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Postgrad Med J 88:690-693 doi:10.1136/postgradmedj-2012-130912
  • Original article

Reporting of incorrect cause-of-death causal sequence on death certificates in the USA: using hypertension and diabetes as an educational illustration

  1. Ichiro Kawachi6
  1. 1Department of Medical Record and Information Management, Occupational Medicine and Neurology, Chi Mei Medical Center, Tainan, Taiwan
  2. 2Department of Occupational Safety, College of Environment, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
  3. 3Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
  4. 4Department of Leisure, Recreation and Tourism Management, Southern Tainan University of Science and Technology, Tainan, Taiwan
  5. 5NCKU Research Center for Health Data and Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  6. 6Department of Society, Human Development and Health, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
  1. Correspondence to Dr Tsung-Hsueh Lu, NCKU Research Center for Health Data and Institute of Public Health, College of Medicine, National Cheng Kung University, No 1, Dah Hsueh Road, Tainan City, Tainan 701, Taiwan; robertlu{at}mail.ncku.edu.tw
  • Received 29 February 2012
  • Accepted 14 August 2012
  • Published Online First 18 September 2012

Abstract

Background Little is known about the extent of reporting an incorrect cause-of-death (COD) causal sequence on death certificates.

Objective To determine the frequency of incorrect reporting of hypertension as cause of diabetes on death certificates in the USA.

Methods Multiple-cause mortality files were used to identify death certificates which mentioned both hypertension and diabetes in the USA from 1985 to 2005. The frequency of reporting hypertension on the line below diabetes in part I of the death certificate was calculated.

Results The percentage of cases in which both hypertension and diabetes were included in part I of the death certificate, in which hypertension was reported on the line below diabetes on the death certificate—that is, suggesting that hypertension was a cause of diabetes—increased from 15.5% in 1985 to 36.1% in 2000 and 38.2% in 2005.

Conclusions The frequency of reporting of an incorrect COD causal sequence on death certificates in the USA has increased. Education, training and questioning the opinions of certifying physicians are needed to improve the quality of reporting of COD statements.