Medical adverse events in the US 2018 mortality data

Abstract

Although medical error has been estimated as a major cause of death in the US, the capability of current diagnostic coding systems and standard death certificates to capture these events has been criticized. This register-based study aimed to scrutinize medical adverse event deaths (i.e., deaths due to adverse events occurring within the healthcare practice, avoidable or unavoidable, including late complications and sequelae of such events) in the US National Vital Statistics 2018 mortality dataset. Individual-level data on underlying and multiple causes of death according to the tenth revision of the International Classification of Diseases (ICD-10) coding system were extracted together with the decedents’ sex, age, ethnicity and education level. Adverse event deaths were identified by ICD-10 codes Y40–Y84 and Y88. The dataset comprised a total of 2 846 305 certified deaths. An adverse event ICD-10 code was used as the underlying cause of death in 0.16% (n = 4620) of the cases, and appeared on the list of multiple causes in 1.13% (n = 32 226) of the cases. Odds for adverse event death were higher among younger than elderly individuals, among those of black than white ethnicity, and among individuals with higher education level. The present data indirectly support previous evidence that a large number of adverse events remain underrecognized or misclassified. Future analyses are needed to reveal the root causes behind underreporting and to analyze whether it occurs at random or in a systematic way.

Educational Gradients Behind Medical Adverse Event Deaths in the US—A Time Series Analysis of Nationwide Mortality Data 2010–2019

“…However, this study also had limitations. It is generally evident that medical adverse events are underrepresented in cause-of-death statistics ( 3 , 6 ). The retrospective nature of the data and lack of information on other domains than basic demographic traits prevented more detailed analyses of mediating and confounding factors.…”

“…Adverse event deaths, including late complications and sequelae of adverse events, were proxied by ICD-10 codes Y40—Y84 and Y88. These included the following subcategories ( 6 ):…”

“…In this study, the term is used to capture a wide range of cases, both avoidable or unavoidable, including late complications and sequelae of injuries caused by medical management. Even though deaths due to medical care appear common ( 3 – 5 ), the theme has been lacking scientific attention ( 3 , 6 ). Further efforts should be directed to the research and prevention of medical adverse events ( 7 – 13 ).…”

Urbanization level and medical adverse event deaths among US hospital inpatients over the period 2010–2019

“…In this study, NCHS mortality data were taken as ‘face value’. However, there have been concerns whether adverse events are efficiently and accurately captured in mortality datasets ( Makary and Daniel, 2016 , Oura, 2021 ). The data appear prone to diagnostic and coding errors; the potential errors in cause-of-death coding may vary by region depending on, e.g., whether death certificates are filled by medical staff or not.…”

“…Of patients and clients receiving health care services, inpatients are particularly vulnerable to non-fatal and fatal adverse events ( Classen et al, 2011 , Makary and Daniel, 2016 , Schwendimann et al, 2018 ). It is thus imperative that further resources will be dedicated to the research and prevention of adverse events ( Bates and Singh, 2018 , Oura, 2021 ), starting with inpatient care.…”