An overview of the death certification reforms
All Swedish RA death certificates for the years and were studied. A total of such certificates were identified. Four major qualifications for the coders to reject physicians' non-RA underlying cause, and for giving preference to RA in the registration of the underlying cause of death were discerned: RA appeared to have been favoured to the greatest extent by the NCBS i when RA was likely to have caused the reported underlying condition; ii when there is only one, non-RA, diagnosis reported in Part I of the certificate, and this diagnosis does not completely describe the train of events leading to death; iii when the diagnosis for the non-RA underlying condition provides less precise information about the site or nature of the underlying condition, compared with another diagnosis for another condition, RA, stated on the certificate; or iv when the reported non-RA underlying condition was unlikely itself to cause death, and was not reported as a cause of a more serious condition.
The NCBS' increased registration of RA as the underlying cause of death between and could be explained neither by physicians' inadequacies in making out death certificates nor by a strict application of the international coding rules for registration of the underlying cause of death.
The International Form of Medical Certificate of Cause of Death
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