Mortality in medicolegal deaths in Hyogo Prefecture (1986-88).

Only three medical examiner offices are undertaking inquests on medicolegal deaths and no coroner system exists in Japan. Medical practitioners are also entrusted to hold such inquests. Certificates filed by the medical examiners of Hyogo Prefecture were compared with those filed by medical practitioners. Medical examiners certified deaths as "heart failure" only when no pathological changes were found after an autopsy. Of 2,622 deaths caused by diseases, 1,707 were certified as "heart failure" by medical practitioners without performing an autopsy. The term "heart failure" seems likely to be misused for deaths of which causes are unknown. Although the age-adjusted mortality rate for "heart disease" in Japan (98.7 per 100,000 population) showed a higher rate than for "cerebrovascular disease" (84.2), it included 53.9 for "heart failure". The misuse of the term "heart failure" seems to have introduced serious bias into the recent mortality statistics of Japan. This inaccuracy is due to ignorance about the importance of mortality statistics and ICD. Improvement in the reliability of mortality statistics is necessary for disease prevention projects through clinical medicine and public health means.