BackgroundMedical Certification of Cause of Death (MCCD) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. On the contrary, incomplete and inaccurate MCCD data can significantly impair the precision of a national health information database. In the current study, the accuracy of death certificates at two tertiary cancer care hospitals in Northern India, has been evaluated.MethodsThis retrospective study has been conducted at Tata Memorial Centres namely, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital, Varanasi, India on MCCD over a period of two and a half years. Medical records and death certificates of all the deceased were examined. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. The accuracy of this information was validated using the medical records. Errors in the death certificates were classified according to Haque’s grading scale.1Results778 deaths occurred during the study period between May 2018 to December 2020, and all certificates were accessed for analysis. Only 30 (4%) certificates were error-free. 591(75.9%) death certificates had an inappropriate immediate cause of death. 231(29.7%) death certificates had incorrectly labelled mode of death, such as cardiopulmonary arrest as the immediate cause of death. 585 (75.2%) death certificates had an incorrect underlying cause of death. Majority of the death certificates were prepared by the post MBBS junior residents and this was significantly associated with higher certification errors.ConclusionA high rate of errors was identified in the death certificates completed at our hospitals. Inaccurate death certificates related to cancers can potentially influence the cancer statistics of the defined region and thereby affect policymaking for cancer prevention and control. There is a pressing need for appropriate intervention/s to resolve this important issue. In an attempt to improve the quality of certification, it is envisaged to conduct training for all consultants and residents in proper death certification.
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