demographic yearbook annuaire demographique 1951

Accuracy of diagnosis
Some countries limit the publication of cause-of-death
statistics to deaths with medical attendance or to deaths
that occur in hospitals. In this manner, the unreliable element
of the laymen's medical diagnosis is eliminated. Such
statistics, however, are very limited in their usefulness because
they cannot be related to the population from which
the deaths arose, nor can they be taken as representative
of the general population.
Even if every decedent were attended by a medical practitioner
before death, there would still be some question as
to the reliability of the results, for medical diagnosis is not
an exact science. This fact is demonstrated frequently by
clinical-pathological conferences where clinical findings are
compared with the anatomical findings at autopsy. Such
comparisons indicate that the accuracy of diagnosis varies
between diseases as well as between physicians.
In addition, a number of studies have found significant
differences between cause-of-death statistics derived from
death certificates and those derived from clinical-pathological
findings available on hospital records. These studies
usually give only the experience of certain hospitals, and
the results cannot be applied to all deaths in a population.
However, they are indicative of the difficulty of obtaining
accurate diagnoses even under favorable circumstances.
The accuracy of diagnosis depends to a large extent on
the existing level of medical knowledge and on the acumen
and ability of the medical practitioners. There are important
differences among practitioners in the quality and
intensity of medical education received, in the type and
length of medical experience and in the degree to which
diagnostic aids and facilities are utilized.
There are provisions in the laws of certain countries that
may deter the medical certifier from revealing medical
information prejudicial to the memory of the decedent or
to his survivors. Even without such laws, it is known that
this factor of professional secrecy operates to a certain extent
in the reporting of specific causes such as syphilis and other
venereal diseases, alcoholism, tuberculosis and cancer.
In order to prevent public disclosure of individual causes
of death, some countries have made the information on
death certificates confidential. The degree of confidentiality
of these records varies, and it is not known how frequently
physicians exercise their preference to certify another cause
instead of the true cause of death.
Where medical resources are relatively inadequate, statistics
of causes of death are likely to contain a large number
of deaths attributed to ill-defined and unknown causes and
to senility. (Senility may, in most cases, be regarded as an
"ill-defined" cause, representing insufficient diagnosis.)
Most of the deaths so classified are deaths without medical
attendance, though some may represent inexpert medical
service or careless medical reporting.
The table below shows recent data on the percentage of
all deaths reported as due to ill-defined and unknown causes,
including senility. These data relate to the areas for which
statistics are shown in this Yearbook and which reported
more than 1,000 deaths for the years specified. The proportion
of unsatisfactory medical returns varies from 1.3 per
cent for deaths tabulated for New Zealand to 56.5 per cent
for Cyprus. A high proportion of ill-defined and unknown
causes is an important consideration from the statistical
point of view because it undoubtedly represents a differential
understatement of the frequency of the more specific
causes of death. For example, if it were possible to obtain a
competent diagnosis on those deaths classified as due to
senility, it is likely that a significant number of them would
be assigned to some form of heart disease or to other chronic
diseases.
TALBE 0
Percentage of deaths reported as due to ill-defined and unknown causes (including senility): Selected countries
Country rear Percentage Country rear Percentage
AFRICA
ASIA (cont.)
Mauritius.................... 1949 13.2 Japan....................... 1949 8.7
Possessions in North Africa (Sp.): Macau...................... 1947 7.5
Ceuta and Melilla.......... 1949 13.2 Portuguese India.............. 1949 23.4
Sao Tome and Principe........ 1948 26.5 EUROPE
Union of South Africa: Austria...................... 1948 8.6
Europeans................. 1947 4.9 Belgium..................... 1949 16.7
AMERICA, NORTH Denmark.................... 1947 3.5
Alaska....................... 1948 7.1 Finland...................... 1948 12.8
Canada...................... 1948 1.6 France...................... 1947 17.1
Costa Rica................... 1949 7.7 Germany:
Dominican Republic.......... 1949 28.8 Berlin..................... 1949 6.6
EI Salvador.................. 1948 23.2 Iceland...................... 1947 15.8
Netherlands Antilles........... 1949 12.6 Ireland...................... 1948 14.0
Puerto Rico. . . . . . . . . . . . . . . . . . 1948 8.5 Italy........................ 1948 8.6
United States................. 1948 1.9 Luxembourg................. 1949 15.4
Windward Islands............ 1948 22.4 Malta and Gozo.............. 1949 7.5
Netherlands.................. 1949 8.4
AMERICA, SOUTH
Norway..................... 1948 13.0
British Guiana................ 1949 13.6 Portugal...... . .............. 1949 16.8
Colombia.................... 1948 25.7 Spain....................... 1948 9.2
Peru........................ 1948 19.2 Sweden...................... 1947 9.4
Surinam..................... 1949 32.7 Trieste...................... 1949 6.5
ASIA United Kingdom ............. 1948 2.9
Ceylon...................... 1949 15.5 OCEANIA
Cyprus...................... 1949 56.5 Australia.................... 1948 3.3
Hong Kong.................. 1948 5.7 Hawaii...................... 1948 3.0
Israel....................... 1948 5.7 New Zealand (ex. Maoris) ...... 1949 1.3
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