MMWR Morb Mortal Wkly Rep. 2021 Apr 9;70(14):523-527. doi: 10.15585/mmwr.mm7014e2.
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.
在向疾病预防控制中心报告的死亡证明中，约有 37.5 万人的死亡归因于 COVID-19（1）。有人担心，有些死亡被不当归因于 COVID-19（2）。分析官方死亡证明上的国际疾病分类，第十版（ICD-10）诊断可能提供一种便捷有效的方法来证明报告的 COVID-19 死亡是否被高估。疾病预防控制中心评估了截至 2021 年 2 月 22 日向疾病预防控制中心报告的 2020 年美国死亡证明上与 COVID-19（U07.1）ICD-10 代码同时出现的诊断的文件记录。在列出 U07.1 的 378048 份死亡证明中，共有 357133 份（94.5%）至少有一个其他 ICD-10 代码；20915 份（5.5%）仅有 U07.1。总的来说，在至少有一个其他诊断的 357133 份死亡证明中（占所有 378048 份死亡证明的 91.9%），有 97.3%被记录为同时存在一个可能的连锁事件条件（例如肺炎或呼吸衰竭）、一个重要的促成条件（例如高血压或糖尿病）或两者兼而有之。总的来说，70%-80%的死亡证明既有连锁事件条件又有重要的促成条件，或者只有连锁事件条件；这在 18-84 岁的成年人、男性和女性、所有种族和族裔的人、在住院、门诊或急诊环境中死亡的人以及死因列为自然的人身上都有体现。这些发现支持了使用官方死亡证明进行 COVID-19 死亡率监测的准确性。在死亡证明上高质量地记录同时出现的诊断对于全面和权威的公共记录至关重要。随着大流行的继续，为填写死亡证明的专业人员提供持续的信息和培训（3）仍然很重要。准确的死亡率监测对于了解导致 COVID-19 的严重急性呼吸系统综合征冠状病毒 2 变异株的影响以及 COVID-19 疫苗的效果以及为公共卫生行动提供指导至关重要。
