Our findings were compared with those of previous studies on errors in death certificates. In our study, maximum mortality was seen in the over-60-year-old age group (29.4%) with more predominance of male mortality than female mortality.
In the present study 100% of the death certificates were found with errors and form 4 was used as a death certificate to enter the death-related details with no column for entry of ICD 10 coding. Similar findings were observed in Patel et al’s study, in which 100% of death certificates were found with errors [1] whereas the percentage of complete and error-free MCCDs was low (2.6%) in a study done by Patil et al. [3]
In another study, there were 40 death certificates, and not one of them was error-free with major errors in 23 cases (57.5%), with incorrect sequencing being the most common (55%) of these. The most frequent minor error (92.5%) was failing to account for disease time interval. [4] Error rates in previous studies ranged from 32–99.2%. [5–10]
In this study, 29% of the certifying physicians wrote part I and part II of the MCCDs using abbreviations which was similarly documented in studies conducted in India. (21%) and Bangladesh (50.7%) [11, 12]. Abbreviations should not be used in death certificates; full and accurate terminology for the medical condition should be noted. [3]
A common error usually observed in death certification is incorrect sequence of events leading to death mentioned in part I of the MCCD where the causes are not chronologically provided in logical sequences with the immediate cause mentioned on line I (a) and the “underlying cause of death (UCOD)” mentioned on the last line of part I. In 6–55% of death certificates, it is a common observation. [4,11,12]. However, in our study, incorrect sequence was seen in 11.2% cases. The casual sequences reported in part I should be logical in terms of time and pathology. [3]
The primary disease (as UCOD) that initiated subsequent disease conditions is typically not mentioned as the immediate and antecedent cause of death in part I of the death certificate, which is a significant error found in improperly filled MCCDs. In contrast to another study, which asserted that such errors were present in 18.38% of cases, our analysis found that such errors were present in 7.9% of MCCDs. [3]
In the death certificates analyzed, several health-related fields were either left blank or incompletely or incorrectly filled in. All types of minor errors were identified in this study. In 99.2% of cases, we fail to specify the interval between death and morbid conditions, which substantially explains the high rate of minor errors. This inference is regrettable since quantifying the time frame between the onset of disease and death can help determine the causes of death and order them correctly into the underlying, intermediate, and direct causes of death. There have been reports of certifying physicians failing to include the time interval in death certificates in anywhere from 81.5% and nearly 95.6% of cases. [4, 6, 12]
Although Patil et al’s study reported it in 26.47% of cases, illegible handwriting, which is regarded as a minor error, was found in 5.4% of death certificates. Although the proper coding of the cause of death is not affected by unreadable writing in the death certificate, the quality of the death certificate is affected and is most likely to be misconstrued. [3]