Diabetes as Cause of Death (Hansard, 11 July 2001)

The information requested falls within the responsibility of the National Statistician, who has been asked to reply.

Letter to Lord Harrison from the Executive Director, Office for National Statistics, Mr John Pullinger, dated 11 July 2001.

The National Statistician has been asked to reply to your recent question on whether Her Majesty's Government will ensure accurate recording of death due to diabetes on death certificates so as to get a more accurate picture of the extent to which diabetes leads to death. I am replying in his absence. (HL153)

The Office of National Statistics (ONS) places great importance on the quality of the information collected through the deaths registration system and constantly seeks to ensure that this remains fit for purpose, reliable and authoritative.

Doctors are required to certify all deaths to the best of their knowledge and belief. They should describe the sequence of diseases or injuries which led to the death, and other conditions which may have contributed to it. The earliest event in the sequence is the underlying cause of death. Guidance notes on completion are contained in every book of death certificates. These follow the recommendations of the World Health Organisation and national legal requirements. These notes were thoroughly updated in 1997.

According to ONS statistics, about 6,000 people die with diabetes as the underlying cause of death in England and Wales each year. Since 1993, ONS has also published statistics using all the conditions mentioned on the death certificate. These show that 18,500 have diabetes mentioned on their death certificates but not as the underlying cause.

Most people dying today have a number of diseases, conditions and complications. It is up to the attending doctor to decide what contribution each disease makes to the death. ONS "instructions to certifiers" and training material aim to help them to do this accurately and consistently.

ONS produced a video and other training material for medical students and doctors on how to certify cause of death. These were sent to all medical schools and postgraduate deans in England and Wales, and continue to be distributed. ONS is exploring other ways of providing training and advice.