[Certification of main cause of death in Barcelona, 1985]

The aim of the present study was the validation of the underlying cause of death of the patients who died in Barcelona hospitals in 1985. A sample of deaths was stratified on the basis of the 17 categories of International Classification of Diseases (ninth revision), and the underlying cause as stated in the Statistical Death Certificate was compared with the cause that was considered to be "more likely" according to the available clinical documentation. The agreement index in the 17 ICD-9 categories was 71.8%. The groups with reliable rates were tumours, congenital defects and perinatal abnormalities. It is concluded that the fulfillment of the Statistical Death Certificate should be improved following the WHO recommendations; this could be achieved with training programs for clinicians.