demographic yearbook annuaire demographique 1951

The extent to which the statistical offices have been called
upon to select a cause of death for tabulation purposes
varies considerably. In a number of countries, only a small
proportion of death certificates show more than one cause
of death (see table M). In these areas, the physician presumably
makes the selection before the cause of death is
reported to the statistical office. But the difficulty is that,
while this procedure relieves the offices of the problem of
choosing, there is generally no assurance that all of the
certifying medical practitioners will follow the same principles
of the selection. Thus, a low percentage of multiple
causes in reports to the statistical office cannot be taken to
mean that the data are accurate or comparable.
In some countries, on the other hand, more than half the
death reports include more than one cause (see percentages
for Denmark, England and Wales, Sweden, Switzerland and
the United States). This may be taken as a general indication
that medical returns are more complete. It also means
that the vital statistics offices are faced with complex problems
in assigning the causes of death. To the extent that
different offices develop different rules of procedure, the
resulting data are of a correspondingly limited comparability.
It is apparent, therefore, that more uniform selection procedures
are needed, regardless of whether they are applied
by the attending physician or by the statistical office. Such
procedures should be a cooperative undertaking in which
both the medical and the statistical factors are taken into
account. Their object should be to distinguish the underlying
cause from other diseases and conditions that may
have accompanied or resulted from the underlying cause.
TABLE M
Proportion of death certificates reporting more
than one cause of death in certain countries 1
Country
Argentina , .. , ..
Australia .
Brazil:
Federal District. .
Canada .
Chile 3 •••.•••..•.•••••••••.•.•
Denmark .
Dominican Republic .
England and Wales 4 .••..•••••••
France , .
Greece 5••.•••••••...•••• , •••••
Guatemala .
Italy .
Netherlands 2 •••••••••••••••••••
New Zealand 2 •••••••••••••••••
Nicaragua .
Peru .
Sweden .
Switzerland .
Union of South Africa .
United States .
Year
1947
1947
1947
1931 2
1947
1947
1947
1947
1935
1945
1947
1936
1947
1947
1936
1936
1947
1947
1947
1947
1947
1925
1940
Per cent
10
50-
16
33
44
10-15
75
"None"
45
55
3
12
"Few"
20-30
31
50
0.3
Less than 1
"Frequent"
60
50-55
44
55
1 Except where noted, data obtained from the national statistical
offices by the United States Committee on Joint Causes of Death.
2 United States Bureau of the Census, "Classification ofJoint Causes
of Death," Vital Statistics-Special Reports, Vol. 5, No. 47, Washington,
August 30, 1938, page 387.
3 Hospital deaths only.
4 The Registrar-Ceneral's Statistical Review of England and Wales for the
Six Years 1940-1945, Text, Vol. 1, Medical, His Majesty's Stationery
Office, London, 1949, page 80.
• Deaths reported from municipalities and some cities of 10,000
or more.
New international procedures
While the problem of uniformity in the method of selecting
the causes of death to be tabulated has been a subject of
frequent international discussion, it was not until the Sixth
Decennial Revision Conference in 1948 that international
agreement was finally reached. The Conference proposed
the adoption of a uniform medical certificate form and uniform
rules of procedure as an essential prerequisite for
proper selection and classification of causes of death. These
proposals may be regarded as steps of an importance almost
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