Cause of Death

on the
Death Certificate
in line with ICD

Quick reference guide

Cause of death information serves

• epidemiology and prevention
• managing health care
• comparing health in different populations

Certification of death is one of the first steps in getting an overview of the

health of people.
The diseases or conditions recorded on a death certificate represent the
best medical opinion.
A properly completed cause-of-death certificate provides a description of
the order, type and association of events that have resulted in the death.
The diagnoses reported on the certificate are coded with the International
Classification of Diseases, 10th edition. This coded data is analyzed and
used both nationally and internationally no matter what language was used
to complete the certification.
 7. Annexes

Cause of Death on the certificate - how to fill in?

Frame A: Death certificates may look different in most countries. But the
section on the cause of death is identical world wide.
Frame A has two parts, called Part 1 and Part 2, and a section to record the
time interval between the onset of each condition and the date of death.

Part 1 - is used for diseases or conditions that form part of the

sequence of events leading directly to death.
The immediate (direct) cause of death is entered on the first line, 1(a).
There must always be an entry on line 1(a).
The entry on line la may be the only condition reported in Part I of the
certificate.
Where there are two or more conditions that form part of the sequence of
events leading directly to death, each event in the sequence should be
recorded on a separate line.
In any case you must record the disease, injury or external cause that
resulted in the death. Do not record the mode of dying, such as cardiac
arrest, respiratory failure or heart failure.
Try to be as specific as you can. "Unknown" cause of death should be
recorded in cases where thorough testing or autopsy examination cannot
determine a cause of death. "Unknown" is better than any speculation on the
possible cause of death.
Always fully spell out all terms. Abbreviations can be interpreted in different
ways. Terms such as "suspected" or "possible" are ignored in evaluation of
the entries. For example "suspected Diabetes" will be interpreted as
"Diabetes". The four lines may not provide enough space for the chain of
events. Do not waste space with unnecessary words. Some clinical terms
are very vague. For example, "tumour" does not specify behaviour (see also
last page of this flyer).
Duration - is the time interval between the onset of each condition that
is entered on the certificate (not the time of diagnosis of the condition), and
the date of death. The duration information is useful in coding certain
diseases and also provides a useful check on the order of the reported
sequence of conditions.
Part 2 - is used for conditions that do not belong in Part 1 but whose
presence contributed to death.

Frame B: Some detail is frequently forgotten in Part 1 and 2 (Frame A).

Separate detailed questions ask for detail such as previous surgery, mode of
death or place of occurrence. Frame B is not shown in this information sheet.
It is self-explanatory.
Cause of Death on the certificate - step by step

Start at line 1(a), with the immediate (direct) cause, then go back in time to
preceding conditions until you get to the one that started the sequence of
events. You will get very close to the time the patient was healthy.
Now, you should have reported the underlying or originating cause on
the lowest used line and a sequence of events leads from the underlying
cause up to the immediate (direct) cause in the first line 1 (a).
Finally, record the time interval between the onset of each condition
entered on the certificate and the date of death. Where the time or date of
onset is not known you should record a best estimate. Enter the unit of time
(minutes, hours, days, weeks, months, years).

Example

Frame A: Medical data: Part 1 and 2

1 Time interval from onset
Cause of death
Report disease or condition to death
directly leading to death on Cerebral haemorrhage
line a a 4 hours

Due to:
Report chain of events in due b 4 moths
Metastasis of the brain
to order (if applicable)
Due to:
c 5 years
State the underlying cause Breast cancer
on the lowest used line Due to:
d

2 Other significant conditions

contributing to death (time intervals can
be included in brackets after the
condition)

• Write clearly and do not us abbreviations.

• Be sure the information is complete.
• Do not speculate on the cause of death.
• Do not fill in laboratory results or statements like "found by partner".
(there may be separate fields on the form for this kind of information)
• One condition per line should be sufficient.
Frequently used ill-defined terms

Accident Specify circumstances

Specify intent, as car accident, suicidal, or
assault; Specify place of occurrence
Alcohol, drugs Specify use: long term or single, addiction
Complication of surgery Specify disease: disease that caused surgery
Dementia Specify cause: Alzheimer, infarction, old age,
other
Hepatitis
Specify course, etiology: acute or chronic,
alcoholic If viral: specify Type (A, B, C, ...)
Infarction Specify site: heart, brain, ...
Specify cause: arteriosclerotic, thrombotic,
embolic...
Infection Specify: primary or secondary, causative
organism
If primary: specify bacterial or viral
If secondary: specify the primary infection
Leukaemia Specify: acute, subacute, chronic lymphatic,
myeloid, monocytic
Pneumonia Specify: primary, aspiration, cause, causative
organism
If due to immobility: specify the cause of the
immobility
Pulmonary embolism Specify cause: cause of embolism
If post-surgical or immobility: specify disease
that caused surgery or immobility
Renal failure Specify: acute, chronic or terminal, underlying
cause of insufficiency, such as arteriosclerosis,
or infection
If due to immobility: specify the cause of the
immobility
Thrombosis Specify: arterial or venous Specify: the blood
vessel
If post-surgical or immobility: specify disease
that caused surgery or immobility
Tumour Specify: behaviour, location, metastases
Urinary tract infection
Specify: site in the urinary tract, causative
organism, underlying cause of infection
If due to immobility: specify the cause of the
immobility

www.who.int/classifications ©WHO 2015