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December 17, 1982

Alcohol and Death Certificates

JAMA. 1982;248(23):3096. doi:10.1001/jama.1982.03330230018016

To the Editor.—  Although the accuracy of death certificates has been questioned,1-3 they continue to be the primary source of mortality statistics. Death certificates may seriously underestimate the prevalence of certain diseases.4 This may be especially true for alcoholism.1-5In an ongoing study of alcoholism, mortality was confirmed in 246 of 1,289 (19%) known alcoholics five to eight years after treatment of alcoholism or its complications. Autopsies were performed on 102 patients (43.6%). Two raters compared the death certificates and the available autopsies of 50 of these patients to determine the validity of death certificate information, with special regard to alcohol-related diseases or conditions.Using the autopsy as the standard for determining the cause of death, both raters agreed that only 60% of the death certificates gave an accurate general epidemiological description of the patient's death. In the 40% of certificates, where discrepancies occurred between the two