Accuracy Of Death Certification Research Articles

A Large Postmortem Database of COVID-19 Patients Can Inform Disease Research and Public Policy Decision Making.

Autopsies performed on COVID-19 patients have provided critical information about SARS-CoV-2's tropism, mechanisms of tissue injury, and the spectrum of disease. To provide an updated database of postmortem disease in COVID-19 patients, assess relationships among clinical and pathologic variables, evaluate the accuracy of death certification, and correlate disease variables to causes of death. The 272 postmortem examinations reported in this paper were submitted by 14 pathologists from 9 medical or forensic institutions across the United States. The study spans the eras of the 3 principal COVID-19 strains and incorporates surveyed demographic, clinical, and postmortem data from decedents infected with SARS-CoV-2, including primary and contributing causes of death. It is the largest database of its kind to date. Demographics of the decedents reported here correspond well to national statistics. Primary causes of death as determined by autopsy and official death certificates were significantly correlated. When specifically cited disease conditions found at autopsy were correlated with COVID-19 versus non-COVID-19 death, only lung findings characteristic of SARS-CoV-2 infection or the absence of lung findings were significantly associated. Changes in hospitalization and disease likely stem from longer lifespans after COVID-19 diagnosis and alteration in treatment approaches. Although Omicron variants preferentially replicate in the upper airways, autopsied patients who died of COVID-19 in that time period showed the same lung damage as earlier decedents. Most importantly, findings suggest that there are still unelucidated risk factors for death from COVID-19 including possibly genetic susceptibility.

Suicide mortality in Italy during the first year of the COVID-19 pandemic

BackgroundItaly was severely hit by COVID-19 during 2020 and great concern about the possible increase of suicide rates in the population has arisen since early pandemic phases. Analyses limited to March–April have shown a drop in suicides in both sexes. This study aims to analyze suicide mortality in Italy during the whole 2020 making comparisons with the pre-pandemic period 2015–19, by sex, age and geographic area. MethodsOfficial cause-of-death data with national coverage were used to analyze suicide mortality by sex, month, age class and geographic area in the population aged ≥10 years (54,595,179). The monthly number of suicide deaths in 2020 was compared to the average number in 2015–19. Age-specific and age-adjusted suicide rates in 2020 and in 2015–19 were compared using rate-ratios with 95 % confidence intervals. ResultsCompared to 2015–19 a non-significant reduction of the overall suicide rate was observed during 2020, both in males (−3 %) and females (−7 %). Suicide rates non-significantly decreased in most age groups; an increase, although not statistically significant, was found among males aged ≥75 years and females aged ≥85 years. Suicide deaths reduced mainly in Central-Southern areas and the Islands, while they slightly increased in the North especially among males. LimitationsStudy limitations include accuracy of death certification and the relatively brief observation period. ConclusionsThe study contributes to the analysis of early effects of the COVID-19 pandemic on suicide mortality in the whole population highlighting sex, age and territorial differences and suggesting to monitor possible increases in a longer observation period.

Accuracy of Death Certification of Cause of Death in Home Deaths by Grama Niladhari in Selected Divisional Secretariat Areas of Sri Lanka

Accuracy of Death Certification of Cause of Death in Home Deaths by Grama Niladhari in Selected Divisional Secretariat Areas of Sri Lanka

Evaluation of Medical Certification of Cause of Death in Tertiary Cancer Hospitals in Northern India.

Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information. To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020). A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded. A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors. A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control. This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors.

Proper death certification in the time of the COVID-19 pandemic: Forensic perspective.

It is well known that the quality of death certificates determines the accuracy of public health mortality data. In the light of a pandemic, forensic pathologists must understand the true definition of a COVID-19 death and the requirements for filling out the death certificate, as these are critical for maintaining accurate and trustworthy mortality data. To determine the scope and evolution of the COVID-19 epidemic, accurate death certification is critical. We believe that COVID-19 should be enlisted under part II or section "note" (if it exists in DC form in a particular country) of the DC in all suicide instances and putrefied bodies with positive autopsy swabs for SARS-CoV-2. In addition to our suggestions for the completion of the DC in some COVID-19 instances, we feel that forensic pathologists should follow the WHO criteria for proper DC completion in COVID-19 cases. Better physician education at this stage of the pandemic would increase adherence to existing (WHO and CDC) standards. As a result, forensic pathologists with competence in death certification could help by teaching treating physicians in this area.

Using Catchment Population to Estimate Sporadic Creutzfeldt-Jakob Disease Incidence.

Catchment populations have several uses. A method using catchment population to estimate the incidence of sporadic Creutzfeldt-Jakob disease (sCJD) is described. A cohort of nine consecutive patients diagnosed with sCJD, symptom onset spanning 26 months, were observed at a rural tertiary university medical center that has approximately 40,000 hospital discharges annually. An effective catchment population was determined using surrounding county utilization frequency that captured all nine sCJD patients and accounted for over 87% of discharges. The effective sCJD hospital catchment population was 1.266 million, implying an annual sCJD incidence rate of 3.39 per million (95% CIs, 1.55-6.43), assuming a Poisson distribution for sCJD occurrence. This annual incidence rate suggests that many sCJD patients are unrecognized and unreported. An advantage of this catchment population method is independence from death certificate accuracy, important in rare diseases that are both rapidly and invariably fatal. The relative absence of significant healthcare systems competition in this rural population enhances the reliability of this finding. The most likely explanation for the high sCJD incidence rate suggested by this study is enhanced clinical suspicion and improved diagnostic accuracy.

Cardiovascular mortality and morbidity following radical radiotherapy for lung cancer: Is cardiovascular death under-reported?

BackgroundLung cancer is the most common malignancy worldwide. Radical radiotherapy is an essential treatment in the management of early and locally advanced lung cancer. Cardiac events are known to occur following radical radiotherapy for lung cancer. This study examines the burden of cardiac events post radiotherapy, and estimates the accuracy of death certification in patients who received radical radiotherapy for lung cancer. MethodsWe conducted a retrospective observational cohort study for all patients receiving radical radiotherapy for non-small cell lung cancer (NSCLC) at a large cancer centre between 01/01/2010 to 31/12/2016. Baseline cardiovascular disease and cancer status and treatment data were collected, along with hospital admission data and documented cause of death from the national registry for a median follow-up period of 34 months. ResultsOf 1224 patients included in the analysis, 378 (30.9%) patients had cardiovascular disease at baseline, including 140 (11.4%) with prior myocardial infarction. In the 846 patients without known cardiovascular disease, 451 (53.3%) had a QRISK2 predicted 10-year cardiovascular risk >20% over 10 years. During follow-up, 215 hospitalisations occurred (Incidence rate 6.2 per hundred patient years) which were classified as primarily cardiac, and 622 patients died (18 per 100 patient-years). However, death certificates stated a primary cardiac cause of death in only 33 cases (5.3% of deaths). Notably, 29% of patients dying out of hospital and certified as cancer death did not have documented cancer relapse prior to death, and 61% had no community palliative care input prior to death, implying these events may have been sudden and unexpected. ConclusionThere is a high prevalence of baseline cardiovascular disease in people undergoing radiotherapy for NSCLC, accompanied by significant rates of post-radiotherapy cardiovascular hospitalisation. However, only a small proportion of deaths are attributed to cardiovascular disease, together with the large amount of sudden deaths observed, this suggests that cardiovascular death is greatly under-reported in official statistics.

Validity of death certificates in the identification of cases of amyotrophic lateral sclerosis (ALS) in the Limousin region, France. A population-based study

Objectives: Mortality data have been used as a proxy for amyotrophic lateral sclerosis (ALS) incidence. However, the accuracy of death certificates (DCs) needs to be validated. This study aims to assess the accuracy of DCs in the identification of ALS cases. Methods: This is a retrospective population-based validation study. DC information, provided by the “Centre d’épidémiologie sur les causes médicales de décès”, including ICD10 codes for specific cause of death for patients recorded in the French register of ALS cases in the Limousin region (FRALim) and deceased between 2000 and 2011, was assessed. The FRALim register was used as gold standard. Results: In the study period, DCs were available for 197 patients diagnosed with ALS, of whom 185 (93.9%) were correctly identified with an ICD10 code (G12.2) corresponding to ALS. The overall sensitivity was 93.9% (95% CI 89.6–96.8) and the positive predictive value (PPV) was 64.9 (59.1–70.4), with higher values in the period 2004–2011 (75.0–78.9). Stratification for sex, age, and year at death did not show difference in accuracy, except a lower PPV during the first years of observation. Conclusions: DCs identifying subjects with a diagnosis of ALS in the Limousin region, France showed an overall good sensitivity and moderate PPV. The absence of ALS diagnosis as the main and underlying cause of death on DCs highlights the need to use DC in combination with other administrative data to create algorithms with higher accuracy performances.

Autopsy Service Death Certificate Review.

Despite the importance of accurate death statistics for epidemiologic studies and public health initiatives, there remains a high frequency of errors in death certification. This deficiency can be addressed by the hospital autopsy service. To improve the quality and accuracy of death certificates issued in the hospital and improve resident and clinician education by initiating a death certificate review process, performed by pathology residents while on their hospital autopsy rotation. A resident reviewed all death certificates issued in the hospital daily through the state electronic death certificate filing system and correlated with the decedent's medical record. When errors were found, the resident filed an amended death certificate with the state. If applicable, the Office of the Medical Examiner was contacted to investigate. The original certifying physician was then contacted via email with an explanation for the amendment. In 12 months, 590 death certificates were issued by the hospital. Eighty-eight of 590 (15%) were amended. Of those 88 amended, 41 (47%) were missing an underlying cause of death, 7 (8%) had an inaccurate cause of death, 41 (47%) failed to include relevant contributory causes of death, and 17 (19%) had major typographic errors. Of 88, 24 (27%) fell under the Office of the Medical Examiner's jurisdiction and were reported with a subsequent change in the manner of death in 23 of 88 cases (26%). Death certificate review by the autopsy service improves the accuracy of death certification, impacts resident and clinician education, and serves as quality assurance for both the hospital and the state.

Medical certification of cause of death during COVID-19 pandemic - a challenging scenario.

Death certificate data is used to monitor local, regional and national mortality trend and is helpful in improving public health as well as public safety. Accurate and reliable information about the cause of death in a population is useful for understanding disease burden estimation and trends in the health of populations; moreover, the information provided by such data is vital in terms of public health planning as well. With the continuous upsurge in mortality due to coronavirus disease 19 (COVID-19), mortality analysis could be valuable in addressing the current pandemic and implementing the epidemic control strategies effectively and efficiently. Given that COVID-19 death certification substantially affects the local and national responses towards disease prevention and transmission, the importance of the accuracy and quality of information in these certificates cannot be understated. Hence, accurate death certification related to COVID-19 is vital to understand the extent and progression of the current pandemic.

Completeness and accuracy of death certificate on cause of clinical death at Ludira Husada Tama Hospital Yogyakarta in 2015-2017

Background: Ludira Husada Tama Hospital is one of privately-owned hospitals in Yogyakarta. Being classified as a type D hospital, the author aims to observe the implementation of writing death certificate in terms of completeness and accuracy. Objective: To know the completeness and the accuracy of death certificate on cause of clinical death at Ludira Husada Tama Hospital in 2015-2017 Method: This study is a descriptive-observational study using crosssectional method. This study was taken place at Ludira Husada Tama Hospital, Yogyakarta by taking the medical record of the patient who die in this hospital which have death certificate on cause of clinical death in 2015-2017. Result: The amount of medical record contains death certificate on cause of clinical death at Ludira Husada Tama Hospital Yogyakarta in 2015-2017 that met inclusion and exclusion criteria is 55 data. In the completeness of death certificate on cause of clinical death at Ludira Husada Tama Hospital Yogyakarta in 2015-2017, 98% is classified as fair and 2% is classified as poor. In the accuracy of death certificate on cause of clinical death at Ludira Husada Tama Hospital Yogyakarta in 2015- 2017, the percentage of accuracy on the section I (a) is 62%, on the section I (b, c) is 22%, on the section I (d) is 20%, and on the part II is 11% accurate. Conclusion: In the completeness of death certificate on cause of clinical death at Ludira Husada Tama Hospital Yogyakarta in 2015-2017, 98% is classified as fair and 2% is classified as poor. In the accuracy of death certificate on cause of clinical death at Ludira Husada Tama Hospital Yogyakarta in 2015-2017, the percentage of accuracy on the section I (a) is 62%, on the section I (b, c) is 22%, on the section I (d) is 20%, and on the part II is 11% accurate.

Death certificate errors in one Saudi Arabian hospital

Proper completion of death certificates is of vital importance. This study assessed the accuracy of death certification at one major hospital in Riyadh, Saudi Arabia. We collected all certificates from 1997 to 2016 and scored them on the degree of accuracy. We found no errors of incompleteness or missed contributors to death. However, in all certificates (100%), cause of death was either incorrect or absent; 75% provided no cause of death. Further large-scale studies should be conducted in other hospitals to determine the exact prevalence of these serious errors.

Accuracy and the factors influencing the accuracy of death certificates completed by first-year general practitioners in Thailand

BackgroundAlthough death certificates (DCs) provide valuable health information which may help to guide local health policies and priorities, there is little information concerning their validity in Thailand. First-year general practitioners (GPs) have a major role in DC completion, especially in provincial general hospitals. The aim of this study was to evaluate the accuracy and factors influencing the accuracy of DCs completed by first-year GPs in Thailand, compared with the cause of death (COD) derived from medical records by experts.MethodsThis retrospective study was conducted at 14 provincial general hospitals in Thailand during the June 2011 to May 2012 study period. Medical records and DCs completed by first-year GPs who graduated from 16 Thai medical schools were sampled. The cause of death recorded on the DCs was compared with the medical conditions and histories derived from patient medical records. A cross-sectional survey of the 210 GPs who completed the DCs reviewed in this study was also conducted. Respondent GPs’ demographic characteristics, factors associated with COD, and COD coding system were evaluated.ResultsFive hundred and sixty-three medical records and corresponding DCs were included. Of those, 36.9% of DCs were found to be correct. Common mistakes included incorrect sequence of events leading to death (32.4%), and mode of death use (26.2%). Of the 210 GPs, 155 questionnaires were completed and returned. The mean time spent on recording COD and completing DCs in the medical school curriculum was 2.1 ± 0.9 h and only 27.7% of participants had experience in completing DCs by themselves during medical school. Mean medical school GPA was significantly higher in the correctly completed DC GPs group than in the incorrectly completed DC GPs group (3.3 ± 0.4 vs. 3.2 ± 0.3; p = 0.03). However, no significant difference was found for other factors associated with COD between groups.ConclusionsThis is the first study documenting gaps and disparities in DC accuracy, and factors influencing completion of DCs among first-year GPs in Thailand, based on a clinical assessment of medical records. GPs made errors on 63.1% of DCs. This finding suggests that proven education, system-related support, and additional training interventions specific to DC completion are required.

Accuracy of death certification of dementia in population-based samples of older people: analysis over time.

Backgrounddeath certification data are routinely collected in most developed countries. Coded causes of death are a readily accessible source and have the potential advantage of providing complete follow-up, but with limitations.Objectiveto investigate the reliability of using death certificates for surveillance of dementia, the time trend of recording dementia on death certificates and predictive factors of recording of dementia.Subjectsindividuals aged 65 and over in six areas across England and Wales were randomly selected for the Medical Research Council Cognitive Function and Ageing Study (CFAS) and CFAS II with mortality follow-up.Methodsprevalence of dementia recorded on death certificates were calculated by year. Reporting of dementia on death certificates compared with the study diagnosis of dementia, with sensitivity, specificity and Cohen’s κ were estimated. Multivariable logistic regression models explored the impact of potential factors on the reporting of dementia on the death certificate.Resultsthe overall unadjusted prevalence of dementia on death certificates rose from 5.3% to 25.9% over the last 26 years. Dementia reported on death certificates was poor with sensitivity 21.0% in earlier cohort CFAS, but it had increased to 45.2% in CFAS II. Dementia was more likely to be recorded on death certificates in individuals with severe dementia, or those living in an institution, yet less likely reported if individuals died in hospital.Conclusionrecording dementia on death certificate has improved significantly in the England and Wales. However, such information is still an underestimate and should be used alongside epidemiological estimations.

Deaths From Pneumonia-New York City, 1999-2015.

"Pneumonia and influenza" are the third leading cause of death in New York City. Since 2012, pneumonia and influenza have been the only infectious diseases listed among the 10 leading causes of death in NYC. Most pneumonia and influenza deaths in NYC list pneumonia as the underlying cause of death, not influenza. We therefore analyzed death certificate data for pneumonia in NYC during 1999-2015. We calculated annualized pneumonia death rates (overall and by sociodemographic subgroup) and examined the etiologic agent listed. There were 41 400 pneumonia deaths during the study period, corresponding to an annualized age-adjusted death rate of 29.7 per 100 000 population. Approximately 17.5% of pneumonia deaths specified an etiologic agent. Age-adjusted pneumonia death rate declined over the study period and across each borough. Males had an annualized age-adjusted pneumonia death rate 1.5 (95% confidence interval [CI], 1.5-1.5) times that of females. Non-Hispanic blacks had an annualized age-adjusted pneumonia death rate 1.2 (95% CI, 1.2-1.2) times that of non-Hispanic whites. The annualized pneumonia death rate increased with age group above 5-24 years and neighborhood-level poverty. Staten Island had an annualized age-adjusted pneumonia death rate 1.3 (95% CI, 1.2-1.3) times that of Manhattan. In the multivariable analysis, pneumonia deaths were more likely to occur among males, non-Hispanic blacks, persons aged ≥65 years, residents of neighborhoods with higher poverty levels, and in Staten Island. While the accuracy of death certificates is unknown, investigation is needed to understand why certain populations are disproportionately recorded as dying from pneumonia in NYC.

Accuracy of death certification in cutaneous squamous cell carcinoma: A retrospective case review

Accuracy of death certification in cutaneous squamous cell carcinoma: A retrospective case review

Trend of Ill-Defined Causes of Death in Egypt (2000–2013) in Comparison to Selected Eastern Mediterranean Countries, and an Intervention Study to Improve The Accuracy of Death Certification in One District in Cairo, Egypt

Trend of Ill-Defined Causes of Death in Egypt (2000–2013) in Comparison to Selected Eastern Mediterranean Countries, and an Intervention Study to Improve The Accuracy of Death Certification in One District in Cairo, Egypt

Mortality Analysis of the Life Span Study (LSS) Cohort Taking into Account Multiple Causes of Death Indicated in Death Certificates.

Mortality analyses have been performed using underlying causes of death as reported on death certificates; these are uniquely determined for a deceased person according to the World Health Organization coding system. Comorbidities, the disease conditions other than the underlying cause of death from death certificates recording multiple causes of death, have rarely been explored in Life Span Study subjects. The purpose of this study was to clarify associations between atomic bomb radiation exposure and mortality from combinations of the underlying cause of death and comorbidities. The focused follow-up period was 1977-2003, prior to which death certificate accuracy was unreliable. The study cohort was comprised of 10,017 people for whom the category "all circulatory disease" was listed as the underlying cause of death, of which heart disease (rheumatic, hypertensive and ischemic heart disease) and stroke were major subtypes. Comorbidities considered were pneumonia, renal disease, diabetes mellitus, cancer and the major circulatory disease subtypes listed above. Poisson regression models were used for analyses. Excess relative risks (ERRs) for mortality at 1 Gy were significantly increased when cancer was comorbid with all circulatory disease, heart disease, ischemic heart disease or stroke, ranging from 0.61 [95% confidence interval (CI): 0.13, 1.41; N = 177] for all circulatory diseases to 1.60 (CI: 0.07, 4.86; N = 42) for ischemic heart disease. Among the other comorbidities, only diabetes comorbid with heart disease had a significant radiation dose response (ERR at 1 Gy of 0.62, CI: 0.10, 1.46; N = 128). It remains uncertain if the high ERRs with comorbid cancers were anomalous due to the small number of cases or some dissimilarity in statistical methodologies, or if this might suggest some pathogenetic basis for increased fatality. For this reason, further investigation is required.

Assessment of a Regression Method to Reclassify Deaths Attributable to Heart Failure

<p><strong>BACKGROUND: </strong>Evaluation of cause-specific mortality for public health research depends on accurate death certificates and vital records. However, ill-defined causes of death (termed garbage codes), such as heart failure, are often listed as the underlying cause of death. We examined a regression method proposed by Ahern and colleagues for redistributing deaths attributed to heart failure and compared it to a simulation of the regression method by bootstrapping. </p><p><strong>METHODS: </strong>Deaths attributed to heart failure in four U.S. states (Maryland, Minnesota, Mississippi and North Carolina) were redistributed to a set of underlying causes of death using regression models that identified the proportion of deaths for each target code within a given state-age-sex-education group using ICD-10 mortality data. The results were compared with 3,000 bootstrapped samples with replacement regression.</p><p><strong>RESULTS: </strong>The odds of death from heart failure in the population studied increased with age, was higher in whites and lower in decedents with greater than a high school education compared to those with less than high school education. There were 18 (29.0%) subgroups that showed no significant redistribution targets for the Ahern regression method and 28 (45.2%) for the bootstrapped regression method. Ischemic heart disease was a distribution target for 28 (45.2%) of the Ahern regression subgroups and 22 (35.5%) of the bootstrapped regression subgroups. The Ahern regression method and bootstrapped regression methods were discordant in 19 (30.6%) out of the 62 subgroups examined.</p><p><strong>CONCLUSION: </strong>The Ahern regression method tended to redistribute deaths attributed to heart failure to more target groups compared with the bootstrapped regression method. Both the Ahern regression and the bootstrap regression methods were computationally intensive and inefficient, and results appeared to be influenced by the choices of sex-age-education group strata. Other methods such as coarsened exact matching and improvements to the Ahern approach are desirable additions to the tools available to mitigate the impact of garbage codes on the accuracy of death certification.</p>

Accuracy of Death Certificates and Assessment of Factors for Misclassification of Underlying Cause of Death.

BackgroundCause of death (COD) information taken from death certificates is often inaccurate and incomplete. However, the accuracy of Underlying CODs (UCODs) recorded on death certificates has not been comprehensively described when multiple diseases are present.MethodsA total of 450 consecutive autopsies performed at a geriatric hospital in Japan between February 2000 and August 2002 were studied. We evaluated the concordance rate, sensitivity, and specificity of major UCODs (cancer, heart disease, and pneumonia) reported on death certificates compared with a reference standard of pathologist assessment based on autopsy data and clinical records. Logistic regression analysis was performed to assess the effect of sex, age, comorbidity, and UCODs on misclassification.ResultsThe concordance rate was relatively high for cancer (81%) but low for heart disease (55%) and pneumonia (9%). The overall concordance rate was 48%. Sex and comorbidity did not affect UCOD misclassification rates, which tended to increase with patient age, although the association with age was also not significant. The strongest factor for misclassification was UCODs (P < 0.0001). Sensitivity and specificity for cancer were very high (80% and 96%, respectively), but sensitivity for heart disease and pneumonia was 60% and 46%, respectively. Specificity for each UCOD was more than 85%.ConclusionsResearchers should be aware of the accuracy of COD data from death certificates used as research resources, especially for cases of elderly patients with pneumonia.