City Health Information
December 2012 New York City Department of Health and Mental Hygiene Vol. 31(6):41-49
Improving Cause of Death Reporting: Update 2012
  • Accurate and detailed cause of death reporting is critical for disease surveillance, public health research, and forensic investigations.
  • Cause of death reporting requires:
    • Review of the medical record
    • Identification of all conditions and events leading or contributing to the death
    • Ordering the conditions and events in a medically probable sequence
Image of death headlines

Death certificates are both important legal documents and essential public health tools. Rapid reporting enables families to arrange funerals and settle estates quickly and helps government agencies prevent the fraudulent use of birth certificates, driver's licenses, Social Security benefits, and other entitlements. Timely and detailed documentation of cause of death (and other significant conditions and events related to that cause) is crucial to public health reporting and surveillance. The New York City (NYC) Health Department and the Centers for Disease Control and Prevention (CDC) rely on cause of death data to identify outbreaks and emergencies, such as pandemic flu and heat waves. For these reasons, the NYC Health Code requires that all deaths be reported within 72 hours.

The NYC Health Department and other government agencies, as well as hospitals, researchers, and community-based organizations, use statistics from death certificates to identify public health priorities and develop appropriate interventions. Detailed cause of death reporting yields accurate information about neighborhood differences in the number of deaths due to diabetes, for example, enabling policymakers to target community interventions such as healthy food initiatives or physical activity programs. Incomplete or nonspecific reporting can lead to inaccurate statistics that can affect interventions, policy, and funding. Reporting cardiac arrest as the cause of death without recording the underlying condition (eg, metastatic breast cancer or chronic obstructive pulmonary disease) may cause an underestimation of mortality due to the true underlying illness (1-3). Chart review studies have identified substantial inaccuracies in cause of death reporting in NYC (4). Educating providers can improve the quality of death certificate information, making it a more useful tool for assessing population health (5).

Because the quality of cause of death data is critical for legal and public health purposes, each death undergoes multiple levels of review. Medical providers must understand how to document cause of death in sufficient detail to meet review requirements and avoid the need for resubmission. Electronic reporting in the NYC Electronic Vital Events Registration System (EVERS) has simplified the death certification process, but misconceptions still affect the quality and timeliness of reporting (Box 1).


  • The "Burial Desk" at the NYC Health Department will not register the death if the cause provided is too complex.
    Not true. Both the Burial Desk and the Office of the Chief Medical Examiner (OCME) prefer detailed and complete descriptions of the cause of death.
  • You must use a cause from the "list" of acceptable causes.
    Not true. There is no list of acceptable causes of death. Use your clinical judgment and the patient's medical history to detail causes of death.
  • Funeral directors have the authority to request a specific change to the Cause of Death section.
    Not true. The funeral director is not authorized to tell the provider what to write as the cause of death, but may tell the hospital staff or health care provider to contact OCME or the Health Department about the cause of death.
  • Information from the death certificate doesn't really matter anyway; it's just to determine whether the death is a Medical Examiner case or not.
    Not true. Death certificate information has many important public health and legal uses.
  • The certificate cannot be submitted if the cause of death fields in the Electronic Vital Events Registration System (EVERS) are yellow.
    Not true. If you see an error message and yellow highlighted field, you must verify or update your entry and hit Validate. If the field remains yellow, but you feel the entry is complete and accurate, check the Override box, save the override, and submit the case. The data entry field will remain yellow after the override

PDF version of Box 1

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