Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19): Expanded in February 2023 to Include Guidance for Certifying Deaths Due to Post-acute Sequelae of COVID-19

Flagg, Lee Anne

doi:10.15620/cdc:124588

Cited by 3 publications

(2 citation statements)

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“…Whether confirmed by diagnostic tests or only suspected, the WHO advocates that SARS-CoV-2 infection be assigned as the UCoD when consistent clinical symptoms suggest infection, "unless there is a clear alternative cause of death that cannot be related to COVID disease" (Ibidem). Similarly, guidance in the US explicitly stipulated that pre-existing conditions that did not cause coronavirus disease "but can increase the risk of contracting a respiratory infection and death" should be reported as comorbidities 12 . However, these recommendations were not published until April 2020 and were not fully enforced until the following months of the pandemic 13 .…”

Section: Introductionmentioning

confidence: 99%

The Importance of Cause-of-Death Certification for the COVID-19 Burden Assessment: the Case of Central Europe

Fihel,

Janick,

Buschner

et al. 2024

Preprint

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Background: In Central Europe, the increase in mortality during the COVID-19 pandemic exceeded the number of deaths registered due to coronavirus disease. Miscertification of COVID-19 has been suggested as one of the possible explanations. Analysis of all mentions from death certificates allows us to identify cases where COVID-19 was reported as a contributing rather than the underlying cause of death (UCoD). Methods: Analysis of 187,000 death certificates with a COVID-19 mention from Austria, Bavaria, Czechia, Lithuania and Poland, 2020–2021. Cause of Death Association Indicators (CDAIs) and Contributing CDAIs were calculated to identify and measure the strength of associations between COVID-19, reported as UCoD or not, and all other medical mentions. Results: Death certificates reporting COVID-19 included on average more medical information than other death certificates. In 171,600 deaths with COVID-19 as the UCoD, ten groups of comorbidities and ten types of complications revealed significant and strong association with COVID-19. Further 15,700 deaths were certified with COVID-19 only as a contributing condition, of which almost 20% were assigned to typical coronavirus complications, such as cerebral infarction, Acute Myocardial Infarction, renal failure. In Austria, Bavaria, Czechia and Lithuania the reported scale of COVID-19 mortality would have been 18-27% higher had COVID-19 been coded as the UCoD in all the cases. Conclusions: Complete death certificate information allows us to assess the scale of COVID-19 miscertification and the burden of COVID-19. Deaths registered with a coronavirus comorbidity were equivalent to the total estimated excess mortality in Austria and Czech Republic, and its large proportion in Lithuania and Bavaria.

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Section: Introductionmentioning

confidence: 99%

The Importance of Cause-of-Death Certification for the COVID-19 Burden Assessment: the Case of Central Europe

Fihel,

Janick,

Buschner

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The World Health Organization (WHO) recommends that a death in a probable or confirmed COVID-19 case be reported as a death due to COVID-19, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g., unnatural deaths) [ 17 ]. According to the US Centers for Disease Control and Prevention, a death should be reported as related to COVID-19 when a confirmed COVID-19 infection results in death, or when a death in a suspected or presumed COVID-19 case without laboratory results is recorded as a death due to COVID-19 on the death certificate by a medical professional [ 18 ]. In the UK, deaths within 28 days of the confirmation of COVID-19 infection are counted as COVID-19-related deaths, and cases where the cause of death is clearly determined to be COVID-19 by a medical professional are also recommended to be counted as deaths due to COVID-19 [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for deaths associated with COVID-19 according to the cause of death classification in Republic of Korea

Kim

Lee

et al. 2023

PHRP

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Objectives: This study aimed to classify coronavirus disease 2019 (COVID-19)-related deaths according to whether COVID-19 was listed as the cause of death, and to investigate the differences in demographic characteristics and risk factors for COVID-19 death classifications.Methods: A total of 5,625 deaths in South Korea among patients with confirmed COVID-19 from January 20, 2020 to December 31, 2021 were selected. Excluding false reports and unnatural deaths, 5,597 deaths were analyzed. Based on death report data, deaths were classified according to whether the cause of death was listed as COVID-19 (CD) or not (NCD). The epidemiological characteristics and causes of deaths were investigated using descriptive, univariate, and multivariate statistical analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to analyze the risk factors.Results: The case fatality ratio was 0.89% and increased with age. Additionally, 96.4% of the subjects had an underlying disease, and 53.4% died in winter. The proportion of NCDs was 9.3%, of whom 19.1% died at home and 39.0% were confirmed to have COVID-19 after death. Malignant neoplasms (102/416 vs. 637/4,442; OR, 1.71; 95% CI, 1.36−2.16; p<0.001) were significantly associated with NCD.Conclusion: This is the first study to analyze risk factors by cause of death using COVID-19 death report data in South Korea. These results are expected to be used as evidence for establishing a death monitoring system that can collect timely information in a new infectious disease pandemic.

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Unrecognised COVID-19 deaths in central Europe: The importance of cause-of-death certification for the COVID-19 burden assessment

Fihel,

Janicka,

Buschner

et al. 2024

PLoS ONE

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Objective In Central Europe, the increase in mortality during the COVID-19 pandemic exceeded the number of deaths registered due to coronavirus disease. Excess deaths reported to causes other than COVID-19 may have been due to unrecognised coronavirus disease, the interruptions in care in the overwhelmed health care facilities, or socioeconomic effects of the pandemic and lockdowns. Death certificates provide exhaustive medical information, allowing us to assess the extent of unrecognised COVID-19 deaths. Materials and methods Data from 187,300 death certificates with a COVID-19 mention from Austria, Bavaria (Germany), Czechia, Lithuania and Poland, 2020–2021, was used. The two step analysis uses Cause of Death Association Indicators (CDAIs) and Contributing CDAIs to identify and measure the statistical strength of associations between COVID-19 and all other medical mentions. Results 15,700 deaths were reported with COVID-19 only as a contributing condition (comorbidity). In three cases out of four, a typical, statistically significant coronavirus complication or pre-existing condition was registered as the underlying causes of death. In Austria, Bavaria, Czechia and Lithuania the scale of COVID-19 mortality would have been up to 18–27% higher had COVID-19 been coded as the underlying cause of death. Unrecognised coronavirus deaths were equivalent to the entire surplus of excess mortality beyond registered COVID-19 deaths in Austria and the Czech Republic, and its large proportion (25–31%) in Lithuania and Bavaria. Conclusions Death certificates with typical coronavirus complications or comorbidities as the underlying causes of death and contributing COVID-19 mentions were plausibly unrecognized coronavirus deaths.

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Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19): Expanded in February 2023 to Include Guidance for Certifying Deaths Due to Post-acute Sequelae of COVID-19

Abstract: "This report provides guidance to death certifiers on proper cause-of-death certification for cases where confirmed or suspected COVID–19 infection resulted in death. "

Cited by 3 publications

References 0 publications

The Importance of Cause-of-Death Certification for the COVID-19 Burden Assessment: the Case of Central Europe

The Importance of Cause-of-Death Certification for the COVID-19 Burden Assessment: the Case of Central Europe

Risk factors for deaths associated with COVID-19 according to the cause of death classification in Republic of Korea

Unrecognised COVID-19 deaths in central Europe: The importance of cause-of-death certification for the COVID-19 burden assessment

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