{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:02:22Z","timestamp":1790121742009,"version":"4.0.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"the National Science and Technology Council","award":["NSTC112-2314-B-006-082-MY2"],"award-info":[{"award-number":["NSTC112-2314-B-006-082-MY2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study examined changes in COVID-19-related death certification practices (ie, reporting COVID-19 in Part I of the death certificate) and the quality of cause-of-death (COD) reporting (acceptable and rejected causal sequences) in the United States from 2020 to 2023. In 2020, 2021, 2022, and 2023, 385\u2009293, 463\u2009273, 246\u2009196, and 76\u2009024 death certificates, respectively, mentioned COVID-19. COVID-19 was selected as the underlying COD in 91%, 90%, 76%, and 65% of these certificates, corresponding to reporting COVID-19 in Part I in 93%, 91%, 78%, and 67% of certificates, respectively. Acceptable causal sequences were reported in 51%, 51%, 45%, and 41% of certificates, whereas rejected causal sequences were reported in 21%, 22%, 23%, and 23%, respectively. Using 2020 as the reference year, the adjusted odds ratios (95% CIs) for 2023 were 0.18 (0.18, 0.18) for reporting COVID-19 in Part I, 0.77 (0.76, 0.78) for reporting acceptable causal sequences, and 1.14 (1.12, 1.16) for reporting rejected causal sequences. In conclusion, COVID-19-related death certification practices changed substantially over the study period, paralleling the decline in the virulence of SARS-CoV-2. The quality of COVID-19-related COD reporting declined modestly from 2020 to 2023.<\/jats:p>","DOI":"10.1093\/aje\/kwag215","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:11:45Z","timestamp":1788520305000},"source":"Crossref","is-referenced-by-count":0,"title":["Changes in COVID-19-related death certification practices and quality of cause-of-death reporting in the United States from 2020 to 2023"],"prefix":"10.1093","author":[{"given":"Shu-Yu","family":"Tai","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Wen","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University , Tainan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Kawachi","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4715-3787","authenticated-orcid":false,"given":"Tsung-Hsueh","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University , Tainan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"issue":"1","key":"2026092219170063200_ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1001\/jama.2020.9536","article-title":"The importance of proper death certification during the COVID-19 pandemic","volume":"324","author":"Gill","year":"2020","journal-title":"JAMA."},{"issue":"12","key":"2026092219170063200_ref2","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.7326\/M20-3100","article-title":"Every body counts: measuring mortality from the COVID-19 pandemic","volume":"173","author":"Kiang","year":"2020","journal-title":"Ann Intern Med"},{"issue":"12","key":"2026092219170063200_ref3","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.7326\/M20-6348","article-title":"Measuring pandemic impact: vital signs from vital statistics","volume":"173","author":"Gerberding","year":"2020","journal-title":"Ann Intern Med"},{"issue":"S2","key":"2026092219170063200_ref4","doi-asserted-by":"publisher","first-page":"S45","DOI":"10.2105\/AJPH.2021.306440","article-title":"To save lives, we need to improve the measurement of death","volume":"111","author":"Cochran","year":"2021","journal-title":"Am J Public Health"},{"key":"2026092219170063200_ref5","volume-title":"Physician\u2019s Handbook on Medical Certification of Death","author":"National Center for Health Statistics","year":"2023"},{"key":"2026092219170063200_ref6","volume-title":"International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Volume 2 Instruction Manual, 2010 Edition","author":"World Health Organization","year":"2010"},{"key":"2026092219170063200_ref7","volume-title":"International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Volume 2 Instruction Manual, 2016 Edition","author":"World Health Organization","year":"2016"},{"key":"2026092219170063200_ref8","volume-title":"Part 2c Vital Statistics ICD-10 ACME Decision Tables for Classifying Underlying Causes of Death","author":"National Center for Health Statistics","year":"2016"},{"key":"2026092219170063200_ref9","volume-title":"Guidance for Certifying COVID-19 Deaths","author":"National Center for Health Statistics, Centers for Disease Control and Prevention","year":"2020"},{"key":"2026092219170063200_ref10","volume-title":"Guidance for Certifying Deaths Due to COVID\u201319","author":"National Center for Health Statistics, Centers for Disease Control and Prevention","year":"2020"},{"key":"2026092219170063200_ref11","volume-title":"Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19). 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