Clinical and Health Affairs
The Many Uses for Cause-of-Death Information
By Steve Elkins
Abstract
Prompt, accurate cause-of-death information is valuable to family members, public health officials, researchers, and statisticians. This article discusses how such information is used to track health trends in Minnesota and determine public health and research priorities. It also describes how to electronically enter cause-of-death information into the Minnesota Mortality Registry, the state’s online vital records system.
For many physicians, their final involvement with a patient is completion of the death certificate. In Minnesota, this is a physician’s responsibility. Once a physician has determined the cause of death, it needs to be entered into the state’s vital records system, the Minnesota Mortality Registry (MMR). The information collected through the MMR serves a variety of purposes for families, public health officials, medical researchers, and statisticians. Therefore, it is important that cause-of-death information be entered into the registry as soon after the event as possible.
In 2002, the Minnesota Department of Health implemented the first statewide online death registration system in the country. An upgraded version of the system will be rolled out on January 1, 2010. At that time, the online system will be the only way physicians, medical facilities, funeral homes, and medical examiners can register deaths.
This article reviews why cause-of-death information is so important and describes how to electronically enter cause-of-death information into the MMR.
The Importance of Cause-of-Death Information
For the family, the completed death certificate provides important information about how their loved one died. This information may become part of the medical history of surviving relatives. The death certificate is also needed to settle the decedent’s estate and may provide family members with closure and peace of mind. In addition, cause-of-death information is valuable to those who make decisions about public health, research, and health care priorities and programs. For that reason, the Department of Health shares mortality data with a number of individuals and organizations (Table 1).
Cause-of-death information is critical for those monitoring the public’s health. For example, recent daily reports on deaths caused by influenza have been sent to the state epidemiologist at the Minnesota Department of Health and the Centers for Disease Control and Prevention to track the novel H1N1 influenza virus. The extent to which the virus is contributing to deaths provides an important measure of its virulence. By reviewing data from the MMR, public health officials can better identify, evaluate, and respond to outbreaks and other health concerns.
Information about the leading causes of death (Table 2) is used to determine which medical conditions receive research and development funding. For example, heart disease was the leading cause of death in Minnesota and the United States for many years. Cancer has since become the No. 1 cause of death in part because of advances in the prevention and treatment of heart disease.
Reporting a Death
State law calls for death records to be registered within five days of the death.1 Final disposition of the body may not occur until the registration is complete.
In most cases, the attending physician is responsible for determining the cause of death. However, the medical examiner in the county in which the death occurred is responsible for making sure the cause of death is indicated for all sudden or unexpected deaths, all deaths that may be due entirely or in part to unnatural factors, or when there is a suspicion of any factor other than natural disease processes. Such deaths account for about 8 percent of all deaths in Minnesota each year. Examples include violent deaths resulting from homicide, suicide, or an accident; deaths caused by a fire or associated with burns or chemical, electrical, or radiation injury; unexplained or unexpected perinatal and postpartum maternal deaths; deaths under suspicious, unusual, or unexpected circumstances; deaths that occur during, in association with, or as the result of diagnoses, therapy, or anesthesia; deaths caused by culpable neglect; sudden death of a person not affected by recognizable disease; deaths of persons who have had a fracture of a major bone within the past six months; deaths of persons not seen by their physician within 120 days of their demise; and deaths that occur in an emergency department.2
Deaths that occur under such conditions should be immediately reported to the medical examiner. All other deaths must be certified by a physician who is present at the time of death, a physician or associate of a physician who provided medical treatment for the deceased before death, or a physician who has direct knowledge of the circumstances and cause of death and has access to the medical record of the deceased. Whoever certifies the death should provide the best medical opinion available.
All funeral homes in the state use the MMR to start the death registration process. In the past, physicians who did not use the MMR would receive a faxed worksheet from the funeral home, indicate the cause of death on the worksheet, and fax it back to the funeral home, which would then submit the information to the Department of Health. Starting January 1, 2010, death registration must be done electronically through the MMR. Using the electronic system is expected to prevent errors and delays that arise from trying to read handwritten information that has been faxed twice. For the experienced Internet user, the MMR is intuitive and requires little instruction. To start using the system, go to www.health.state.mn.us/divs/chs/osr/physician-me/participant.html and print the MMR User ID Information form. Fax the completed form to the number indicated on the form. At that time, a user ID and password will be created for you and returned by email, along with specific information about how to fill out the cause-of-death screen online. The MMR can be accessed from any Internet-connected computer once you have a user ID and password; it requires no special software.
Determining the Cause of Death
For statistical and research purposes, it is important that the cause of death and, in particular, the underlying cause of death be reported as specifically and as precisely as possible. Every cause-of-death statement is coded and tabulated by cause-of-death specialists in the Office of the State Registrar according to the latest revision of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems 10th Revision. The cause of a death often is not crystal clear. When there are questions, the rules in this 1,200-plus page manual provide guidance for determining the most likely underlying cause.
Occasionally, additional medical information or autopsy findings become available that would change the cause or causes of death originally reported. In this case, the certifying physician should correct the original death record by immediately reporting the revised cause of death to the Office of the State Registrar using a Cause of Death Amendment Affidavit. This can be obtained by calling 651/201-5012.
Conclusion
Cause-of-death information indicated on death certificates is important to family members, researchers, and health officials. By reporting this information to the Minnesota Mortality Registry in a timely, accurate way, physicians can arm public health officials with the information they need to identify concerns and initiate interventions as early as possible. MM
Steve Elkins is the State Registrar of Vital Records with the Minnesota Department of Health.
References
1. Minnesota Statute 144.221
2. Minnesota Statute 390.11