Question How is official cause of death determined when someone had more than one illness?

May 3, 2020
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Preferably answers would come from people who actually work with death certificates either filling them out or for statistical/data research projects. Sorry if this isn't the best forum, couldn't find one that seemed a better match; please move if necessary.

Are there official rules/guidelines for what type of cause is supposed to be documented on a death certificate? If yes, how does this actually work in real life, as opposed to how it is "supposed" to work?

I ask because this seems to have a dramatic impact on how to view disease fatality impact.

1."On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three," he says. - about deaths in Italy.

2. reading about the Spanish Flu, a paper specifically mentioned that the numbers they chose to use included both flu cases and pneumonia deaths as the two had such a high overlap (sorry couldn’t find the link right now)
 

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