Postmortem Diagnostic Overshadowing: Reporting Cerebral Palsy on Death Certificates

Area of Science:

• Public Health
• Disability Studies
• Mortality Statistics

Background:

• Postmortem diagnostic overshadowing, where a disability is inaccurately reported as the cause of death, affects over half of adults with cerebral palsy.
• This misreporting obscures vital cause of death trends, hindering mortality reduction efforts for this population.

Purpose of the Study:

• To identify factors associated with the inaccurate reporting of cerebral palsy as the underlying cause of death.
• To analyze sociodemographic characteristics, death context, processing, and comorbidities linked to diagnostic overshadowing.

Main Methods:

• Utilized data from the National Vital Statistics System (NVSS) U.S. Multiple Cause of Death files (2005-2017).
• Analyzed a dataset of 29,996 deaths to identify factors contributing to inaccurate cause-of-death reporting in cerebral palsy cases.

Main Results:

• Inaccurate reporting is linked to increased clinical uncertainty surrounding the cause of death.
• The study found associations with the false equivalence of disability and health, and potential racial-ethnic bias.
• Factors such as sociodemographic characteristics, death context, and comorbidities were associated with diagnostic overshadowing.

Conclusions:

• Addressing postmortem diagnostic overshadowing is crucial for accurate mortality data in individuals with cerebral palsy.
• Recommendations include enhanced training on disability and health for death certificate certifiers.
• Policy changes are needed to counteract ableist practices in death certification.