To what extent is dementia underreported on british death certificates?

Of 1042 elderly people randomly sampled from the community in a longitudinal study of ageing, 512 had died in the period 1985–1994, with 44 of these deaths occurring among respondents who, at clinical interview, met DSM‐III‐R criteria for dementia. The presence of dementia, however, was recorded on only 15 (34%) of the 44 death certificates from this group. This low level of recording was not significantly related to the patient's gender, age or place of death. The likelihood of dementia being recorded was also unrelated to date of death, with earlier (1985–1990) and later (1990–1994) certificates showing similar levels of non‐recording. Analyses of all 512 certificates showed that cases of dementia were 2.5 times more likely than the non‐demented to have bronchopneumonia recorded as a principal cause of death. These results confirm earlier links between dementia and death from respiratory disease but suggest that, when assessed in random community samples, the extent to which dementia is under reported on British death certificates is greater than previously estimated.