title: Factors associated with reporting multiple causes of death.
abstract: BACKGROUND
  There is analytical potential for multiple cause of death data collected from death certificates. This study examines relationships of multiple causes of death as a function of factors available on the death certificate (demographics of decedent, place of death, type of certifier, disposal method, whether an autopsy was performed, and year of death).
  
  
  METHODS
  Data from 326,332 Minnesota death certificates from 1990-1998 are examined. Underlying and non-underlying causes of death are examined (based on record axis codes) as well as demographic and death-related covariates. Associations between covariates and prevalence of multiple causes of death and conditional probability of underlying compared to non-underlying causes of death are examined. The occurrence of ischemic heart disease or diabetes as underlying causes are specifically examined.
  
  
  RESULTS
  Both the probability of multiple causes of death and the proportion of underlying cause compared to non-underlying cause of death are associated with demographic characteristics of the deceased and other non-medical conditions related to filing death certificate such as place of death.
  
  
  CONCLUSIONS
  Multiple cause of death data provide a potentially useful way of looking for inaccuracies in reporting of causes of death. Differences across demographics in the proportion of time a cause is selected as underlying compared to non-underlying exist and can potentially provide useful information about the overall impact of causes of death in different populations.
authors.affiliation: Division of Biostatistics, University of Minnesota, A460 Mayo Building MMC 303, 420 Delaware Street S.E, Minneapolis, MN 55455, USA. melanie@biostat.umn.edu
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Wall
authors.forename: Jinzhou
authors.initials: J
authors.lastname: Huang
authors.forename: John
authors.initials: J
authors.lastname: Oswald
authors.forename: Diane
authors.initials: D
authors.lastname: McCullen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003644:Death Certificates; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000401:mortality; D040442:Public Health Informatics; D012107:Research Design