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Related Experiment Videos

Reliability of death certificate diagnoses.

M A Moussa1, M Z Shafie, M M Khogali

  • 1Department of Community Medicine, Faculty of Medicine, Kuwait University, Safat.

Journal of Clinical Epidemiology
|January 1, 1990
PubMed
Summary

Death certificates in Kuwait significantly under-estimated underlying causes like cardiovascular disease and diabetes. Improved death certification practices and training are crucial for accurate mortality statistics.

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Area of Science:

  • Public Health
  • Medical Records Analysis
  • Epidemiology

Background:

  • Accurate death certification is vital for reliable mortality statistics.
  • Previous studies suggest potential inconsistencies in cause-of-death reporting.

Purpose of the Study:

  • To assess the consistency between initial death certificates and clinical records in Kuwait.
  • To evaluate the under-estimation of specific underlying causes of death (hypertensive diseases, ischaemic heart diseases, cerebrovascular diseases, diabetes mellitus).

Main Methods:

  • A retrospective study of 470 deaths from 5 general hospitals in Kuwait.
  • Independent review of clinical records and death certificates by two cardiologists using WHO criteria.
  • Analysis of agreement between original certificates and reviewer assessments using kappa index.

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Main Results:

  • Poor agreement (kappa index) was found between original death certificates and reviewer assessments.
  • Original certificates under-estimated cerebrovascular diseases by 69.2%, diabetes mellitus by 60%, ischaemic heart diseases by 33.5%, and hypertensive diseases by 31.8%.
  • Associated causes of death were also consistently under-estimated by initial certifiers.

Conclusions:

  • Significant bias exists in initial death certification in Kuwait, leading to under-estimation of major causes of mortality.
  • Recommendations include utilizing hospital death committee reports, adopting multiple-causes-of-death reporting, and enhancing medical professional training on death certification.