Death Certificate Surveillance: A Component of Death Investigation

Abstract

Introduction Medical examiners/coroners serve various functions beyond the medicolegal framework, including making contributions to public safety and health. In order to effectively fulfill this role, it is essential to ensure accurate certification of each death. Materials and Methods In Vermont, the Department of Health, Vital Records Division has developed a death certificate surveillance program in which all registered deaths are reviewed by the Office of the Chief Medical Examiner (OCME). A death certificate is fagged by the OCME for further investigation when cause and manner of death statements are incomplete, erroneous, or suggest the possibility of an unnatural death. If necessary, after review, death certificates are amended. Death Certificate Review (DCR) cases between 2008 and 2011 were retrieved from the OCME database. Data were evaluated for amendments of cause and manner of death. Results The OCME reviewed all death certificates and further investigated 4.4% and amended 3.3% of all death certificates in Vermont between the years 2008–2011. Eighty-eight percent of the amended DCRs were for cause of death statements and 10% resulted in change of manner. For the latter, change from natural to accident was most frequent. Conclusions Death certificates are a major source of epidemiologic data. Ensuring complete and accurate death certification through death certificate surveillance is a small but significant contribution of the OCME to public health.

Death Certification Errors and the Effect on Mortality Statistics

“…5 The accuracy of the death certificate is paramount, but several studies have demonstrated that errors in certification are common. 4,[6][7][8][9][10][11][12][13][14][15][16] In New York City, inaccurate cause of death on certificates led to inaccurate health disparity tracking. One study of death certificates in 2008 revealed that the disparity in premature heart disease between white and black people in New York City was underestimated because hospitals that incorrectly overreported premature heart disease served larger proportions of white people than black people.…”

“…5 The accuracy of the death certificate is paramount, but several studies have demonstrated that errors in certification are common. 4,6 –16…”

“…Many medical schools do not offer formal training on death certification, and physicians learn through on-the-job experience. 2,9,10,[12][13][14]19 Studies conducted on the implementation of educational programs showed a reduction in certification error rates, 2,4,9,19 but educational programs are not routine and do not reach most certifiers (eg, physicians, advanced practice registered nurses, physician assistants). Medical Examiners, however, receive formal training on certification and complete death certificates as part of their daily work.…”