Postmortem Diagnostic Overshadowing: Reporting Cerebral Palsy on Death Certificates

Scott D. Landes, J. Dalton Stevens, Margaret A. Turk

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Postmortem diagnostic overshadowing—defined as inaccurately reporting a disability as the underlying cause of death—occurs for over half of adults with cerebral palsy. This practice obscures cause of death trends, reducing the effectiveness of efforts to reduce premature mortality among this marginalized health population. Using data from the National Vital Statistics System 2005 to 2017 U.S. Multiple Cause of Death files (N = 29,996), we identify factors (sociodemographic characteristics, aspects of the context and processing of death, and comorbidities) associated with the inaccurate reporting of cerebral palsy as the underlying cause of death. Results suggest that inaccurate reporting is associated with heightened contexts of clinical uncertainty, the false equivalence of disability and health, and potential racial-ethnic bias. Ending postmortem diagnostic overshadowing will require training on disability and health for those certifying death certificates and efforts to redress ableist death certification policies.

Original languageEnglish (US)
Pages (from-to)525-542
Number of pages18
JournalJournal of health and social behavior
Issue number4
StatePublished - Dec 2022


  • ableism
  • cerebral palsy
  • death certification
  • diagnostic overshadowing

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health


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