Implications of the 2017 change in the French death certificate for the accuracy of mortality statistics worldwide.

backgroundDifferentiating between types of deaths is crucial because it allows us to better understand and prevent them, and it is essential to bringing justice to homicide victims. While there is extensive knowledge about the ways in which identifying manner of death can go wrong, the advocated solutions of more training and resources have not been put to the test. A peculiarity of the French death investigation system, along with a change in the French death certificate in 2017 allow us to test the efficacy of more specific instructions as a type of training as a solution to inaccurate information on types of deaths.

methodsUsing nationwide French death certificates information available through the Epidemiological Center on Causes of Death (CépiDC) from 2016 until 2019, we conducted a before-and-after natural experiment to establish whether the 2017 change impacted the quality of mortality statistics in France. We ran logistic regression models on the likelihood that a medicolegal investigation was conducted, as well as on the quality of ICD codes for causes of death.

findingsThe 2017 change in the French death certificate led to a two-fold increase in medicolegal investigations as well as an almost 10% increase in the quality of ICD codes of causes of death nationwide.

interpretationThe more specific instructions provided through the changes to the French death certificate led to improved mortality statistics, thereby providing support for the hypothesis that more training increases the quality of mortality statistics. Future research should establish dose-response, as well as focusing on policy implications beyond the French context.