An international comparison study indicated physicians' habits in reporting diabetes in part I of death certificate affected reported national diabetes mortality

Background and Objective: Physicians may find it confusing to decide whether to report diagnoses in part I or part II of the death certificate. The aim of this study was to contrast differences in diabetes mortality through a comparison of physicians' habits in reporting diabetes in part I of death certification among Taiwan, Australia, and Sweden. Methods: A cross-sectional, intercountry comparison study. We calculated the proportion of deaths with mention of diabetes in which diabetes was reported in part I of the death certificate and the proportion of deaths with mention of diabetes in which diabetes was selected as underlying cause of death. Results: We found that half of the differences in reported diabetes mortality among Taiwan, Australia, and Sweden were due to differences in reporting deaths with mention of diabetes anywhere on the certificate, and half due to differences in proportion of deaths with mention of diabetes in which diabetes was reported in part I of the death certificate. Conclusion: Differences in the reporting of diabetes in part I of the death certificate among physicians in Taiwan, Australia, and Sweden was one of the factors that affected differing reported diabetes mortality in Taiwan, Australia, and Sweden.