Alliance for Pandemic Preparedness

April 1, 2021

Death Certificate–Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance — United States, January–December 2020

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  • The number of US death certificates from 2020 listing COVID-19 and at least one other co-occurring diagnosis were consistent with the number of deaths attributable to COVID-19 in 2020 (approximately 375,000) reported to the CDC’s National Vital Statistics System (NVSS). Among 378,048 death certificates including the ICD-10 code for COVID-19, 5.5% (20,915) only listed that code. Of the 357,133 (92% of total) death certificates with at least one other code, 97% had a co-occurring diagnosis that was a plausible chain-of-event condition (such as pneumonia), a significant contributing condition (such as hypertension), or both.
  • Deaths reported from inpatient settings accounted for 64% (240,770) of all death certificates, 86% of which had co-occurring diagnoses identified as chain-of-event and significant contributing conditions. 2.5% (9,638) of death certificates had co-occurring diagnosis codes not categorized as chain-of-event or contributing conditions, which were noted more frequently among those who died at home, were declared dead on arrival, and whose manner of death was not natural. 35% and 10% of deaths from individuals aged <18 years and 18-29 years, respectively, belonged in this small proportion of deaths.

Gundlapalli et al. (Mar 31, 2021). Death Certificate–Based ICD-10 Diagnosis Codes for COVID-19 Mortality Surveillance — United States, January–December 2020. MMWR. Morbidity and Mortality Weekly Report. https://doi.org/10.15585/mmwr.mm7014e2