Nearly Half of Death Certificates List Inaccurate Cause of Death

Data from Missouri shows that 45.8% of death certificates indicated an underlying cause of death "inconsistent with CDC's guidelines for death certificate completion."

Nearly half of the death certificates filed by a group of Missouri hospitals were inaccurate, according to a study from The Centers for Disease Control and Prevention.

Data from hospitals with high inpatient death rates between 2009 and 2012 revealed that 45.8% of death certificates indicated "an underlying cause of death that was inconsistent with CDC's Guidelines for Death Certificate completion."

The results appeared in the January 17 issue of the agency's Morbidity and Mortality Report.

The study looked at data from eight hospitals with high death rates in two metro areas, Kansas City and St. Louis. The CDC's data on national inpatient hospital death rates was used as a benchmark.

The Importance of Knowing Exactly Why We Die

The death certificates were obtained from the Missouri Department of Health and Senior Services Vital Statistics Bureau.

A total of 205 medical charts were randomly selected for review from three disease categories:

• Heart disease
• Cancer
• Renal disease

Only 181 (88%) were reviewed because charts were unavailable or incomplete for 24 patients.

Researchers focused on the three conditions because reported deaths from these conditions were substantially higher in Missouri than in the rest of the United States.

The underlying cause of death was based on a comparison of the chart review with the cause of death recorded on the death certificate. A physician and an epidemiologist examined the certificates for compliance with CDC guidelines.

Researchers found overreporting of heart disease and renal disease and underreporting of cancer as the cause of death.

"Accuracy of death certificates is of paramount importance, considering that such data are widely used to direct public health projects as well as to fund hospital-based programs and clinical research," the report stated.

"However, several studies have demonstrated that death certificates are often completed incorrectly, leading to inaccurate mortality statistics being ascertained from death records."

The CDC researchers note that as a result of the agency's findings, Missouri has adopted a web-based training program on death certificate completion based on the CDC guidelines.