{"id":559,"date":"2020-05-05T13:57:00","date_gmt":"2020-05-05T13:57:00","guid":{"rendered":"https:\/\/covidqanda.org\/?p=559"},"modified":"2020-11-11T13:01:36","modified_gmt":"2020-11-11T18:01:36","slug":"how-are-covid-deaths-coded-on-death-certificates","status":"publish","type":"post","link":"https:\/\/covidqanda.org\/?p=559","title":{"rendered":"How are COVID deaths coded on death certificates?"},"content":{"rendered":"\n

Question: <\/strong>When they are counting deaths from COVID, do you know if they are also counting secondary infections and\/or underlying contributing factors on death certificates? It would be interesting to know how many of the deaths would also be counted as antibiotic-resistant infections. And when death statistics are compiled, does one death with multiple causes listed get listed as 4 deaths when listing the causes? For instance, my father-in-law recently died and they listed four causes \u2014 head and neck cancer (the underlying issue of course), lung infection (the pneumonia), kidney failure (as a result of his body fighting the infection) and I think ultimately something having to do with his lungs being filled with fluid. So ultimately it was the fluid that killed him, but the others obviously contributed. So when they collect the statistics, does his death count as \u201cpneumonia\u201d? or \u201chead-and-neck cancer\u201d?<\/p>\n\n\n\n

Answer:<\/strong> This is a great question, thanks for asking. And I\u2019m sorry for your recent loss of your father-in-law.<\/p>\n\n\n\n

A longer answer follows, but here are the short answers to your questions, 1) multiple causes are counted; 2) antibiotic-resistant infections are counted, but for COVID-19, I don\u2019t believe the data are available yet; 3) underlying cause is what\u2019s counted when you\u2019re looking at most cause of death tables (e.g. head and neck cancer). Now for the longer answer\u2026<\/p>\n\n\n\n

Recording Deaths<\/p>\n\n\n\n

A \u201cmedical certifier\u201d (e.g. coroner or health professional) completes Section 2 of the death certificate (Figure 1)<\/strong>. The medical certifier lists the \u201cunderlying cause of death,\u201d which is defined by the WHO<\/a> as \u201cthe disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury,\u201d as well as the other conditions that contribute to the death (up to 20 conditions can be listed). The conditions are listed in causal order<\/a> with the underlying cause being the lowest on the list (like the order you shared in your question). Per CDC<\/a>, in the United States \u201cthere is an average of three causes listed per certificate. Approximately 20 percent have only one cause of death and 45 percent have three or more causes.\u201d<\/p>\n\n\n\n

Coding Deaths<\/p>\n\n\n\n

After the medical certifier completes the bottom portion of the death certificate, the funeral director typically completes the top portion. Thereafter, the certificate is sent to the State\u2019s vital statistics office (or the like) and each State then sends these certificates on to CDC\u2019s National Center of Health Statistics (NCHS). At NCHS, the data are entered into a specialized computer system and either the computer or a trained coder translates these conditions into International Classification of Diseases, Tenth Revision (ICD-10<\/a>) codes. These codes are used worldwide to enable comparable cause-of-death mortality data collection and analysis. And yes, these codes can be very specific, including specific codes for antibiotic resistant infections.<\/p>\n\n\n\n

Tabulating Deaths<\/p>\n\n\n\n

When it comes to aggregate statistics, cause of death data is reported in two ways: 1) underlying cause and 2) multiple cause. You use both sets of statistics for different, complementary analyses. The \u201cleading cause of death\u201d tables we frequently see or \u201ctop 10 causes of death\u201d are based on underlying cause data. We also need to focus on multiple cause analysis to understand disease interaction, and consider other interventions to reduce mortality. This paper from Epidemiology<\/em><\/a> gives a nice description of both types of statistics.<\/p>\n\n\n\n

Calculating COVID-19 Deaths<\/p>\n\n\n\n

This process applies to COVID-19 too. CDC describes COVID-19 death recording here<\/a> and death coding and tabulation here<\/a>. While in most cases, COVID-19 will be the underlying condition, CDC\u2019s counts of COVID-19 deaths may include those for which COVID was the contributing cause<\/a> depending on the analysis. Additionally, the ICD-10 code for COVID-19 (U07.1) is applied not only to \u201cconfirmed\u201d deaths, but also to those that are \u201cpresumed\u201d and \u201cprobable\u201d (e.g. without laboratory confirmation). A couple of relevant notes:<\/p>\n\n\n\n

1) CDC also collects death counts from states on a daily basis. These counts, listed here<\/a>, are different from the counts listed with NCHS<\/a>, which are always several weeks behind because they are based on death certificates received and entered into NCHS\u2019s system; and<\/p>\n\n\n\n

2) Our World in Data offers a really nice description of COVID-19 mortality around the world, including great graphs (for example, see Figure 2)<\/strong>. I highly recommend!<\/p>\n\n\n\n

Figure 1. U.S. Standard Death Certificate<\/strong><\/p>\n\n\n\n

\"Image<\/figure>\n\n\n\n

Figure 2. Daily Confirmed COVID-19 Deaths (from <\/strong>ourworldindata.org<\/strong><\/a>)<\/strong><\/p>\n\n\n\n

\"Image<\/figure>\n","protected":false},"excerpt":{"rendered":"

Question: When they are counting deaths from COVID, do you know if they are also counting secondary infections and\/or underlying contributing factors on death certificates? It would be interesting to know how many of the deaths would also be counted as antibiotic-resistant infections. And when death statistics are compiled, does one death with multiple causes listed […]<\/p>\n","protected":false},"author":1,"featured_media":560,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[147,22],"tags":[112],"class_list":["post-559","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-evergreen","category-mortality","tag-data-availability","fallback-thumbnail"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/covidqanda.org\/wp-content\/uploads\/2020\/11\/May-5.png?fit=666%2C720&ssl=1","_links":{"self":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/559","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=559"}],"version-history":[{"count":1,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/559\/revisions"}],"predecessor-version":[{"id":561,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/posts\/559\/revisions\/561"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=\/wp\/v2\/media\/560"}],"wp:attachment":[{"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=559"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=559"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/covidqanda.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=559"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}