Evaluating the validity of cause-of-death statistics in Taiwan (II): Characteristics of high frequency death certificates certifiers

This study describes the characteristics of high-frequency death certificate certifiers and the quality of their cause-of-death diagnoses in order to provide information for designing a program to improve the quality of cause-of-death statistics. In Taiwan, there were 111,927 death certificates issued in 1994 and the frequency of death certificates issued by one certifier a year was highly skewed. One hundred and ten doctors issued more than 100 death certificates a year. They comprised 0.67% of all certifiers, but the death certificates issued by them accounted for 22.47% of all death certificates. These certifiers had great influence on the quality of cause-of-death statistics in Taiwan. Most of these high frequency certifiers were: older in age, not graduated from medical schools, general practitioners and served in non-teaching hospitals or clinics. The percentage of formative errors on cause-of-death diagnoses was higher for high-frequency certifiers as compared to low-frequency certifiers. The special 'administrative certification' process in Taiwan is the reason for the large number of high-frequency death certifiers. The defects of this system are discussed and some proposals for improvements are raised in this study.