Practice of Epidemiology Using Multiple Cause-of-Death Data to Investigate Associations and Causality between Conditions Listed on the Death Certificate

Death rarely results from only one cause, and it can be caused by a variety of factors. Multiple cause-of-death data files can list as many as 20 contributing causes of death in addition to the reported underlying cause of death. Analysis of multiple cause-of-death data can provide information on associations between causes of death, re-vealing common combinations of events or conditions which lead to death. Additionally, physicians report the causal train of events through which they believe that different conditions or events may have led to each other and ultimately caused death. In this paper, the authors discuss methods used in studying associations between reported causes of death and in investigating commonly reported causal pathways between events or conditions listed on the death certificate. cause of death; death certificates; mortality Abbreviations: EOR, exposure odds ratio; HIV, human immunodeficiency virus; MCOD, multiple cause-of-death; MOR, mortality odds ratio. Death certificate data are generally analyzed by examin-ing the underlying cause of death as reported on the death certificate by the medical examiner (1). However, deaths rarely have only one cause, and this method does not allo