Is smoking recorded accurately on death certificates? A study of patients who died from chronic obstructive pulmonary disease (COPD) and lung cancer in a tertiary referral centre

Abstract

Introduction

Death certification provides an important source of mortality data. This data is used to monitor the health of the population and to plan health services accordingly. It is also used in research into the health effects of exposure to various risk factors. 1 Since 1992 doctors in the UK were permitted to cite smoking as a cause of death without referral to the coroner. 1 However, a recent study suggests that smoking is rarely recorded on death certificates despite smoking being attributed to 18% of all deaths in England. 2 We sought to determine whether or not smoking was being recorded accurately on death certificates in patients who died from COPD and lung cancer at one hospital.

Methods and Results

Notes were reviewed for all the patients who died from COPD and lung cancer between January-November 2011 (N=183). Smoking history was recorded for 127 (69%) patients; 117 (92%) had smoked. Of these 117 patients, cause of death was certified as COPD [N=81 (69%)] and lung cancer [N=44 (38%)]. In all cases, smoking was not recorded on any part of the death certificate.

Conclusions

Smoking is not recorded appropriately on death certificates in patients who died from COPD and lung cancer. This limits death certificates as a potential useful source of epidemiological data on smoking.

References

1. http://www.gro.gov.uk/images/medcert_July_2010.pdf

2. Proctor, I et al. Does smoking kill? A study of death certification and smoking. J Clin Pathol. 2012. 65(2): 129-32.