The validity of death certificates: routine validation of death certification and its effects on mortality statistics

The 3478 death certificates (7.1% of all annual death certificates) of this study comprise those national death certificates in 1995 submitted for val idation to the panel representing both medical and nosological expertise. A s such, it is highly selected and represents, from the nosological point of view, the most inconsistently filled-in portion of Finnish death certifica tes. The routine validation procedure is essentially based on exploitation of the extra medical information, i.e. the case history, on the Finnish dea th certificate form. Altogether, 2813 (80.9%) out of 3478 certificates coul d be adjusted at the primary panel session; the rest required further clari fication. The re-assignment of cause of death by the panel and the impact o f panel adjustments on the national mortality statistics is assessed here b y comparing the initial death certification and the finally registered unde rlying cause of death grouped into ICD-9 major categories with special refe rence to the subcategories of neoplasm, cardiovascular disease (HVD) and un natural death. A statistically significant decline (p<0.0001) in deaths, bo th in the category of symptoms, signs and ill-defined conditions and in the pulmonary circulation disease subcategory of HVD with 37.6 and 35.1%, resp ectively, was observed. The decrease of 11.1% in the benign or NUD neoplasm subcategory and the increase of 8.6 and 7.0% in the categories of endocrin e disease, and musculo-skeletal and connective tissue disease, respectively , are essential observations as to the quality of the cause of death regist er. The effect on the HVD major category was practically nil. At the HVD-su bcategorial level, a decrease of 14.0% for diseases of the veins and lympha tics and other circulatory diseases and an increase of 3.5% for hypertensiv e diseases (HYP) were the two next most obvious alterations to the diseases of the pulmonary circulation, but were without statistical significance. F or ischaemic heart disease and other subcategories, the effects were minor. The unnatural deaths as a whole increased in the final statistics with onl y 0.9%. In the study data, categorial changes ranged from the decrease of 7 5.2% for symptoms, signs and ill-defined conditions to the increase of 77.3 % for endocrine diseases. In conclusion, the Finnish death certificate form , death certification practices and cause of death validation procedure see m to serve the coding of causes of death for mortality statistics appropria tely. The results of the study form a relevant reference background to eval uation of epidemiological studies on mortality. (C) 2001 Elsevier Science I reland Ltd. All rights reserved.