recall, whereas SVM had the highest specificity but lower overall performance. XGBoost was notably less effective across metrics. Precision-recall analysis showed Gzip+KNN's superiority. On an unbalanced dataset, BERT and Gzip+KNN demonstrated consistent accuracy.