The first manuscript in which I shared the work 40 years ago bore the same title as this editorial. At that time Yater and I1 concluded that
The death certificate is an important document.
The inaccuracy of many death certificates detracts greatly from their value.
Clinical determination of the causes of death is often difficult, the general percentage of correct diagnoses being probably less than 50%.
When two diseases coexist, it may be difficult at times to decide which is the principal cause of death and which the contributory.
The exact mechanism of death in many diseases is not fully known.
Intravascular infection, pneumonia, and tuberculosis are the main contributory or terminal states as shown by a study of 220 necropsies.
Now, 40 years later, all the foregoing statements (with the exception of the one about tuberculosis) probably cannot be challenged. Consider especially the inaccuracy of death certificates. From time
Hussey HH. The Cause of Death. JAMA. 1974;229(1):75. doi:10.1001/jama.1974.03230390051031