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Public Health


Angela W. Prehn


Suicide is one of the leading causes of death in the United States. Death certificates are currently being used by public health professionals and policy makers as a main source of public health surveillance data on suicide. The accuracy of death certificates in tracking and reporting suicides has not been well quantified or evaluated in the United States. Death certificates from other countries have been found to under-report suicide. The purpose of this study was to evaluate the accuracy of death certificates in reporting suicides in the United States. The National Violence Death Reporting System (NVDRS) collects information on all violent deaths from multiple sources including medical records, law enforcement reports, and vital records. Suicide cases recorded in the NVDRS data from 2003 through 2017 were used as a reference standard to evaluate the accuracy of death certificates in reporting suicide in the United States (n = 201,912). Using a multifactorial conceptual framework and a quantitative cross-sectional design, several risk factors were analyzed to determine if they influenced the accurate reporting of suicide on the death certificate. Using a binomial logistic regression model, 13.4% (Nagelkerke R2 = .134) of the variation in accuracy can be attributed to age, race, marital status, education, method of suicide, substance abuse status, year, and state. This study establishes that the death certificate is highly accurate (99.57%) at reporting suicide deaths overall. Therefore, death certificate data can be used as an accurate data source upon which to base public health decisions, interventions, and tracking. It is important that policy and intervention decisions be based on accurate data to effectively and efficiently influence social change.

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