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Medical certification of cause of death

Periodic validation studies

Most countries that collect mortality information publish an annual summarised list of causes of death. However, very few countries routinely validate the quality of COD data reported by their CRVS systems. 

Conducting routine COD validation studies are vital to ensuring COD reported by CRVS systems are correct.

If data are not validated, a reported COD cannot be assumed to be correct – even if all deaths are medically certified. Physicians certifying deaths sometimes make mistakes, for all the reasons cited earlier (See Guidance on completing the international form of medical certificate of cause of death) and there may also be social, legal or financial pressures that impede the correct certification of certain causes of death.

When physicians certify a COD, they base their decision on the information available in the medical record of the deceased person. If the medical record has been poorly completed and maintained, it may not provide all the information necessary to certify the death correctly.

One way to validate the quality of medical certification is to carry out a medical record review and compare the derived causes of death with those reported by the CRVS systems. In principle, a deceased person’s medical records should include details of the circumstances and events leading up to death, and can be used to diagnose the COD, and hence assess the quality of COD certification. Several such studies have now been carried out in different countries to validate the COD information reported by CRVS systems. 

Study methodology for conducting routine COD validation studies are detailed in the Read more section.

Read more

Health Information Systems Knowledge Hub (2009). Promoting the periodic assessment of the quality of medical records and cause-of-death data: lessons learned from a medical records study in Sri Lanka. University of Queensland. 

Naghavi M et al (2010).  Algorithms for enhancing health utility of national causes-of-death data. Population Health Metrics 

Rampatige R, et al. (2014). Systematic review of statistics on causes of deaths in hospitals: Strengthening the evidence for policy-makers. Bulletin of the World Health Organization 92:807–816. Available from: 

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