Are Statutory Requirements Followed in the Certification of Traumatic, Unexpected, and Unattended Deaths in Missouri?

Medical examiners and coroners (ME/Cs) investigate deaths important to public health. This cross-sectional study evaluated 343,412 death certificates from 2007 to 2012 in Missouri. We examined agreement between cause and manner of death by year and ME/C contact as well as 2010–2012 trends in ME/C contact. There was near perfect agreement between cause and manner of death when an ME/C was contacted (kappa=0.97,p<0.0001) and a significant increase in the proportion of deaths with ME/C contact from 2010 to 2012 (p=<0.0001). There was a significantly higher proportion of ME/C-certified deaths using the electronic system in 2010-2012 (aOR=1.18,95% CI 1.15, 1.21) compared to the manual system in 2007-2009. Black, non-Hispanic (aOR=1.50, 95% CI 1.43,1.57) and Hispanic (aOR=1.31, 95% CI 1.13, 1.51) deaths, compared to White, non-Hispanic deaths, were associated with a significantly greater odds of ME/C certification. Race as an independent predictor of ME/C death certification warrants further research.