Death Certificate

Most industrialized countries have required certification of deaths for years, and death certificates are a primary source of mortality data in many countries. In such countries, death certificates are the official source of information about deceased persons, the date and location of their death, and the causes of their death. In the United States, mortality data are collected in local jurisdictions and reported using a Standard Certificate of Death and model procedures developed cooperatively by the National Center for Health Statistics (NCHS) and local jurisdictions, the latter being the 50 states, two cities (New York City and Washington, D.C.), and five territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). The NCHS compiles and releases aggregated data drawn from death certificates, but requests for a copy of the death certificate for an individual must be directed to the local jurisdiction. Release of death certificate information for an individual may be restricted to relatives and persons with a documented medical need or lawful right to the data.

The Standard Certificate of Death for the United States was most recently revised in 2003. Death certificate information customarily supplied by the medical certifier (typically a physician, medical examiner, or coroner) includes the date and time the person was pronounced dead; the immediate cause of death and up to three conditions leading to the immediate cause; other conditions contributing significantly to death; whether an autopsy was performed and whether the autopsy findings were available to complete the death certificate; if tobacco use contributed to the death; if the manner of death was natural; an accident, a suicide, a homicide, pending investigation or could not be determined, and if accidental, more details about the nature of the accident.

Information on the Standard Certificate of Death typically completed or confirmed by the funeral director includes decedent's name, sex, Social Security number, age, birthplace, residence, marital status, military services, name and address of parents and spouse, place of death, method and place of disposition (burial, cremation, donation, etc.), education, race, ethnicity, usual occupation, and kind of business or industry in which they were employed.

Information from death certificates is widely used in public health reporting, surveillance, and epidemiological research because the data are collected in a standard format and are available, at least theoretically, for every person who dies in the United States. However, death certificate information must be interpreted with care. Some researchers, such as Michael S. Lauer and colleagues, have strongly criticized the usefulness of cause-of-death information drawn from death certificates: They point out that even under ideal conditions, it is often difficult to determine the cause of death in the presence of comorbid illnesses and without information drawn from an autopsy and that the death certificate is often completed by a physician who is unfamiliar with the deceased person's medical history. A more moderate view regards cause-of-death information drawn from death certificates to be accurate for some diseases such as specific cancers but questionable in other cases, so the usefulness of this type of information depends on the particular disease or risk factor being studied. The intended use of the information should also be considered: For instance, death certificate information may be adequate for routine surveillance on many causes of death but completely inadequate for research on many specific causes.

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