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Quality of death certification based on the documented underlying cause of death: A retrospective study
Salim Al Busaidi1, Abdullah M Al Alawi1, Reema Al Masruri2
1Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
Insights
Inaccurate underlying cause of death (UCOD) data is common, affecting 80% of cases. Old age, male sex, and training doctors were linked to these inaccuracies in mortality data.
Area of Science:
- Medical Informatics
- Public Health
- Epidemiology
Background:
- Underlying cause of death (UCOD) documentation is critical for mortality data, influencing national policies and healthcare.
- Inaccuracies in UCOD reporting are globally prevalent, linked to factors like sociodemographic development and physician training.
- Assessing UCOD quality and associated factors is vital for improving public health data integrity.
Purpose of the Study:
- To evaluate the accuracy of documented UCOD in death certificates.
- To identify potential factors contributing to inaccuracies in UCOD reporting.
Main Methods:
- Retrospective study of in-patient deaths at Sultan Qaboos University Hospital (Jan 2020 - Dec 2020).
- Review of 384 death certifications for UCOD accuracy using a WHO-recommended framework.
Main Results:
- Approximately 80% of UCOD data were found to be inaccurate.
- Inaccuracies were significantly associated with older age, certification by doctors in training, and admission under the Department of Medicine.
- Old age, male sex, and certification by doctors in training independently predicted inaccurate UCOD data.
Conclusions:
- Inaccurate UCOD data is a widespread problem, particularly in developing nations.
- Implementing death certification training, periodic audits, and feedback mechanisms can enhance mortality data accuracy.
- Improving UCOD accuracy is essential for reliable public health surveillance and policy-making.
Background:
The underlying cause of death (UCOD) documented in the death certificate is a cornerstone in the mortality data that has significant impact on national policies, health system, and socioeconomics. However, a wide range of inaccuracies have been reported worldwide and were linked to multiple factors, including sociodemographic development and lack of physician training. Hence, this study aimed to assess the quality of death certification by reviewing the reported UCOD in the death certificate and study the potential factors that might be associated with inaccuracies.
Methods:
All in-patient deaths that occurred in the Sultan Qaboos University Hospital from January 2020 to 31 December 2020 were included in this retrospective study. The study investigators reviewed all death certifications that were recorded during the study period for the accuracy of the documented UCOD using a systemic framework recommended by the World Health Organization.
Results:
The study included 384 mortality cases. The mean age at the time of death was 55.7 ± 27.1 years, and 209 (54.3%) cases were men. Approximately 80% (95% confidence interval: 84-76%) of the deceased patients had inaccurate data on the UCOD. Old age (58.1 ± 25.8 vs 46.5 ± 30.1, p < 0.001), death certification by doctor in training (70.8% vs 51.9%, p = 0.001), and admission under the Department of Medicine (68.5% vs 54.4%, p = 0.019) were more common in mortality cases with inaccurate data on the UCOD. Regression analysis confirmed that old age, male sex, and certification by doctor in training were independent predictors of inaccurate data on the UCOD.
Conclusion:
Inaccurate data on the UCOD is a prevalent issue in many healthcare settings, especially in the developing countries. Introduction of death certification training in the medical curriculum for medical doctors, implementation of periodic auditing, and provision of feedback are among the evidence-based approaches that are likely to improve the overall accuracy of mortality data.
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