To the Editor.
—Dr Pinner and colleagues1 should be congratulated for devising a more meaningful way to use International Classification of Diseases, Ninth Revision (ICD-9) coding to extract the impact of infectious diseases on our national mortality data. Their data clearly show an increasing trend of deaths associated with infectious disease.However, like any study based on death certificate data, the hard numbers from their study are based on a foundation of sand. The accuracy of any given death certificate is questionable at best2-4 and is ultimately unknown. The dwindling US autopsy rate further confounds the accuracy of death certificate data.5I review large numbers of completed death certificates, and I find that attending physicians often omit the true underlying cause of death and list instead the complications of the underlying cause that posed the most vexing clinical problems. In how many cases from the article by
Randall B. Increasing US Mortality From Infectious Diseases. JAMA. 1996;275(18):1399-1400. doi:10.1001/jama.1996.03530420027022