Measuring the Mortality Burden of Diabetes: Assessing the Value of a Death Certificate Checkbox

Katherine Hempstead, Rutgers University

It is widely believed that the mortality burden of diabetes has been under-measured. Many diabetics do not have diabetes listed as a cause of death on their death certificates. Additionally, the mortality rate among diabetics from causes other than diabetes is difficult to measure. One response has been to add a checkbox for diabetes status to the death certificate. Several states, including New Jersey, have added checkboxes, and a number of other states have legislation pending. Yet it is not clear whether a diabetes check box is a desirable addition to the death certificate. The presence of a checkbox can affect cause of death coding in unintended ways. This study uses death data from 2004 and 2005 to assesses the accuracy of the diabetes checkbox in New Jersey and its effect on the reporting of diabetes as an underlying and/or contributory cause of death.