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



While there is no list of acceptable causes, certain conditions should not be entered as the underlying cause of death (ie, the last or only line in Part I).

Nonspecific causes are event or conditions that occurred along the path to death, and can therefore be listed as immediate or intermediate causes, but must be accompanied by the underlying condition(s) that gave rise to them. Mechanisms of death are not considered causes of death and should generally not be included in the cause of death statement (see Box 3).

Special Situations

Elderly patients: Identifying the underlying cause of death can be especially challenging with elderly patients. Avoid using uninformative terms such as "senescence," "infirmity," and "advanced age," which do not describe the unique circumstances of the death. Review the medical record, nursing home record, and information provided by family members to identify the underlying cause, for example, "renal failure due to dehydration, due to underlying dementia." If necessary, use qualifying terms such as "probable" or "likely."
Cancer-related deaths: When the cause of death is cancer, provide as much information as possible, including stage, primary site, and site of metastases.
Medical Examiner cases: You must contact the Office of the Chief Medical Examiner (OCME) at 212-447-2030 before registering the death in cases of deaths not entirely due to natural causes and in the circumstances listed in Box 4.



Nonspecific conditions can be the intermediate or immediate cause, but not underlying cause

Cirrhosis   Pulmonary embolism
End-stage kidney disease Cerebral infarct
End-stage liver disease Spontaneous hemorrhage
Pulmonary fibrosis Sepsis
Dementia Pneumonia
Other end-stage organ diseases Gastrointestinal hemorrhage
Congestive heart failure Cardiac arrhythmia
Myocardial infarct Multi-organ failure
Deep vein thrombosis Paraplegia/quadriplegia

Mechanisms of death are not part of the cause of death statement

Cardiopulmonary arrest   Respiratory arrest
Cardiac arrest Asystole

PDF version of Box 3


Contact the Office of the Chief Medical Examiner at (212) 447-2030 in cases of:

  • Criminal neglect and violence
  • Drug and chemical overdose and poisoning
  • Exposure to excessive heat or cold
  • Physical, chemical, biological, and radiological injuries
  • Workplace-related injuries
  • Any injury contributing to death, regardless of when it occurred
  • Deaths during diagnostic or therapeutic procedures or due to complications from these procedures
  • Sudden death when the individual is in apparent good health
  • Deaths of unidentified individuals
  • Deaths of individuals in legal detention, jails, or police custody
  • Deaths of individuals unattended by a physician in the past 31 days
  • A fetus delivered dead in the absence of a physician or midwife
  • Neonatal deaths when premature delivery was due to maternal trauma or drug abuse

PDF version of Box 4