The Washington PostDemocracy Dies in Darkness

Study: Nearly one-third of all death certificates are wrong

Death certificates are important public health documents. They help epidemiologists understand leading causes of deaths and how they are changing. They power big studies of what killed us in the past — and what kills us now.  And, according to a new Center for Disease Control study, about a third of them may be wrong.

Columbia University's Barbara A. Wexelman led a survey of 521 resident physicians in New York City. About one-third of those doctors completed more than 11 death certificates in the past year, making them pretty familiar with how the system works.

"Only one-third of the respondents," Wexelman and her team found, "believed the current system accurately documents correct cause of death." Nearly half — 48.6 percent —  of respondents reported having identified a cause of death that did not actually represent what the person died from. A small number, 2.9 percent, had ever gone back and updated a death certificate after learning new information about the patient's circumstance.

As to why doctors were reporting inaccurate causes of death, it actually appears to be a weirdly bureaucratic reason: Three-quarters said the system they use in New York City would not accept what they thought to be the real cause of death. So they put in something else instead. Other reasons for reporting the wrong cause of death that turned up in the survey included "My attending told me to put something else" and "I did not know why the patient died/I took my best guess."

"This is the first comprehensive survey of medical, surgical, and emergency medicine residents on the current cause-of-death reporting system," Wexelman and her co-authors write. "It is also the first to document that physicians completing death certificates often knowingly complete them inaccurately. These errors may have lasting effects on the public health priorities of the community."

Correction: This article initially stated that nearly one-half of all death certificates were inaccurate. While nearly one-half of all doctors say they have filed an inaccurate death certificate, this study found that 30 percent of the death certificates filed were inaccurate.