Syracuse University, Syracuse, NY, USA.
SUNY Upstate Medical University, Syracuse, NY, USA.
J Health Soc Behav. 2022 Dec;63(4):525-542. doi: 10.1177/00221465221078313. Epub 2022 Mar 10.
Postmortem diagnostic overshadowing-defined as inaccurately reporting a disability as the underlying cause of death-occurs for over half of adults with cerebral palsy. This practice obscures cause of death trends, reducing the effectiveness of efforts to reduce premature mortality among this marginalized health population. Using data from the National Vital Statistics System 2005 to 2017 U.S. Multiple Cause of Death files (N = 29,996), we identify factors (sociodemographic characteristics, aspects of the context and processing of death, and comorbidities) associated with the inaccurate reporting of cerebral palsy as the underlying cause of death. Results suggest that inaccurate reporting is associated with heightened contexts of clinical uncertainty, the false equivalence of disability and health, and potential racial-ethnic bias. Ending postmortem diagnostic overshadowing will require training on disability and health for those certifying death certificates and efforts to redress ableist death certification policies.
死后诊断遮蔽——将残疾不准确地报告为死亡的根本原因——发生在超过一半的脑瘫成年人中。这种做法掩盖了死亡趋势，降低了努力减少这一边缘化健康人群过早死亡的有效性。利用 2005 年至 2017 年美国国家生命统计系统（National Vital Statistics System）的多死因文件（N=29996）的数据，我们确定了与不准确报告脑瘫为死亡根本原因相关的因素（社会人口统计学特征、死亡的背景和处理的各个方面以及合并症）。结果表明，不准确的报告与临床不确定性的加剧、残疾和健康的虚假等同以及潜在的种族-民族偏见有关。要消除死后诊断遮蔽，就需要对那些认证死亡证明的人进行残疾和健康方面的培训，并努力纠正歧视性的死亡认证政策。
