How we die is not really that simple

2012-03-03 19:55

Death certificates may state what we die of, but it’s not as simple as one might think.

South African death certificates may give a broad indication of the main causes of its citizens’ deaths,
but researchers are concerned about the quality and accuracy of the information they contain.

Research conducted by the Medical Research Institute reveals that on 21% of the 572?673 death certificates issued in 2009, it was not stated who it was that decided the cause of death of the patient.

Half of the reasons were based on a doctor’s opinion, and post-mortems were held in only 8.6% of cases.

About 15% of the underlying causes of death were determined by an “interview with a member of the family”.

Researchers also suspected that, especially in remote rural areas, many certificates were simply filled in by a village chief.

On 12.7% of death certificates issued in 2009, the causes of death were so poorly defined, or were completely absent, that they couldn’t be categorised.

Analysis of statistics from previous years also show that many deaths in South Africa are described by
so-called garbage codes. For example, conditions and symptoms that cannot cause death.

It is for these reasons that Dr?Debbie Bradshaw and her colleagues at the Medical Research Institute, which investigates the effect and causes of illnesses and death, are developing methods to improve the country’s death data.

They wrote in the September issue of the South African Medical Journal that 13.7% of the causes of death were poorly described on death certificates issued in 2008. Further investigation showed that 29.5% used garbage codes to describe underlying causes.

Garbage codes refer to aspects like risk factors, such as high blood pressure, which do not cause death but endanger your life. They also refer to the mechanism of death – such as heart failure – and partial descriptions – such as cancer in an unknown body area.

Bradshaw warns that Statistics SA’s 2009 report, which was only published in December, must, just like any older information, be interpreted with caution.

Many deaths are linked vaguely to symptoms. There are even a number of descriptions included in what caused the deaths of some South Africans, such as lice, emotional stress or personality disorders, blindness and “symptoms and signs relating to the voice and speech”.

In the case of unnatural deaths, the role of violence is not sufficiently indicated.

Meantime, researchers have begun analysing the causes of death for the year 2008 in such a way that they can be assessed in terms of lost years of life – or premature death.

Poorly described deaths have been proportionately allocated to other categories according to age and gender.

The result has given a different picture from what the death certificates appeared to indicate at first glance.

The results that were published in the District Barometer 2010/2011 showed that HIV (human immunodeficiency virus) was responsible for 9.8% of lost years of life in 2008. But in that year, this was given as the cause of death on only 2.5% of the certificates.

Bradshaw believes that the effect of HIV is probably still seriously underestimated.

Tuberculosis, lower respiratory infections and diarrhoea were responsible for nearly 39% of lost years of life. These illnesses are often Aids-related, and the experts feel that this shows that HIV/Aids is a leading cause of death among South Africans.

Accidents involving transport (4.1%) were fifth, followed by cerebral haemorrhage and strokes (3.6%), heart diseases related to high blood pressure (3.2%), interpersonal violence (3%), diabetes (3%) and cardiac arterial diseases (2.7%).

Bradshaw and her colleagues hope to complete a more accurate report on causes of death later this year.

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