On a Kentucy Death Certificate the Cause of Death Was Improper Feeding What Does That Mean

• Journal List
• Public Health Rep
• v.132(6); Nov-Dec 2017
• PMC5692167

Public Health Rep. 2017 Nov-Dec; 132(6): 669–675.

Death Certification Errors and the Effect on Mortality Statistics

Lauri McGivern, MPH, ¹ Leanne Shulman, MS,¹ Jan K. Carney, MD, MPH,² Steven Shapiro, MD,¹ and Elizabeth Bundock, MD, PhD¹

Lauri McGivern

¹Office of the Chief Medical Examiner, Vermont Department of Health, Burlington, VT, USA

Leanne Shulman

¹Office of the Chief Medical Examiner, Vermont Department of Health, Burlington, VT, USA

Jan K. Carney

²Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA

Steven Shapiro

¹Office of the Chief Medical Examiner, Vermont Department of Health, Burlington, VT, USA

Elizabeth Bundock

¹Office of the Chief Medical Examiner, Vermont Department of Health, Burlington, VT, USA

Abstract

Objective:

Errors in cause and manner of death on death certificates are common and affect families, mortality statistics, and public health research. The primary objective of this study was to characterize errors in the cause and manner of death on death certificates completed by non–Medical Examiners. A secondary objective was to determine the effects of errors on national mortality statistics.

Methods:

We retrospectively compared 601 death certificates completed between July 1, 2015, and January 31, 2016, from the Vermont Electronic Death Registration System with clinical summaries from medical records. Medical Examiners, blinded to original certificates, reviewed summaries, generated mock certificates, and compared mock certificates with original certificates. They then graded errors using a scale from 1 to 4 (higher numbers indicated increased impact on interpretation of the cause) to determine the prevalence of minor and major errors. They also compared International Classification of Diseases, 10th Revision (ICD-10) codes on original certificates with those on mock certificates.

Results:

Of 601 original death certificates, 319 (53%) had errors; 305 (51%) had major errors; and 59 (10%) had minor errors. We found no significant differences by certifier type (physician vs nonphysician). We did find significant differences in major errors in place of death (P < .001). Certificates for deaths occurring in hospitals were more likely to have major errors than certificates for deaths occurring at a private residence (59% vs 39%, P < .001). A total of 580 (93%) death certificates had a change in ICD-10 codes between the original and mock certificates, of which 348 (60%) had a change in the underlying cause-of-death code.

Conclusions:

Error rates on death certificates in Vermont are high and extend to ICD-10 coding, thereby affecting national mortality statistics. Surveillance and certifier education must expand beyond local and state efforts. Simplifying and standardizing underlying literal text for cause of death may improve accuracy, decrease coding errors, and improve national mortality statistics.

Keywords: death certificate, errors, mortality statistics, ICD coding, cause of death

The National Center for Health Statistics (NCHS) reported >2.5 million deaths in the United States in 2013, each of which generated a death certificate. ¹ The death certificate is a legal document that serves multiple purposes, such as providing families with the cause and manner of death and being required to settle estates, insurance, and other survivor benefits. ² Death certificates have a direct effect on legal proceedings, civil and criminal, and provide important evidence in court. In civil cases, death certificates are used in personal injury actions, health care liability claims, and insurance and workers' compensation claims. ³

Death certificates also have far-reaching effects on families, education programs, health surveillance, public health research and funding, policy, and health statistics. Death certificates track the health of a population and guide the allocation of resources for research and health programs. ⁴ During Hurricane Sandy, the Red Cross used death certificates to track fatalities related to the storm to provide assistance to surviving family members, including counseling, emergency housing, and other disaster-related needs. ⁵ The accuracy of the death certificate is paramount, but several studies have demonstrated that errors in certification are common. ^{4,6 –16}

In New York City, inaccurate cause of death on certificates led to inaccurate health disparity tracking. One study of death certificates in 2008 revealed that the disparity in premature heart disease between white and black people in New York City was underestimated because hospitals that incorrectly overreported premature heart disease served larger proportions of white people than black people. ¹⁷ In a study by Yin et al, misclassification of colon and rectal cancer deaths on death certificates affected estimated survival rates. The study compared cancer site data from the California Cancer Registry with cause of death on death certificates between 1993 and 1995 and found misclassification in 700 of 11 404 (6%) colon cancer deaths and 1958 of 5011 (39%) rectal cancer deaths, of which 1605 of 1958 (82%) were misclassified as colon cancer. When deaths were reclassified correctly, the cause-specific survival rate for colon and rectal cancer decreased. ¹⁸

Physicians and other health care professionals are responsible for completing the medical certification (ie, cause and manner of death) on death certificates but often lack proper training and experience to do so. Many medical schools do not offer formal training on death certification, and physicians learn through on-the-job experience. ^{2,9,10,12 –14,19} Studies conducted on the implementation of educational programs showed a reduction in certification error rates, ^2,4,9,19 but educational programs are not routine and do not reach most certifiers (eg, physicians, advanced practice registered nurses, physician assistants). Medical Examiners, however, receive formal training on certification and complete death certificates as part of their daily work.

The primary objective of this study was to characterize errors in cause and manner of death reported on the death certificate among non–Medical Examiners. A secondary objective was to compare International Classification of Diseases, 10th Revision (ICD-10) ²⁰ coding to analyze the effect of errors in cause of death on death certificates on the 113 Selected Causes of Death and Rankable Causes of Death ²¹ to determine how these errors affect national statistics.

Methods

We randomly selected 750 cases from death certificates completed by non–Medical Examiners in the Vermont Electronic Death Registration System (EDRS) ²² between July 1, 2015, and January 31, 2016, using a data management system called Crystal Reports, version 11.0. ²³ Of the 750 cases, we completed a retrospective review on 601 (80%) certificates that met inclusion criteria (ie, non–Medical Examiner case, appropriate medical information to determine cause of death, medical records within 3 months of death, medical records received during the study period). We had no inclusion or exclusion criteria for place of death. We abstracted data on demographic characteristics (name, age, date of birth, date and time of death, location and place of death), cause and manner of death (including cause and contributory causes), and certifier type (physician, advanced practice registered nurse, physician assistant) from the original certificates to Microsoft Excel.

We requested medical records on all cases. Cases were randomly assigned for review to 1 of 5 nationally certified medicolegal death investigators who are registered nurses and routinely review medical records and write reports for the purpose of cause and manner of death determination by the Office of the Chief Medical Examiner (OCME). Blinded to the original certification, they reviewed the records, abstracted and summarized the medical history and circumstances of death, and generated a report.

The investigator report (without patient-identifying data or information on original certification) was submitted to 2 physician Medical Examiners for their determination of cause, contributory cause(s), and manner of death. We entered the Medical Examiners' determinations into the study database. Medical Examiners met to review cases and develop a mock death certificate (including cause, contributory cause[s], and manner of death) by consensus. This study was deemed not human research and considered exempt by the University of Vermont Internal Review Board.

Statistical Analysis

We compared mock certificates with original certificates and classified errors by using a standard error analysis form. We analyzed errors and graded them on a scale from 1 to 4, with 4 being the most severe, based on a similar scale used to assess certification errors in a previous Vermont university–affiliated hospital study ⁶ :

• Grade 1: Minor error (limited impact on interpretation)

  • 1a. Inappropriate information included on death certificate

  • 1b. Abbreviations

• Grade 2: Minor error (potential impact on interpretation)

  • 2a. Errors of sequencing (regardless of whether an underlying cause was provided)

  • 2b. Multiple underlying causes of death in Part I

• Grade 3: Major error (impact on interpretation of contributing causes)

  • 3a. Major comorbidities/contributing cause(s) absent or wrong

• Grade 4: Major error (impact on interpretation of cause and manner of death)

  • 4a. Underlying cause listed as contributory cause (in Part II)

  • 4b. No underlying cause in Part I

  • 4c(1). Wrong underlying cause

  • 4c(2). Underlying cause not on last line of Part I

  • 4d. Wrong manner of death

We analyzed the prevalence of each error by using 2 variables: (1) qualification of certifier (physician or nonphysician) and (2) place of death (nonhospital facility [nursing home, long-term care facility, or hospice], hospital [inpatient, emergency department, outpatient, or intensive care unit], or private residence). We used the Pearson χ² goodness-of-fit test for uniform distribution across the categories of each independent variable (qualification of certifier, place of death) to determine if any 2 categories differed significantly in error prevalence. If we detected a significant deviation from the uniform distribution of error rates, we completed pairwise comparisons with z tests using a Bonferroni correction for multiple comparisons. We performed all analyses using Microsoft Excel, with α = .05 considered significant.

We compared ICD-10 coding for the original certificates with coding for the mock certificates in 580 of the 601 cases. In 21 cases, the original certificate was amended by the OCME before records were sent to NCHS for initial coding; therefore, original coding was not available. According to routine vital records procedures, original certifications were coded by NCHS through ICD-10 cause-of-death lists for tabulating mortality statistics ²⁰ ; codes returned from NCHS were extracted from the Vermont EDRS. We sent the literal text of the mock certificates to NCHS, which followed the same ICD-10 coding protocol. NCHS returned codes for each certificate, and we entered them in the study database. We analyzed differences in order of codes, number of codes, and specific codes generated from original and mock certificates. We assessed the potential effect of certificate errors on national statistics by examining how the difference in underlying cause-of-death code affected the 113 Selected Causes of Death list and the Rankable Causes of Death list, which are used by NCHS to tabulate and disseminate mortality statistics. ²¹

Results

Error Analysis

Of the 601 original death certificates examined, 319 (53%) had errors; 305 (51%; 95% CI, 47%-55%) had major errors; and 59 (10%; 95% CI, 7%-12%) had minor errors. Most certificates with minor errors also had major errors; only 14 certificates had minor errors but no major errors (Table 1).

Table 1.

Errors and grades of errors on 601 randomly selected death certificates completed by non–Medical Examiners (physicians, advance practice registered nurses, and physician assistants), Vermont, July 1, 2015, to January 31, 2016

		Death Certificates With Error
Error	Grades of Errora	No.	% (95% CI)
Any errors	—	319	53 (49-57)
Major errorb	3 and 4	305	51 (47-55)
Minor errorc	1 and 2	59	10 (7-12)
Inappropriate information included	1a	21	3 (2-5)
Abbreviations used	1b	5	1 (0-2)
Errors of sequencing	2a	33	5 (4-7)
Multiple UCOD in Part Id	2b	22	4 (2-5)
Major comorbidities error	3a	232	39 (35-42)
Correct UCOD not in Part Id	4a	158	26 (23-30)
No UCOD in Part Id	4b	92	15 (12-18)
Wrong UCOD on death certificate	4c	107	18 (15-21)
UCOD not on the last lined	4c	174	29 (25-33)
Wrong manner of death	4d	22	4 (2-5)

We found no significant difference between physician and nonphysician certifiers in the percentage of certificates with major errors (51% vs 48%) or minor errors (9% vs 13%). We found a significant difference in the percentage of certificates with major errors (but not minor errors) by place of death. Certificates for deaths in hospitals were more likely to have major errors than certificates for deaths in a private residence (59% vs 39%, P < .001). Certificates indicating deaths in a nonhospital facility were also more likely to have major errors than certificates indicating deaths in a private residence (53% vs 39%, P = .006) (Table 2).

Table 2.

Rates of minor and major errors by place of death in 601 randomly selected death certificates completed by non–Medical Examiners (physicians, advanced practice registered nurses, and physician assistants), Vermont, July 1, 2015, to January 31, 2016

		Death Certificates With Errors
Error Typea: Place of Death	Total No. of Death Certificates	No.	% (95% CI)	P Valueb
Majorc				<.001
Nursing home, long-term care facility, or hospice	188	100	53 (46-60)
Hospital (inpatient, emergency department, outpatient, or intensive care unit)	212	126	59 (53-66)
Private residence	199	78	39 (32-46)
Minord				.92
Nursing home, long-term care facility, or hospice	188	18	10 (5-14)
Hospital (inpatient, emergency department, outpatient, or intensive care unit)	212	20	9 (5-13)
Private residence	199	20	11 (6-15)

Before consensus, Medical Examiners were discordant for underlying cause of death in 71 of 601 (12%) mock certificates and for contributory causes of death in 149 of 601 (25%) mock certificates. Fifty-five percent of Medical Examiner discordance in underlying cause of death was due to inversion of cause and contributory cause. Therefore, notable discordance due to differences of medical opinion occurred in only 32 of 601 (5%) mock certificates.

Coding Comparison

Of 580 death certificates, 537 (93%) had a difference in ICD-10 codes between the original certificates and mock certificates, and 348 (60%) had a change in the underlying cause-of-death code (Table 3). Of these 348 cases, 231 (66%) had at least 1 type of error, most commonly a grade 4 error (221 of 231); the other 117 cases did not have a certification error but did have a change in underlying cause-of-death ICD-10 code. Of the 117 certificates without a certification error, 80 (68%) of the underlying cause-of-death ICD-10 code changes were associated with a variation in literal text between original certificates and mock certificates; 18 (15%) were caused by inconsistent coding; 13 (11%) were caused by cause of death and contributory cause of death being reversed between original certificates and mock certificates; 3 (3%) had a mechanism coded; and 3 (3%) were not coded from the last line. A few certificates had nearly identical original and mock certificates but were coded differently.

Table 3.

Change in UCOD ICD-10 code affecting the 113 Selected Causes of Death^a and the Rankable Causes of Death^b after comparison of original and mock death certificates,^c Vermont, July 1, 2015, to January 31, 2016

	Death Certificates
Type of Change in UCOD ICD-10 Code	Total No.	No. (%) With Change
Any change	580	348 (60)
UCOD code change that affects the 113 Selected Causes of Death	348	289 (83)
UCOD code change that affects the Rankable Causes of Death	348	169 (49)

Of the 348 cases with an underlying cause-of-death code change, 289 (83%) would have affected the 113 Selected Causes of Death list, meaning that the change in code resulted in the death being categorized as a different cause according to the 113 Selected Causes of Death groupings (Table 3). A total of 169 of 348 (49%) cases with an underlying cause-of-death ICD-10 code change would have changed categories in the Rankable Causes of Death list. We examined how various types of literal text errors in the underlying cause of death affect the 113 Selected Causes of Death and rankable cause categories (Table 3). Absence of the correct underlying cause of death in Part I (141 certificates) resulted in a category change in the 113 Selected Causes of Death list in 115 (82%) certificates and a category change in the Rankable Causes of Death list in 90 (64%) certificates. Ninety-one certificates did not have the correct underlying cause of death anywhere on the certificate, which resulted in a change in the 113 Selected Causes of Death list in 79 (87%) certificates and a category change in the Rankable Causes of Death list in 57 (63%) certificates. A total of 156 certificates did not have the underlying cause of death as the last line of Part I, which resulted in a category change in the 113 Selected Causes of Death list in 128 (82%) certificates and a category change in the Rankable Causes of Death list in 99 (63%) certificates.

Discussion

Our study, which used Medical Examiner determinations based on medical records as the gold standard, indicated a large percentage of errors in death certificates completed by non-Medical Examiners. Error rates between physician and nonphysician certifiers were not significantly different. This finding was not surprising, because neither group receives formal training in certification and both groups have the same requirement to read an abbreviated tutorial during registration for use of the Vermont EDRS.

Previous studies of death certification errors did not use clearly defined rating scales, making it difficult to compare them with our study. Our finding that death certificates for hospital deaths had a higher percentage of major errors (59%) compared with previous studies in the same setting that reported rates of 24% to 45%. ^4,6,13,15 Some discrepancy in percentage of major errors was likely caused by differing methodologies and definitions of major errors. For example, Myers et al ⁴ found major errors (defined as no underlying cause of death, sequencing errors or no underlying cause of death on the last line, or multiple competing causes) on 48 of 146 (32%) certificates issued by internal medicine residents. If we had used a similar definition, the percentage of errors in our study would have been comparable. The methodology and error classification scheme in Pritt et al was the closest to the one we used, but they did not classify errors in the contributory cause as major. They found that 34% of death certificates reviewed had a major error. ⁶ Our study classified absent or wrong major contributory causes of death as a major error, which we felt was important because contributory causes of death are used in algorithms to determine underlying causes of death. The leading preventable causes of death, such as obesity and diabetes, are often contributory causes of death, ^{24 –26} and using this information provides a more accurate, literature-based, and public health perspective. If major error was redefined as only grade 4 errors (wrong or absent underlying cause of death in Part I, underlying cause of death not on last line, or wrong manner), then the percentage of major errors in our study would be 30%.

Overall, we found significantly fewer minor errors than major errors (10% vs 51%). The Vermont EDRS prompts certifiers to avoid the use of abbreviations, but other minor errors tabulated in this study (eg, inappropriate information, errors of sequencing, and multiple causes in Part I) are not detected by Vermont EDRS prompts. We classified errors of sequencing and multiple underlying causes in Part I as minor errors because they were expected to have only a minimal effect on the overall interpretation of the cause from reading the literal text. But, from a coding standpoint, the errors potentially have a significant effect. The most egregious sequencing error, not having the underlying cause of death as the last line, was therefore considered a major error. Indeed, when this error type was present, it most often caused a category change in the 113 Selected Causes of Death and Rankable Causes of Death lists.

Inaccuracies in death certification are common, but our findings indicate that Vermont has a similar or higher percentage of major errors compared with other regions as reported in the literature. ^4,6,13,15 The OCME takes an active role in reviewing all death certificates and providing feedback to certifiers either through email or a telephone call. The OCME offers education to medical students, pathology residents, and interns on proper death certification. Vermont's EDRS requires first-time users to complete a brief tutorial about death certification. EDRS provides feedback to certifiers through "soft" and "hard" edits when information is missing or a cause is nonspecific or suggests a nonnatural death. The edits require the certifier to stop and review the cause of death for accuracy, completeness, and Medical Examiner consideration. Despite these efforts, the error rate is still high.

The potential impact of certification errors and changes in ICD-10 underlying cause-of-death codes on mortality statistics was large and unexpected. The underlying cause of death changed in 60% of certificates. Eighty-three percent of these changes would have affected the 113 Selected Causes of Death list, and almost half would have affected the Rankable Causes of Death list. Although certification errors and variations in certification style were the primary reasons for code changes, the coding process clearly contributed. In 34% of cases in which the ICD-10 code for underlying cause of death changed, our grading scheme detected no error of certification. The reason for code change was most frequently variation in literal text that affected nosologists' interpretation. Accurate certification is the foundation for good epidemiologic data, but the certification error rate is not directly proportional to the error of mortality statistics, because nosologist interpretation and coding algorithms (manual vs automated coding) may mitigate some certification errors and introduce other errors. A more in-depth analysis of the effect of certification errors in the context of coding algorithms is needed.

Strengths

This study was unique for several reasons. The use of original medical records rather than coded data or problem lists and the use of physician reviewers with expertise in death certification provided optimal retrospective evaluation. We used a clearly defined error scale, which can be adjusted to allow for comparison or use in future studies. In Vermont, all death certificates are entered into the EDRS and reviewed by the OCME as part of routine death surveillance and improvement of certificate quality and completeness. Many Medical Examiner and coroner offices lack the personnel and resources to perform such comprehensive surveillance. Unlike previous studies, this study was not limited to specific populations by selection for place of death, certifier type, or major cause category. In addition, similar studies to assess error rates in death certification do not include the effects on ICD-10 coding and mortality statistics.

Limitations

This study also had several limitations. Vermont is unique in that it has 1 centralized office with the ability to review all death certificates in the state through an electronic death registry and either amend certificates directly or provide feedback to certifiers to improve quality. Therefore, the results from this study may not be generalizable to jurisdictions that do not have a similar system, available personnel, funding, or access to an electronic death registry. Certificates for deaths in a private residence had a significantly lower percentage of major errors (39%) than certificates for deaths in hospital and nonhospital facilities (59% and 53%, respectively). However, these findings may have been affected by sampling bias caused by exclusion criteria and may be generalized only to cases that have adequate medical records. Therefore, we cannot draw a strong conclusion. No studies on death certification errors in private residences or nonhospital facilities have been published, so comparisons cannot be made.

Our determination of cause and manner of death was limited by the quality of medical records. We excluded many death certificates because of inadequate documentation, which was most apparent in deaths at long-term care facilities and nursing homes, where many records were handwritten and difficult to read. The high exclusion rate from nonhospital facilities may have falsely reduced the reported number of errors. Some discrepancies between original and mock certifications may have been caused by differences in medical opinion rather than overt error, particularly in multifactorial deaths with several major medical conditions. However, mock certification by consensus limited this sort of error.

Conclusions

Implementation of the Vermont EDRS in 2008 has improved timeliness and reduced errors, but Vermont still has a high error rate despite active interventions to improve quality. Jurisdictions with less active efforts may have even higher error rates. Errors in certification are further compounded by errors in coding. Death certificate surveillance must expand beyond efforts by local vital records departments and Medical Examiner and coroner offices. Methods to further improve quality may include comprehensive reviews of hospitals' own death certificates with internal feedback to certifiers, similar to other ongoing quality improvement initiatives. Standardizing or simplifying underlying cause-of-death literal text on the death certificate may also improve accuracy and decrease coding errors, thereby improving national mortality statistics.

Further research is needed in several related areas. Research on death certification errors that occur outside of an academic setting or hospital is limited. Similar studies in other regions of the country, with different systems, may shed light on the extent of the problem in the United States. In our experience, education and outreach have a negligible effect on the quality and accuracy of cause-of-death statements. The effectiveness of educational programs should therefore be evaluated before implementation. More studies are needed to evaluate the relative contributions of death certification and coding errors on national mortality statistics.

Footnotes

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Vital Statistics Cooperative Program contract between the Centers for Disease Control and Prevention and the Vermont Department of Health. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of Centers for Disease Control and Prevention.

References

1. Xiu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep. 2016;64(2):1–119. [PubMed] [Google Scholar]

2. Brooks EG, Reed KD. Principles and pitfalls: a guide to death certification. Clin Med Res. 2015;13(2):74–82. [PMC free article] [PubMed] [Google Scholar]

4. Myers KA, Farquhar DR. Improving the accuracy of death certification. CMAJ. 1998;158(10):1317–1323. [PMC free article] [PubMed] [Google Scholar]

5. Casey-Lockyer M, Heick RJ, Mertzlufft CE, et al. Deaths associated with Hurricane Sandy—October-November 2012. MMWR Morb Mortal Wkly Rep. 2013;62(20):393–397. [PMC free article] [PubMed] [Google Scholar]

6. Pritt BS, Hardin NJ, Richmond JA, Shapiro SL. Death certification errors at an academic institution. Arch Pathol Lab Med. 2005;129(11):1476–1479. [PubMed] [Google Scholar]

7. Fischtein D, Cina SJ. Errors on death certificates requiring amendments: the Broward County experience. Am J Forensic Med Pathol. 2011;32(2):146–148. [PubMed] [Google Scholar]

8. Croft PR, Lathrop SL, Zumwalt RE. Amended cause and manner of death certification: a six-year review of the New Mexico experience. J Forensic Sci. 2006;51(3):651–656. [PubMed] [Google Scholar]

9. Middleton D, Anderson R, Billingsly T, Virgil NBM, Wimberly Y, Lee R. Death certification: issues and interventions. Open J Prev Med. 2011;1(3):167–170. [Google Scholar]

10. Tatsumi K, Shapiro S, Bundock E. Death certificate surveillance: a component of death investigation. Acad Forensic Pathol. 2013;3:99–104. [Google Scholar]

11. Hanzlick R. Quality assurance review of death certificates: a pilot study. Am J Forensic Med Pathol. 2005;26(1):63–65. [PubMed] [Google Scholar]

12. Cambridge B, Cina SJ. The accuracy of death certificate completion in a suburban community. Am J Forensic Med Pathol. 2010;31(3):232–235. [PubMed] [Google Scholar]

13. Smith Sehdev AE, Hutchins GM. Problems with proper completion and accuracy of the cause-of-death statement. Arch Intern Med. 2001;161(2):277–284. [PubMed] [Google Scholar]

14. Wexelman BA, Eden E, Rose KM. Survey of New York City resident physicians on cause-of-death reporting, 2010. Prev Chronic Dis. 2013;10:E76. [PMC free article] [PubMed] [Google Scholar]

15. Cina SJ, Selby DM, Clark B. Accuracy of death certification in two tertiary care military hospitals. Mil Med. 1999;164(12):897–899. [PubMed] [Google Scholar]

16. Nashelsky MB, Lawrence CH. Accuracy of cause of death determination without forensic autopsy examination. Am J Forensic Medic Pathol. 2003;24(4):313–319. [PubMed] [Google Scholar]

17. Johns LE, Madsen AM, Maduro G, Zimmerman R, Konty K, Begier E. A case study of the impact of inaccurate cause-of-death reporting on health disparity tracking: New York City premature cardiovascular mortality. Am J Public Health. 2013;103(4):733–739. [PMC free article] [PubMed] [Google Scholar]

18. Yin D, Morris CR, Bates JH, German RR. Effect of misclassified underlying cause of death on survival estimates of colon and rectal cancer. J Natl Cancer Inst. 2011;103(14):1130–1133. [PubMed] [Google Scholar]

19. Degani AT, Patel RM, Smith BE, Grimsley E. The effect of student training on accuracy of completion of death certificates. Med Educ Online. 2009;14:17. [PMC free article] [PubMed] [Google Scholar]

20. Centers for Disease Control and Prevention, National Center for Health Statistics. International Classification of Diseases, Tenth Revision (ICD-10) https://www.cdc.gov/nchs/icd/icd10.htm. Accessed August 30, 2017.

21. Centers for Disease Control and Prevention, National Center for Health Statistics. Instruction manual, part 9: ICD-10 cause-of-death lists for tabulating mortality statistics (updated 2002 to include ICD codes for terrorism deaths for data year 2001 and WHO updates to ICD-10 for data year 2003). https://www.cdc.gov/nchs/data/dvs/im9_2002.pdf.pdf. Published 2002. Accessed September 6, 2016.

23. Business Objects Software Ltd. SAP Crystal Reports Version 11.0. Dublin, Ireland: Business Objects Software Ltd; 2004. [Google Scholar]

25. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104(3):512–519. [PMC free article] [PubMed] [Google Scholar]

26. Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4):e1000058. [PMC free article] [PubMed] [Google Scholar]

---

Articles from Public Health Reports are provided here courtesy of SAGE Publications

---

lesageupcome.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5692167/

Share this post