51% of Vermont death certificates list wrong cause of death, study finds

More than half of all death certificates signed by someone other than a medical examiner list the wrong cause of death, which affects families, mortality statistics and public health research, according to a study published in Public Health Reports.

Here are five things to know:

1. For the study, researchers used the Vermont Electronic Death Registration System to identify 601 death certificates filled out between July 1, 2015, to January 31, 2016. Researchers then compared these death certificates to clinical summaries from each individual's medical records. Medical examiners, blind to the original certificates, read the clinical summaries and created "mock certificates," which were then compared with the original certificates. The medical examiners then graded the original certificates with the mock copies on a scale of 1 to 4 to indicate minor or major errors.  

2. Of the 601 original death certificates, 53 percent had errors, 51 percent had major errors and 10 percent had minor errors. Researchers found major differences in errors based on place of death, but not by certifier type. Certificates from deaths that occurred in hospitals were more prone to major errors than certificates from deaths that occurred in private residences.  

3. Researchers concluded the high error rate in certificates affect national mortality statistics and require higher surveillance and standards.  

4. Inaccurate death certificates also cause health conditions to be disproportionately over- or underreported, which can influence public health officials' decisions to overlook or underfund public health programs and initiatives, according to OZY.

"We don't really have a good sense for how accurate death certificates are,” admits Anderson. Based on "well-conducted studies," Bob Anderson, chief of the mortality statistics branch at the National center for Health Statistics, told OZY. Mr. Anderson estimates inaccurate nationwide causes of death between 20 to 30 percent.

5. Inadequate physician training may also influence incorrect death certificates. A 2013 study published in Preventing Chronic Disease found about half of New York City residents knowingly reported inaccurate causes of death.

"Most doctors don't wake up in the morning and think, 'I want to lie on a death certificate today' … Everyone's trying to be as accurate as possible," Barbara Wexelman, MD, a breast surgeon at Cincinnati-based TriHealth Cancer Institute, told OZY. "Many times, we don't know why a patient died, but the system sort of forces you to put something, and that may not be the most accurate diagnosis."

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