| Summary: | Conventional coding rules for death certificates substantially over-count diabetes mellitus as the underlying cause, and correspondingly under-count other conditions such as vascular or renal disease. For, among patients with diabetes reported on the death certificate, conventional rules ascribe vascular or renal deaths to the accompanying diabetes. Thus, although “underlying cause” is defined appropriately by the World Health Organization (WHO) as “the disease or injury which initiated the train of morbid events leading directly to death”, conventional WHO coding rules do not necessarily provide it. We explore the relevance of this to renal and vascular mortality in Mexico, where diabetes is common, and assess separately the substantial overall importance of diabetes.
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