Appendix 1: Procedures for certification

and coding of causes of death The international form of medical certificate of cause of death has two parts. Certifying physicians are required to record a sequence of causes originating from the underlying cause of death in Part I of the certificate, and contributory causes of death in Part II. By convention, official statis-tical agencies report mortality measures based on underlying causes of death. In the USA and Australia (and several other countries), data from medical certificates of cause of death is processed through the Medical Mortality Data System, developed by the Centers for Disease Control and Prevention, USA. The MMDS includes a software program called the ACME, which applies rules prescribed by the World Health Organization to select the code for the underlying cause of death. The ACME program primarily selects the underlying cause as ‘diabetes with renal complications ’ when the death certificate mentions diabetic nephropathy, intracapillary glomerulosclerosis, or Kimmelsteil–Wilso