The Importance of Proper Death Certification During the COVID-19 Pandemic

Gill, James R.; DeJoseph, Maura E.

doi:10.1001/jama.2020.9536

Cited by 65 publications

(66 citation statements)

References 5 publications

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“…Although validating assertions that for patients with certain comorbidities, SARS-CoV-2 may have been underreported as a UCOD, 51 our findings suggest these assertions are oversimplified because of overreporting of SARS-CoV-2 for those with other comorbidities including the second and third top causes of natural death in the United States, cancer and CLRD. 52 Despite concerns about underreporting of SARS-CoV-2 on death certificates, 53 overreporting began to slightly numerically exceed underreporting by the late pandemic period.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cause-of-Death Attribution During the Covid-19 Pandemic: Association with Hospital Quality Metrics and Implications for Future Research

Fairman

Goodlet

Rucker³

2020

Preprint

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often comorbid with conditions subject to quality metrics (QM) used for hospital performance assessment and rate-setting. Although diagnostic coding change in response to financial incentives is well documented, no study has examined the association of QM with SARS-CoV-2 cause-of-death attribution (CODA). Calculations of excess all-cause deaths overlook the importance of accurate CODA and of distinguishing policy-related from virus-related mortality. Objective: Examine CODA, overall and for QM and non-QM diagnoses, in 3 pandemic periods: awareness (January 19-March 14), height (March 15-May 16), and late (May 17-June 20). Methods: Retrospective analysis of publicly available national weekly COD data, adjusted for population growth and reporting lags, October 2014-June 20, 2020. CODA in 5 pre-pandemic influenza seasons was compared with 2019-20. Suitability of the data to distinguish policy-related from virus-related effects was assessed. Results: Following federal guidance permitting SARS-CoV-2 CODA without laboratory testing, mortality from the QM diagnoses cancer and chronic lower respiratory disease declined steadily relative to prior-season means, reaching 4.4% less and 12.1% less, respectively, in late pandemic. Deaths for non-QM diagnoses increased, by 21.0% for Alzheimers disease and 29.0% for diabetes during pandemic height. Increases in competing CODs over historical experience, suggesting SARS-CoV-2 underreporting, more than offset declines during pandemic height. However, in the late-pandemic period, declines slightly numerically exceeded increases, suggesting SARS-CoV-2 overreporting. In pandemic-height and late-pandemic periods, respectively, only 83.5% and 69.7% of increases in all-cause deaths were explained by changes in the reported CODs, including SARS-CoV-2, preventing assessment of policy-related mortality or of factors contributing to increased all-cause deaths. Conclusions: Substitution of SARS-CoV-2 for competing CODs may have occurred, particularly for QM diagnoses and late in the pandemic. Continued monitoring of these trends, qualitative research on pandemic CODA, and the addition of place-of-death data and psychiatric CODs to the file would facilitate assessment of policy-related and virus-related effects on mortality.

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Section: Discussionmentioning

confidence: 99%

Changes in Cause-of-Death Attribution During the Covid-19 Pandemic: Association with Hospital Quality Metrics and Implications for Future Research

Fairman

Goodlet

Rucker³

2020

Preprint

View full text Add to dashboard Cite

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“…The increase in influenza and pneumonia deaths may reflect instances where virus testing was not available. 7 The negative results for chronic lower respiratory disease, heart failure, and other diseases of the circulatory system may reflect situations where COVID-19 pre-empted these causes.…”

Section: Discussionmentioning

confidence: 99%

New Insights on Excess Deaths and COVID-19

Wetzler¹,

Cobb²

2020

Preprint

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Background: Weinberger and colleagues estimated that 27,065 of the 122,300 excess deaths in the United States between March 1 and May 30, 2020 did not have a COVID-19 cause of death. Methods: The Centers for Disease Control and Prevention (CDC) post weekly data on mortality for 13 causes of death from the most prevalent comorbid conditions reported on death certificates where COVID-19 was listed as a cause of death. The 2015-2019 data for weeks 10 through 22 were used to forecast the number of deaths from the 13 causes in the absence of COVID-19 during 2020. The forecast was subtracted from the observed number of deaths for each cause during the period March 1 to May 30, 2020. Results: The total of the differences for each of the 13 causes of death, 18,489 deaths, accounts for over two-thirds of the 27,065 excess deaths not due to COVID-19. Conclusion: Combining the 95,235 reported COVID-19 deaths with the 18,489 from the 13 most frequent comorbid conditions reported on death certificates where COVID-19 was a cause suggests that as many as 93% of the excess deaths were due to COVID-19 and implies that COVID-19 deaths were undercounted. Ongoing assessment of excess deaths and causes of death is needed to provide a better understanding of the pandemics dynamics.

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“…Death certificate data can inform the public and policymakers on the progress of the COVID-19 pandemic and provide valuable information about who is dying, where they are from, and what were their associated medical conditions. 6 …”

Section: R Eview R Esultsmentioning

confidence: 99%

Cause of Death Certification in COVID-19 Deaths

Veeranna¹,

Rani²

2020

Indian Journal of Critical Care Medicine

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A bstract Introduction Appropriate cause of death reporting is vital in the pandemic circumstance for effective planning of the control measures. Accurate reporting and registration of the reason for death are crucial in planning of health programs in turn contributing for the national development. Background All births and deaths occurring across India should be mandatorily registered per the Registration of Births and Deaths Act passed in the year 1969. The act also requires the issuance of cause of death certificate by the doctor attending the departed during his last illness. Data obtained from the cause of death certificate provides cause-specific mortality profile, which is required to analyze the health trends of the population. Review results This article discusses the available guidelines on the appropriate documentation of cause of death in the confirmed or suspected coronavirus disease-2019 (COVID-19) infection resulting into death. Conclusion Proper certification of the cause of death leads to better epidemic surveillance. Scrutiny of the clinical sequences from the cause of death certificate is useful to prioritize the allocation of resources for critical care management and to augment our knowledge about underlying causes resulting in mortality from COVID-19. Clinical significance Dissemination of available guidelines on proper documentation of the cause of death in confirmed/suspected COVID-19 cases will reduce the errors in cause of death reporting. How to cite this article Veeranna CH, Rani S. Cause of Death Certification in COVID-19 Deaths. Indian J Crit Care Med 2020;24(9):863–867.

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The Importance of Proper Death Certification During the COVID-19 Pandemic

Cited by 65 publications

References 5 publications

Changes in Cause-of-Death Attribution During the Covid-19 Pandemic: Association with Hospital Quality Metrics and Implications for Future Research

Changes in Cause-of-Death Attribution During the Covid-19 Pandemic: Association with Hospital Quality Metrics and Implications for Future Research

New Insights on Excess Deaths and COVID-19

Cause of Death Certification in COVID-19 Deaths

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