The quality and details of the information recorded on death certificates determine the accuracy of mortality statistics and the validity of research findings based on mortality data. This process results in the Multiple Cause of Death (MCoD) data, in which each record contains one underlying cause and up to 20 multiple causes. Manual coding is applied when the automated process is not executable. NCHS developed multiple computer programs-the Mortality Medical Indexing, Classification, and Retrieval (MICAR) system SuperMICAR Automated Classification of Medical Entities (ACME) and Translation of Axes (TRANSAX)-to automatically code the literal entry of cause-of-death information, systematically select the underlying cause of death, and methodically generate the list of multiple causes of death ( Kochanek et al., 2011). NCHS processes the cause-of-death information in accordance with the World Health Organization (WHO) regulations and the International Classification of Diseases (10th Revision, since 1999) ( Kochanek et al., 2011). In the United States, all the death certificates filed in the states and the District of Columbia are submitted to NCHS, Centers for Disease Control and Prevention (CDC). The cause-of-death information represents the medicolegal opinions on “the chain of events-diseases, injuries, or complications-that directly caused the death” and “other significant conditions contributing to death” (National Center for Health Statistics, 2004a, 2004b). D eath certificates have been the preferred source for mortality statistics because they contain demographic information and (most important) cause-of-death information certified by a physician, coroner, or medical examiner.
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