Improving poisoning surveillance at the national level using death certificate literals, US 2003

Beginning with deaths reported in 2003, the narrative text on the death certificate (referred to as “literals”) has been retained and made available for analysis. The purpose of this research is to determine whether the level of detail provided in the literals can be used to further investigate important public health issues and to develop methods to analyze the data.  To explore the utility of these data, deaths in 2003 with an underlying cause of poisonings and with a multiple cause mentioning a narcotic substance (T40-T40.9) were selected from the multiple-cause-of-death data and merged with the death certificate literals.  The three leading substances identified in the non-specific ICD-10 codes and the associated number of deaths were: (a)  T40.2 Other opioids: Morphine (1,516), Oxycodone (1,495), Hydrocodone (1,370) and (b) T40.4 Other synthetic narcotics: Propoxyphene (561), Fentanyl (556), Meperidine (63).  There were no specific narcotics identified among deaths coded with only an ICD-10 code T40.6 (Other and unspecified narcotics).  Using the literals we were able to identify specific narcotic substances that are not currently identifiable using the ICD-10. These methods could be used to capture further detail reported on the death certificate for other injuries and diseases where ICD-10 cause of death codes are broad and lack specific detail.  This study shows that the literal text recorded on death certificates can be used to improve injury surveillance at the national level.  Additional studies using similar methods could be used to inform decisions regarding updates to ICD-10 and major modifications to ICD-11.