Postmortem Diagnostic Overshadowing: Reporting Cerebral Palsy on Death Certificates

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 margina...

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Bibliographic Details
Published in:Journal of health and social behavior 2022-12, Vol.63 (4), p.525-542
Main Authors: Landes, Scott D., Stevens, J. Dalton, Turk, Margaret A.
Format: Article
Language:English
Subjects:
Adult
Cause of Death
Cerebral palsy
Cerebral Palsy - diagnosis
Certificates
Certification
Clinical Decision-Making
Comorbidity
Death
Death & dying
Death Certificates
Death rituals
Diagnostic systems
Disability
Health
Humans
Marginality
Medical diagnosis
Mortality
Paralysis
Population growth
Premature mortality
Racism
Sociodemographics
Uncertainty
Vital statistics
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Description
Summary: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.
ISSN:0022-1465
2150-6000
DOI:10.1177/00221465221078313