Death Certification Practices Research Articles

Motor neuron disease in a defined English population: estimates of incidence and mortality.

Linked statistics from hospital records and death certificates were used to study the incidence of and mortality from motor neuron disease in a defined English population. The incidence of motor neuron disease, measured as first-admission rates for the disease, was studied from 1963 to 1985 and death certificates for the patients admitted to hospital were obtained to the end of 1990. The average annual first-admission rate for motor neuron disease was 2.1/100,000 men (95% confidence interval (CI) 1.9 to 2.4) and 1.7/100,000 women (95% CI 1.5 to 1.9). First-admission rates increased with age and peaked in the age range 65-84 years. Motor neuron disease was recorded on the death certificate for 86% of patients who died while they had the disease and there was no appreciable change over time in the recording of motor neuron disease as the underlying cause of death. The admission and mortality data derive from different sources, hospital statistical abstracts and death certificates respectively, but trends over time in the two data sets were similar. There was an increase in mortality during the period covered by the study, as there has been in mortality from motor neuron disease nationally, and the increase in mortality in the Oxford region was accompanied by an increase in first-admission rates. It is concluded that the increase in mortality from motor neuron disease probably occurred as a result of an increase in the diagnosed incidence of the disease rather than changes in death certification practice.

Death certification by House Officers and General Practitioners — practice and performance

The objective of this study was to assess the knowledge, attitudes and behaviour of House Officers and General Practitioners (GPs) in relation to death certification, to determine the scope for future intervention. A postal questionnaire was used to survey all House Officers (174) and a 10 per cent random sample of GPs (131) in Mersey Region. The main outcome measures were: death certification experience; knowledge, attitudes and behaviour in relation to data uses and coding; and acceptability of Cause of Death statements. Response rates were comparable-119/174 House Officers (68.4 per cent) and 95/131 GPs (72.5 per cent). Most House Officers (78.8 per cent) and GPs (85.3 per cent) reported that they made the best possible Cause of Death statement but, respectively, 62.4 per cent and 59.3 per cent of these might modify a statement in some circumstances. Significantly more House Officers (70.3 per cent) than GPs (44.2 per cent) acknowledge room for improvement and were amenable to more training (86.6 per cent versus 52.5 per cent), but significantly fewer felt sufficiently instructed (23.7 per cent versus 52.6 per cent). Most respondents (> 90 per cent) considered accurate death certification important, but 46.2 per cent of House Officers had not read the death certificate book instructions. Knowledge was variable, especially concerning Underlying Cause of Death. Written Cause of Death statements were broadly similar in style and standard between groups. Experience did not appear to improve death certification practice. Better and co-ordinated undergraduate and early post-graduate education (which should be continuing and audited), and practical accessible guidance on death certificate completion, might improve standards of practice and performance within the existing framework. Alternative methods of presenting guidance on death certificate completion should be explored.

Misclassification of deaths caused by cocaine. An assessment by survey.

The use of U.S. vital statistics for surveillance of drug-related mortality may be limited by the way in which certifiers complete death certificates and by the constraints of the International classification of diseases, Ninth Revision (ICD-9). ICD-9 is the system used by the National Center for Health Statistics (NCHS) to compile national, cause-specific mortality data from information reported on death certificates. To investigate the extent of variability in certification practices among medical examiners (MEs), we conducted a mailout survey in which we asked a national sample of 49 MEs to review summaries of 28 death scenarios and, for each death, assign the cause and manner of death. Cocaine use was the unequivocal cause of death for 17 of the 28 deaths. We then asked a nosologist at NCHS to code the verbatim survey responses in accordance with the rules and rubrics of the ICD-9 system. Of the 20 MEs who responded, 14 provided complete cause and manner determinations. For the cocaine-caused deaths, the 14 respondents provided 238 cause-of-death statements; 220 (92.4%) explicitly mentioned cocaine. However, only 45 of the 238 responses (18.9%) led to a cocaine-specific ICD-9 code for the underlying cause of death. Our findings illustrate how death certification practices, coupled with the ambiguities of the ICD-9 system, may lead to substantial loss of detail about cocaine-caused deaths and misclassification of these deaths in official compilations of mortality statistics.

Measuring maternal mortality.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 99, Issue 7 p. 540-543 Measuring maternal mortality Erica Royston, Erica Royston Maternal Health and Safe Motherhood Programme Division of Family Health World Health Organization CH-1211, Geneva SwitzerlandSearch for more papers by this authorCarla AbouZahr, Carla AbouZahr Maternal Health and Safe Motherhood Programme Division of Family Health World Health Organization CH-1211, Geneva SwitzerlandSearch for more papers by this author Erica Royston, Erica Royston Maternal Health and Safe Motherhood Programme Division of Family Health World Health Organization CH-1211, Geneva SwitzerlandSearch for more papers by this authorCarla AbouZahr, Carla AbouZahr Maternal Health and Safe Motherhood Programme Division of Family Health World Health Organization CH-1211, Geneva SwitzerlandSearch for more papers by this author First published: July 1992 https://doi.org/10.1111/j.1471-0528.1992.tb13815.xCitations: 18Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume99, Issue7July 1992Pages 540-543 RelatedInformation

Regional differences in mortality from dementia in Australia: an analysis of death certificate data.

Australian death certificate data were analysed to determine whether they can provide useful information on regional differences in the prevalence of dementia. Strong differences between the Australian states were found in the prevalence of dementing disorders at death. However, evidence indicated that death certification practices influenced the prevalence rates found: a) the reported prevalence of various dementing disorders at death has changed greatly over quite a short period; b) the prevalence of dementing disorders at death was more strongly influenced by place of death than by place of birth; and c) the differences between states were a result of very high rates in particular regions which, in one case, could be traced to the death certification practices of a single medical practitioner. It is concluded that death certificate data are not useful for investigating regional differences in the prevalence of dementia.

Coronary heart disease in black populations I. Mortality and morbidity

Coronary heart disease is the leading cause of death among black Americans (57,999 deaths in 1977) despite the widely held belief that CHD is not common in blacks. CHD death rates were lower in black men than in white men in the United States in the 1940s but rose rapidly until they exceeded those of whites in 1968. Since 1968 CHD death rates in blacks have fallen by about 30%, to levels similar to whites but still higher than 1940 rates. Black women have higher CHD mortality than white women. The few population studies of myocardial infarction in the 1970s suggest similar or lower age-specific incidence in black than white men but higher case fatality and more out-of-hospital deaths. Trends in death certification practice and access to medical care may be of particular importance in these differences between blacks and whites.

Death certification by British doctors: a demographic analysis.

Regional differences in mortality from cardiovascular diseases, respiratory diseases, strokes, and other causes have been observed in England and Wales. To determine to what extent the death certification practices of doctors influence these variations, we surveyed 123 British general practitioners and housemen. Each doctor completed death certificates based on fictitious case histories. We found that diagnostic groupings did not vary significantly according to the doctors' region, type of practice, place of medical training, sex, or year of qualification. Doctors qualifying before 1955, however, appeared more inclined than their younger colleagues to list stomach cancer on the death certificate.