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The Importance of Cause-of-Death Certification for the COVID-19 Burden Assessment: the Case of Central Europe

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  • Fihel, Agnieszka
  • Janicka, Anna
  • Buschner, Andrea
  • Ustinavičienė, Rūta
  • Trakienė, Aurelija

Abstract

Background: In Central Europe, the increase in mortality during the COVID-19 pandemic exceeded the number of deaths registered due to coronavirus disease. Miscertification of COVID-19 has been suggested as one of the possible explanations. Analysis of all mentions from death certificates allows us to identify cases where COVID-19 was reported as a contributing rather than the underlying cause of death (UCoD). Methods: Analysis of 187,000 death certificates with a COVID-19 mention from Austria, Bavaria, Czechia, Lithuania and Poland, 2020–2021. Cause of Death Association Indicators (CDAIs) and Contributing CDAIs were calculated to identify and measure the strength of associations between COVID-19, reported as UCoD or not, and all other medical mentions. Results: Death certificates reporting COVID-19 included on average more medical information than other death certificates. In 171,600 deaths with COVID-19 as the UCoD, ten groups of comorbidities and ten types of complications revealed significant and strong association with COVID-19. Further 15,700 deaths were certified with COVID-19 only as a contributing condition, of which almost 20% were assigned to typical coronavirus complications, such as cerebral infarction, Acute Myocardial Infarction, renal failure. In Austria, Bavaria, Czechia and Lithuania the reported scale of COVID-19 mortality would have been 18-27% higher had COVID-19 been coded as the UCoD in all the cases. Conclusions: Complete death certificate information allows us to assess the scale of COVID-19 miscertification and the burden of COVID-19. Deaths registered with a coronavirus comorbidity were equivalent to the total estimated excess mortality in Austria and Czech Republic, and its large proportion in Lithuania and Bavaria.

Suggested Citation

  • Fihel, Agnieszka & Janicka, Anna & Buschner, Andrea & Ustinavičienė, Rūta & Trakienė, Aurelija, 2024. "The Importance of Cause-of-Death Certification for the COVID-19 Burden Assessment: the Case of Central Europe," SocArXiv hy9zn_v1, Center for Open Science.
    • Handle: RePEc:osf:socarx:hy9zn_v1
    DOI: 10.31219/osf.io/hy9zn_v1
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    1. Thomas Hale & Noam Angrist & Rafael Goldszmidt & Beatriz Kira & Anna Petherick & Toby Phillips & Samuel Webster & Emily Cameron-Blake & Laura Hallas & Saptarshi Majumdar & Helen Tatlow, 2021. "A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker)," Nature Human Behaviour, Nature, vol. 5(4), pages 529-538, April.
    2. David Adam, 2022. "The pandemic’s true death toll: millions more than official counts," Nature, Nature, vol. 601(7893), pages 312-315, January.
    3. Agnieszka Fihel & Magdalena Muszyńska-Spielauer, 2021. "Using multiple cause of death information to eliminate garbage codes," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 45(11), pages 345-360.
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