With the daily updates on COVID-19 cases and deaths, I am trying to understand the algorithm behind the assignment of the cause of death.
I was wondering how doctors evaluate and assign the cause of death?
E.g. if someone has a heart attack, following COVID-19 infection (while they are infected - not post recovery) and this person had metabolic syndrome (let's say all dyslipidemia, hypertension and hyperglycaemia) how to we make a decision if the cause death is COVID-19 or diabetes or cardiovascular disease?
To me the guideline given for the assignment of COVID-19 death in Australia seems to have an inherent bias towards COVID-19:
"As per the COVID-19 national guidelines, a COVID-19 death is defined for surveillance purposes as a death in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID19 (e.g. trauma)."
https://www.health.gov.au/resources/covid-19-deaths-by-age-group-and-sex#:~:text=Deaths%20have%20been%20reported%20in,greater%20than%2090%20years%20old.
But I actually do not wish to restrict my question to COVID-19. Instead, I am trying to understand in general how we calculate mortality rates for different diseases, as these numbers inform policy and how funds are allocated.
Especially for complex metabolic conditions, like cardiometabolic ones, how do we decide if someone with type 2 diabetes, and vascular damage potentially due to hyperglycaemia, that had a stroke, will be assigned to the diabetes deaths toll or to the cardiovascular deaths toll?
How does e.g. WHO come up with:
9.5 million deaths from heart attack per annum
6 million deaths from stroke per annum
2 million deaths from diabetes per annum
Ref: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Is there a guideline given to doctors regarding a decision-roadmap to assign the cause of death?
ICD classification can help you out. There are clear cut classifications like Immediate cause of death, antecedent cause and underlying conditions associated with death. If you wish there is an online course on Medical Certification of Death by WHO and University of Toronto. You can go through that, it helped me a lot in better understanding the concept of death certification.
The most precise way to determine the actual cause of death is autopsy. It would be rational that autopsy is performed whenever the cause of death is not clear, but it is usually dependent on the will of relatives. In Croatia family can decide whether they want autopsy or not and it is their call, except in the case of violent death (of course) when it is mandatory.
I do know medicine, but it is generally difficult to make a clear distinction between "the cause" CA of an event E, and the circumstances CI, without which CA would not have caused the event E (or the event E would not have "happened").
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