In the Journals

Medical error third-leading cause of death in US

Medical error was the third-leading cause of death in the United States in 2013, behind only heart disease and cancer, according to an analysis published in BMJ.

The researchers state that typical cause-of-death statistics, complied each year by the CDC, are flawed due to their reliance on physicians, medical examiners, coroners and other officials assigning an ICD code to each case. Currently, human and system errors are not associated with an ICD code, and as such go unrecorded.

“According to WHO, 117 countries code their mortality statistics using the ICD system as the primary indicator of health status,” Marin A. Makary, MD, MPH, of the department of surgery at Johns Hopkins University School of Medicine, and colleagues wrote. “The ICD-10 coding system has limited ability to capture most types of medical error. … Moving away from a requirement that only reasons for death with an ICD code can be used on death certificates could better inform healthcare research and awareness priorities.”

To estimate the contribution of medical error to U.S. deaths in relation to other causes listed by the CDC, the researchers analyzed the scientific literature, starting with the 1999 Institute of Medicine report. The report, which is the most commonly cited estimate of annual medical error deaths in the United States, according to the researchers, describes an incidence of 44,000 to 98,000 deaths annually.

Characterizing the report as “limited and outdated,” the researchers calculated the mean rate of death from medical error using studies published since the 1999 report, which they argue was not based on primary research conducted by the Institute of Medicine, but on the 1984 Harvard Medical Practice Study and the 1992 Utah and Colorado Study.

According to the researchers, the mean rate of annual deaths in the United States from medical error is 251,454, extrapolating to the total number of U.S. hospital admissions in 2013. The top cases of death that year, according to the CDC, were heart disease, with 611,000 deaths, and cancer, with 585,000.

“We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths,” Makary and colleagues wrote. “Although the assumptions made in extrapolating study data to the broader U.S. population may limit the accuracy of our figure, the absence of national data highlights the need for systematic measurement of the problem.” – by Jason Laday

Additional reading:

http://www.bmj.com/content/353/bmj.i2139

Disclosures: The researchers report no relevant financial disclosures.