Erroneous Reporting of Deaths Attributed to Pneumonia and Influenza at 2 New York City Teaching Hospitals, 2013-2014

Abstract

Objectives Cause-of-death information, reported by frontline clinicians after a patient’s death, is an irreplaceable source of public health data. However, systematic bias in cause-of-death reporting can lead to over- or underestimation of deaths attributable to different causes. New York City consistently reports higher rates of deaths attributable to pneumonia and influenza than many other US cities and the country. We investigated systematic erroneous reporting as a possible explanation for this phenomenon. Methods We reviewed all deaths from 2 New York City hospitals during 2013-2014 in which pneumonia or influenza was reported as the underlying cause of death (n = 188), and we examined the association between erroneous reporting and multiple extrinsic factors that may influence cause-of-death reporting (patient demographic characteristics and medical comorbidities, time and hospital location of death, type of medical provider reporting the death, and availability of certain diagnostic information). Results Pneumonia was erroneously reported as the underlying cause of death in 163 (86.7%) reports. We identified heart disease and dementia as the more likely underlying cause of death in 21% and 17% of erroneously reported deaths attributable to pneumonia, respectively. We found no significant association between erroneous reporting and the multiple extrinsic factors examined. Conclusions Our results underscore how erroneous reporting of 1 condition can lead to underreporting of other causes of death. Misapplication or misunderstanding of procedures by medical providers, rather than extrinsic factors influencing the reporting process, are key drivers of erroneous cause-of-death reporting.

Descriptive study of causes of death and COVID-19-associated morbidities from the New York City electronic death record: first wave of the pandemic March–July 2020

“…Future work examines full combinations of conditions which allow for mutually exclusive category reporting. The usual caveats concerning the potential incompleteness of death certificate data also apply 39–44. Common mistakes may include improbable sequencing, and the listing of non-specific conditions or processes as underlying cause.…”

“…The usual caveats concerning the potential incompleteness of death certificate data also apply. [39][40][41][42][43][44] Common mistakes may include improbable sequencing, and the listing of non-specific conditions or processes as underlying cause. Quality control efforts have allowed us to use the most complete and accurate data available for this analysis.…”

Influenza: cause or excuse? An analysis of flu’s influence on worsening mortality trends in England and Wales, 2010–19

“…Conversely, a small study conducted in two teaching hospitals in New York City, USA, retrospectively reviewed all deaths with pneumonia or influenza as the cause of death and found that more than one-third were, in fact, due to heart disease or dementia/Alzheimer’s disease. 66 …”

Pandemics, policy, and the power of paradigm: will COVID-19 lead to a new scientific revolution?

“…Which health-related disciplines were not represented? The Task Force included no experts in behavioral sciences or education, despite the effects of its decisions on mental health service delivery, substance use disorder treatment, and schools and universities [35] , [36] , [37] ; none in decision analytic modeling, despite the influence of nonpeer-reviewed models using controversial methods on governmental decisions [38] , [39] , [40] ; none in risk communication, despite a recognized need to explain public health risks and risk-mitigation policies effectively, using known best practices derived from psychological science [41] ; and none in health informatics, despite known inaccuracies and coding biases in the cause-of-death data on which the Task Force relied [42] , [43] , [44] .…”