SOCIODEMOGRAPHIC CORRELATES OF MULTIPLE CAUSES OF DEATH - REAL OR ARTIFACTUAL

The socio-demographic and epidemiological correlates of the total numb er of causes of death (TC) reported on death certificates were examine d with multiple classification analysis (MCA). The data were all death certificates on white and black adult residents of Michigan who died at ages 25 or older in 1989 to 1991 (n = 222,763). TC was the sum of e very morbid condition named as an underlying, intermediate, or immedia te cause of death. or other medical condition contributing to death bu t not to its underlying cause. Autopsies performed for non-forensic re asons by physicians who are not Medical Examiners (MEs) likely yield t he most accurate diagnoses of the underlying medical cause and counts of all other attendant causes, but they are extremely selective of dec edents who are most closely integrated into the health care system. Th us we required a socio-demographic pattern in TCs to appear in a multi variate analysis not only for this special group of autopsied decedent s but also for the non-autopsied masses before accepting the pattern a s 'real' (not an artifact of underreporting of TC or confoundment with another socio-demographic variable). The MCAs showed that age at deat h and its underlying medical cause were the most important factors rel ated to TC, as suggested by epidemiologic transition theory. Compared with other underlying causes, diabetes, hypertension, and septicemia y ielded the highest average TCs. While sex differences were generally n ot significant within racial groups, somewhat higher average TCs were found for blacks than whites and for lesser educated than for more edu cated decedents. These patterns in TC by race and education may reflec t lifetime disadvantages faced by blacks and the less educated to heal th care or information about health practices.