Alcohol and death certification: a survey of current practice and attitudes.

Alcohol and death certification: a survey of current practice and attitudes Official estimates ofall deaths from cirrhosis in England and Wales are lower than those in other countries with similar levels of alcohol consumption.'In addition, officially recorded death rates from alcoholic cirrhosis appear lower than rates suggested by results of clinical surveys.2These discrepancies are thought to be due largely to underrecording on death certificates, perhaps to avoid the statutory obligation (waived in July 1984) to report deaths related to alcohol to the coroner.3We have examined the recording of alcohol abuse on death certificates and factors influencing such recording. Methods and resultsAll 125 death certificates signed by the 43 preregistration housemen at Middlesex and University College Hospitals over a three month period were examined.Those with a diagnosis in which alcohol may have been aetiologically important (n=40) were selected for review of the case notes (table).Thirty eight case notes were available and were reviewed (a) to establish the accuracy of certification with special reference to alcohol and (b) to assess the adequacy of the history of alcohol consumption recorded.Diagnoses on death certificates selected for review of case notes Diagnosis No of cases Cirrhosis of the liver (two patients certified as alcoholic) 4 Carcinoma of the tongue 2 Carcinoma of the oesophagus 2 Carcinoma of the stomach 5 Carcinoma of the pancreas 5 Cardiovascular diseases 17 Cerebrovascular diseases 5We thank the house officers and the general practitioners who completed the questionnaire.1 Taylor D. Alcohol: reducing the harm.