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The socio-demographic and epidemiological correlates of the total number of causes of death (TC) reported on death certificates were examined with multiple classification analysis (MCA). The data were all death certificates on white and black adult residents of Michigan who died at ages 25 or older in 1989 to 1991 (n = 222,763). TC was the sum of every morbid condition named as an underlying, intermediate, or immediate cause of death, or other medical condition contributing to death but not to its underlying cause. Autopsies performed for non-forensic reasons by physicians who are not Medical Examiners (MEs) likely yield the most accurate diagnoses of the underlying medical cause and counts of all other attendant causes, but they are extremely selective of decedents who are most closely integrated into the health care system. Thus we required a socio-demographic pattern in TCs to appear in a multivariate analysis not only for this special group of autopsied decedents but also for the non-autopsied masses before accepting the pattern as ‘real’' (not an artifact of underreporting of TC or confoundment with another socio-demographic variable). |
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