{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:30:25Z","timestamp":1790199025725,"version":"4.1.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020365","name":"Centers for Disease Control and Prevention Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020365","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study aimed to estimate the accuracy of the underlying Cause of Death (CoD) in the original death certificate, compared with a gold standard certificate based on information from clinical records and relatives, in population deceased in Colombia during 2021.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A sample size of 806 deaths across 92 municipalities in Colombia were estimated from the pool of 326,833 original certificates provided by the National Department of Statistics. A two-stage stratified random sample with replacement was employed for selection. Information from medical records of the deceased and, when necessary, interviews with relatives or witnesses were used to determine CoDs on the gold standard certificate. We analyzed and compared the underlying CoD of the original and standard death certificates to estimate the level of accuracy. Measures of concordance, patterns of false positives and negatives, and a kappa value were utilized as metrics to evaluate the death certificates quality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Information was obtained from 776, representing 96% of the desired sample. The concordance between original and gold standard certificates, categorized according to the ICD-10 chapters, was found in 74%. Higher levels of agreement were observed for \u201ccodes for special COVID-19 situations\u201d (kappa\u2009=\u20090.84) and neoplasms (kappa\u2009=\u20090.84). Higher levels of agreement were observed for \u201ccodes for special COVID-19 situations\u201d (kappa\u2009=\u20090.84) and neoplasms (kappa\u2009=\u20090.84). Overestimation was identified for \u201ccirculatory system diseases\u201d (Chapter IX); \u201cpregnancy, childbirth and puerperium\u201d (Chapter XV); \u201csigns, symptoms, and poorly defined conditions\u201d (Chapter XVIII) and \u201cdiseases of the respiratory system\u201d (Chapter X), while underestimation in \u201cdiseases of the genitourinary system\u201d (Chapter XIV) among CoD. The most significant variations in the fraction of mortality due to specific CoDs corresponded to \u201ccodes for special situations COVID-19\u201d.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The level of concordance between the original and gold standard death certificates was deemed adequate. However, improvements in the death certification process in Colombia are recommended, emphasizing the enhancement of training programs for health professionals.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320466","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T20:02:56Z","timestamp":1747771376000},"page":"e0320466","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Accuracy of information on the underlying cause of death: An analysis in Colombia during the COVID-19 pandemic in 2021"],"prefix":"10.1371","volume":"20","author":[{"given":"Pablo","family":"Chaparro-Narv\u00e1ez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessika Alexandra","family":"Manrique Sanchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6487-2025","authenticated-orcid":true,"given":"Laura","family":"Berrio-Parra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5754-3474","authenticated-orcid":true,"given":"Diana Carolina","family":"Urrego Ricaurte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3294-9761","authenticated-orcid":true,"given":"Luis Jos\u00e9","family":"Torres-Rojas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1201-0009","authenticated-orcid":true,"given":"Nidia Patricia","family":"Orjuela Cantor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Patricia","family":"Mora Aguirre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesid Rojas","family":"Quevedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Su\u00e1rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Casta\u00f1eda-Orjuela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"issue":"6","key":"pone.0320466.ref001","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.2105\/AJPH.2021.306203","article-title":"The COVID-19 Pandemic: Effects on Civil Registration of Births and Deaths and on Availability and Utility of Vital Events Data","volume":"111","author":"C AbouZahr","year":"2021","journal-title":"Am J Public Health"},{"issue":"10001","key":"pone.0320466.ref002","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0140-6736(15)60173-8","article-title":"Civil registration and vital statistics: progress in the data revolution for counting and accountability","volume":"386","author":"C AbouZahr","year":"2015","journal-title":"Lancet"},{"key":"pone.0320466.ref003","first-page":"125","volume-title":"Civil Registration and Vital Statistics: A Unique Source of Data for Policy. 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The Palgrave Handbook of Global Health Data Methods for Policy and Practice [Internet]","author":"C AbouZahr","year":"2019"},{"key":"pone.0320466.ref004","article-title":"Opportunities to Enhance the Utility of Cause of Death Information From Death Certificates","volume":"112","author":"SM Ling","year":"2022","journal-title":"Am J Public Health"},{"key":"pone.0320466.ref005","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2021.306409","article-title":"Serious Illness and Limitations of Death Certificate-Based Data: Urgent Lessons From the Opioid Epidemic","volume":"112","author":"JS Merlin","year":"2022","journal-title":"Am J Public Health"},{"key":"pone.0320466.ref006","article-title":"Four ways CRVS systems can support the UN Sustainable Development Goals.","author":"IDRC-CRDI"},{"issue":"1","key":"pone.0320466.ref007","first-page":"19","article-title":"The quality of death certification practice in Greece","volume":"20","author":"G Filippatos","year":"2016","journal-title":"Hippokratia"},{"issue":"1","key":"pone.0320466.ref008","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12916-020-01519-8","article-title":"Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative","volume":"18","author":"JD Hart","year":"2020","journal-title":"BMC Med"},{"issue":"4","key":"pone.0320466.ref009","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1093\/ije\/dyn121","article-title":"Evaluation of cause-of-death statistics for Brazil, 2002-2004","volume":"37","author":"E Fran\u00e7a","year":"2008","journal-title":"Int J Epidemiol"},{"issue":"10001","key":"pone.0320466.ref010","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/S0140-6736(15)60171-4","article-title":"A global assessment of civil registration and vital statistics systems: monitoring data quality and progress","volume":"386","author":"L Mikkelsen","year":"2015","journal-title":"Lancet"},{"issue":"8","key":"pone.0320466.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0237539","article-title":"Are cause of death data fit for purpose? evidence from 20 countries at different levels of socio-economic development","volume":"15","author":"KM Iburg","year":"2020","journal-title":"PLoS One"},{"key":"pone.0320466.ref012","author":"OPS","year":"2022"},{"issue":"6","key":"pone.0320466.ref013","doi-asserted-by":"crossref","first-page":"766","DOI":"10.15446\/rsap.v19n6.35377","article-title":"Identificaci\u00f3n de los conocimientos de calidad de la informaci\u00f3n de mortalidad en Bogot\u00e1","volume":"19","author":"PE Chaparro-Narv\u00e1ez","year":"2017","journal-title":"Rev salud p\u00fablica"},{"key":"pone.0320466.ref014","doi-asserted-by":"crossref","unstructured":"Cendales R, Pardo C. 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