Study Suggests Medical Error Is Third Leading Cause of Death in US

Medical error is the third-leading cause of death, after heart disease, and cancer, in the United States, according to a study published in BMJ. As a result of the findings, Johns Hopkins University School of Medicine researchers are calling for better reporting on death certificates to help understand the scale of the problem and how to tackle it.

Martin Makary, MD, MPH, professor of surgery, and Michael Daniel, a research fellow, say their research shows that US death certificates are not useful for acknowledging medical error because they rely on assigning an International Classification of Disease (ICD) code to the cause of death. If a cause of death is not associated with an ICD code, it is not captured; thus, if human and system factors are associated with a death, that is not reflected on the death certificate.

“The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used,” explained Makary.

Medical error is defined as an unintended act either of omission or commission or one that does not achieve its intended outcome; the failure of a planned action to be completed as intended (an error of execution); the use of a wrong plan to achieve an aim (an error of planning); or a deviation from the process of care that may or may not cause harm to the patient. This kind of error can be at the individual or system level.

Makary and Daniel used death rate data from 4 studies from 2000 to 2008, including one from the HHS’ Office of the Inspector General and the Agency for Healthcare Research and Quality. Then they used hospital admission rates from 2013 and extrapolated that based on 35,416,020 hospitalizations, there were 251,454 deaths from medical error, which translates to 9.5% of all deaths each year in the United States.

Comparing their estimate to the CDC’s list of the most common causes of death in the United States, the authors calculated that medical error is the third most common cause of death, surpassing respiratory disease—the CDC’s currently listed third leading cause of death.

Makary noted that top-ranked causes of death as reported by the CDC drive the nation’s research funding and public health priorities. While cancer and heart disease get a lot of attention, medical errors do not, and thus do not get deserved funding. More research is needed, they say, because although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences.