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REVISED: Multiple Death Records Due to Death_type or Cause - Version 5.4

Please Discuss:

Multiple Death Records Due to Death_type or Cause - Version 5.4 · Issue #79 · OHDSI/Themis (github.com)

Modified Proposal

Based on discussion during the Themis call on June 6, 2024 to modify the proposal, this is the modified proposal.
Please discuss in Forum Post.

Issue # and location

Issue summary

The table description for the Death table has the following: “A person can have up to one record if the source system contains evidence about the Death”. However, an ICD diagnosis code may map to multiple SNOMED codes:
ICD10: J96.21 (Acute on chronic respiratory failure with hypoxia (HCC))
maps to
SNOMED: 389086002 (Hypoxia) and 67905004 (Acute-on-chronic respiratory failure)
This results in two records with the same death date.
Similarly, a person may have death records from multiple systems (provenance), i.e. EHR and death registry.

Convention type


CDM table

Death Table

CDM field


Links to issue discussion

Provenance of data

EHR death data
Death Registries

Use case

Any research involving Cause of Death or outcomes involving death.

The proposed convention

  1. Stop using CAUSE_CONCEPT_ID, CAUSE_SOURCE_VALUE, CAUSE_SOURCE_CONCEPT_ID to contain cause of death data. Remove these fields in future CDM versions.
  2. Put cause records in the clinical event tables (I.e. Condition, Observation, etc.)
  3. Condition_status_concept_id – can be used to identify primary versus secondary; is contributing cause of death needed?
  4. Type_concept_id – can be used to identify the provenance of the record; the type concepts will need to be expanded (I.e. there isn’t an “EHR death record”)

How would we implement the change?

  • THEMIS convention and CDM documentation.
  • Forward to CDM Workgroup to remove CAUSE_CONCEPT_ID, CAUSE_SOURCE_VALUE, CAUSE_SOURCE_CONCEPT_ID from subsequent versions.

How much of a change is this for the tools? In particular, Atlas.


How would be effectively communicate this change?

THEMIS Repository, note in CDM documentation, Forums

What studies would we break if we implement this solution?


Alternative solutions

Allow multiple death records in the Death table IF they have the same date but different causes or sources. This was approved at one time Multiple deaths on the same day. This approach was considered too confusing for analysts.

Downstream implications

  • Book of OHDSI
  • CDM Convention
  • Data Quality Dashboard (DQD): add checks
  • Analysts: query conditions for death data instead of death table.

Link to DQD check


Related conventions/further information

(Other helpful information, if needed. i.e. related conventions, queries to evaluate source or CDM data, or any additional information)