Discrepancies in death certificates, public health registries, and judicial determinations in Italy

The death certificate is mandated by civil law and serves as a medical-scientific document useful for biostatistics and epidemiological research. For a variety of reasons, death certificates can be misclassified. We reviewed data from self-inflicted deaths collected over an 8-year period by the Forensic Institute of the University Sacro Cuore of Rome (Italy). Four hundred and thirty-five of 2904 were classified as self-inflicted deaths (15%). The comparison with death certificates processed by the local public health authority (ASL) and by the Italian National Census Bureau (Istat) and with the judicial investigation results available in the Italian Penal Court archive shows some discrepancies. One-hundred and twenty-four of 435 deaths were not considered to be self-inflicted but due to a crime (29% overrecording suicide) with a higher reduction for women, suggesting that it is easier to confuse a murder for suicide in female cases. Any discrepancies between the mortality and crime data are discussed in details.