Mortality statistics are critical to determine the burden of disease. Certain causes of death are prone to being misclassified on cause of death certificates. This poses a serious risk for public health and safety, as accurate death certificates form the basis for mortality statistics, which in turn are crucial for research, funding allocation and health interventions. This study uses generalised estimating equations and regression modelling to investigate for which cause of death categories suicide and accident deaths are misclassified as. National mortality statistics and autopsy rates from North America and Europe covering the past forty years were analysed to determine the associations between the different causes of death in cross-sectional and longitudinal models. We find that suicides and deaths by accidents are frequently mutually misclassified. We also find that suicides are frequently misclassified as drug use disorder deaths, in contrast to accident deaths, which are not misclassified as drug use disorder deaths. Furthermore, suicides do not seem to be misclassified as undetermined deaths or ill-defined deaths. The frequency of misclassification shows that the quality of death certificates should be improved, and autopsies may be used systematically to control the quality of death certificates.

死亡率统计对于确定疾病负担至关重要。某些死亡原因很容易在死亡原因证明上被错误分类。这对公共健康和安全构成了严重风险，因为准确的死亡证明构成了死亡率统计的基础，而死亡率统计又对研究、资金分配和健康干预至关重要。本研究使用广义估计方程和回归模型来调查自杀和事故死亡被错误分类为哪些死因类别。对过去四十年北美和欧洲的全国死亡率统计数据和尸检率进行了分析，以确定横断面和纵向模型中不同死因之间的关联。我们发现自杀和意外死亡经常被相互错误分类。我们还发现，自杀经常被错误地分类为药物使用障碍死亡，而意外死亡则不会被错误地分类为药物使用障碍死亡。此外，自杀似乎并没有被错误地归类为未确定的死亡或不明确的死亡。错误分类的频率表明死亡证明的质量有待提高，可以系统地利用尸检来控制死亡证明的质量。