University of Oulu

Petteri Oura, Medical adverse events in the US 2018 mortality data, Preventive Medicine Reports, Volume 24, 2021, 101574, ISSN 2211-3355,

Medical adverse events in the US 2018 mortality data

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Author: Oura, Petteri1,2,3
Organizations: 1Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, P.O. Box 21 (Haartmaninkatu 3), FI-00014, Helsinki, Finland
2Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30 (Mannerheimintie 166), FI-00271, Helsinki, Finland
3Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Elsevier, 2021
Publish Date: 2021-11-18


Although medical error has been estimated as a major cause of death in the US, the capability of current diagnostic coding systems and standard death certificates to capture these events has been criticized. This register-based study aimed to scrutinize medical adverse event deaths (i.e., deaths due to adverse events occurring within the healthcare practice, avoidable or unavoidable, including late complications and sequelae of such events) in the US National Vital Statistics 2018 mortality dataset. Individual-level data on underlying and multiple causes of death according to the tenth revision of the International Classification of Diseases (ICD-10) coding system were extracted together with the decedents’ sex, age, ethnicity and education level. Adverse event deaths were identified by ICD-10 codes Y40–Y84 and Y88. The dataset comprised a total of 2 846 305 certified deaths. An adverse event ICD-10 code was used as the underlying cause of death in 0.16% (n = 4620) of the cases, and appeared on the list of multiple causes in 1.13% (n = 32 226) of the cases. Odds for adverse event death were higher among younger than elderly individuals, among those of black than white ethnicity, and among individuals with higher education level. The present data indirectly support previous evidence that a large number of adverse events remain underrecognized or misclassified. Future analyses are needed to reveal the root causes behind underreporting and to analyze whether it occurs at random or in a systematic way.

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Series: Preventive medicine reports
ISSN: 2211-3355
ISSN-E: 2211-3355
ISSN-L: 2211-3355
Volume: 24
Article number: 101574
DOI: 10.1016/j.pmedr.2021.101574
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Copyright information: © 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (