Trends in Frequency of Reporting Improper Diabetes-related Cause-of-Death Statements on Death Certificates, 1985-2005: An Algorithm to Identify Incorrect Causal Sequences

This study aimed to examine the changes in frequency of reporting improper diabetes-related cause-of-death statements on death certificates based on Multiple-Cause Mortality Files of the United States from 1985 to 2005. An algorithm was developed to identify the causes of death with incorrect causal sequences by using decision tables developed by the National Center for Health Statistics. In 1985, 2 or more diagnoses per line were reported on 35% of death certificates with mention of diabetes in Part I of the death certificate. This percentage decreased to 19% in 2005. In contrast, the prevalence of reporting incorrect causal sequences on death certificates on which diabetes was reported in Part I increased from 22% in 1985 to 35% in 2005. The authors suggest that the most plausible explanation of increasing reporting of incorrect causal sequences was the drastic increase of reporting multiple conditions (especially cardiovascular diseases and cancers) among deaths with mention of diabetes, which made the determination of underlying cause of death much more difficult.