Accuracy of Death Certification in an Autopsied Population With Specific Attention to Malignant Neoplasms and Vascular Diseases

Accuracy of certification of underlying cause of death and implications for US mortality statistics were assessed among 257 autopsied cases collected during the calendar year 1970 at a short-stay general hospital in Atlanta, GA. Clinicopathologic cause of death (CPCD) certificates, with assignment of underlying cause of death based on autopsy findings in combination with pertinent clinical data, were prepared by a pathologist and were employed as a standard of comparison against which the accuracy of the underlying cause of death on the original death certificate was measured. Results suggest that autopsy findings are not necessarily used to supplement clinical data in filling out death certificates. Improper recording of underlying cause of death was found in 42% of the autopsied cases. Malignant neoplasms were found to be underreported and vascular diseases overreported, each by approximately 10%, when original certificates were compared to CPCD certificates. The confirmation rate for original death certificate diagnoses was 89%. In the case of a confirmed diagnosis, the underlying cause of death was substantiated by postmortem findings as having existed regardless of its role in the sequence of events leading to death. The underlying cause of death as assigned by the pathologist was listed on the original death certificate among the sequence of events leading to or contributing to death at the rate of 72% (i.e., this rate measures the sensitivity of the death certificate).