“…In addition, as in all cause-specific mortality studies, we must acknowledge that death certificates may not always be accurately filled out 54. Although the quality of vital registration systems is considered to be ‘very high’ in Spain,55 further research is needed to more comprehensively assess the biases that exist in the death certificate data 56. One possible way to improve the quality of mortality data would be to increase the share of autopsied bodies (currently around 5.6%) to, for example, the levels of Finland (21%),57 and to assess the extent to which certificates may be differently completed according to socioeconomic status.…”
BackgroundSocioeconomic inequalities in alcohol-related mortality in Spain exists, and are postulated to contribute to inequalities in all-cause mortality. We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain.MethodsWe used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016–2018) by educational attainment. We estimated by sex and educational attainment age-standardised alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan variation at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality.ResultsThe use of MCOD resulted in an additional 2543 annual alcohol-related deaths (+75% among men and +50% among women) compared with estimates derived from underlying causes of death. In absolute terms, educational inequalities were the highest among men aged 45–84 and among women aged 45–64. In relative terms, higher inequalities raised in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan variation (2.1% and 1.4% for men and women, respectively).ConclusionAlcohol consumption remains an important lifestyle habit to be tackled in order to reduce socioeconomic inequalities in mortality in Spain, particularly among men.
“…In addition, as in all cause-specific mortality studies, we must acknowledge that death certificates may not always be accurately filled out 54. Although the quality of vital registration systems is considered to be ‘very high’ in Spain,55 further research is needed to more comprehensively assess the biases that exist in the death certificate data 56. One possible way to improve the quality of mortality data would be to increase the share of autopsied bodies (currently around 5.6%) to, for example, the levels of Finland (21%),57 and to assess the extent to which certificates may be differently completed according to socioeconomic status.…”
BackgroundSocioeconomic inequalities in alcohol-related mortality in Spain exists, and are postulated to contribute to inequalities in all-cause mortality. We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain.MethodsWe used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016–2018) by educational attainment. We estimated by sex and educational attainment age-standardised alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan variation at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality.ResultsThe use of MCOD resulted in an additional 2543 annual alcohol-related deaths (+75% among men and +50% among women) compared with estimates derived from underlying causes of death. In absolute terms, educational inequalities were the highest among men aged 45–84 and among women aged 45–64. In relative terms, higher inequalities raised in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan variation (2.1% and 1.4% for men and women, respectively).ConclusionAlcohol consumption remains an important lifestyle habit to be tackled in order to reduce socioeconomic inequalities in mortality in Spain, particularly among men.
“…It is essential to provide further training to doctors about the DC to ensure they understand it is a necessary requirement which must be filled out satisfactorily and to reduce their reluctance and the possible medico-legal consequences entailed [ 26 ].…”
The completion of the death certificate is indispensable in Spain for a death to be recorded in the civil registry. Occasionally, doctors may be reluctant to sign a death certificate due to possible legal consequences. This study seeks to analyse the possible judicial consequences doctors may face upon filling out this medico-legal document. Sentences published on the Judicial Power’s website between 2009 and 2019 containing the term “death certificate” were analysed. From a total of 2100 sentences examined, only 15 were found to contain the term “death certificate” as part of the claim. In only 7 of these cases the claim was made against the physician, and in 5 the physician was found guilty. Three of them concluded falsity via criminal proceedings, one via administrative proceedings for refusing to sign the certificate and one through civil proceedings for filling out an erroneous antecedent cause of death. In view of the above, it can be inferred that the completion of the death certificate poses few judicial consequences for physicians. In addition, this study reveals the importance of the death certificate document as evidence in judicial proceedings.
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