Death certificate–based ICD-10 diagnosis codes for COVID-19 mortality surveillance — United States, January–December 2020
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Death certificate–based ICD-10 diagnosis codes for COVID-19 mortality surveillance — United States, January–December 2020

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      What is already known about this topic? During 2020, approximately 375,000 U.S. deaths were attributed to COVID-19. What is added by this report? Among 378,048 death certificates from 2020 listing COVID-19, 5.5% listed COVID-19 without codes for any other conditions. Among 357,133 death certificates with at least one other condition, 97% had a co-occurring diagnosis of a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), or a significant contributing condition (e.g., hypertension or diabetes), or both. What are the implications for public health practice? These findings support the accuracy of COVID-19 mortality surveillance in the United States using official death certificates. High-quality documentation of death certificate diagnoses is essential for an authoritative public record. Approximately 375,000 deaths during 2020 were attributed to COVID-19 on death certificates reported to CDC (1). Concerns have been raised that some deaths are being improperly attributed to COVID-19 (2). Analysis of International Classification of Diseases, Tenth Revision (ICD-10) diagnoses on official death certificates might provide an expedient and efficient method to demonstrate whether reported COVID-19 deaths are being overestimated. CDC assessed documentation of diagnoses co-occurring with an ICD-10 code for COVID-19 (U07.1) on U.S. death certificates from 2020 that had been reported to CDC as of February 22, 2021. Among 378,048 death certificates listing U07.1, a total of 357,133 (94.5%) had at least one other ICD-10 code; 20,915 (5.5%) had only U07.1. Overall, 97.3% of 357,133 death certificates with at least one other diagnosis (91.9% of all 378,048 death certificates) were noted to have a co-occurring diagnosis that was a plausible chain-of-event condition (e.g., pneumonia or respiratory failure), a significant contributing condition (e.g., hypertension or diabetes), or both. Overall, 70%–80% of death certificates had both a chain-of-event condition and a significant contributing condition or a chain-of-event condition only; this was noted for adults aged 18–84 years, both males and females, persons of all races and ethnicities, those who died in inpatient and outpatient or emergency department settings, and those whose manner of death was listed as natural. These findings support the accuracy of COVID-19 mortality surveillance in the United States using official death certificates. High-quality documentation of co-occurring diagnoses on the death certificate is essential for a comprehensive and authoritative public record. Continued messaging and training (3) for professionals who complete death certificates remains important as the pandemic progresses. Accurate mortality surveillance is critical for understanding the impact of variants of SARS-CoV-2, the virus that causes COVID-19, and of COVID-19 vaccination and for guiding public health action. Suggested citation for this article: Gundlapalli AV, Lavery AM, Boehmer TK, et al. Death Certificate–Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance — United States, January–December 2020. MMWR Morb Mortal Wkly Rep. ePub: 31 March 2021 mm7014e2.htm?s_cid=mm7014e2_w#contribAff mm7014e2-H.pdf
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