Analysis of the quality of death certification in Islamic Republic of Iran

Background: Death certification is a vital source of information for assessing population health worldwide. Aim: To assess the quality of death certificates issued by physicians in the Islamic Republic of Iran. Methods: Using a customized and translated version of the death certificate quality assessment tool designed by the University of Melbourne, we analysed death certificates issued by doctors in Islamic Republic of Iran, to identify errors and make recommendations for quality improvement. Results: Of the 25 123 certificates reviewed, only 29.3% were correctly completed and 67.7% were incomplete. Most (59.1%) of the certificates were issued in hospitals and 18.9% were issued by other doctors. The majority (63.3%) of deaths occurred in hospitals and few surgery centres while a large proportion occurred at home (32.3%). The most common error (86.3%) was, not recording the interval between the onset of illness and death while the least common error (14.5%) was, illegible handwriting. Conclusion: This study found errors and quality gaps in physician-issued death certificates in Islamic Republic of Iran. To enhance the quality of mortality data, there is a need to develop guidelines and train physicians on quality assurance of related data collection. Integrating death certification into existing electronic health data systems can help streamline and significantly enhance the accuracy and efficiency of death certification.