Currently accepted at: JMIR Medical Informatics
Date Submitted: Oct 1, 2025
Open Peer Review Period: Oct 15, 2025 - Dec 10, 2025
Date Accepted: Feb 17, 2026
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/85136
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Concordance of Death Information of Two Health Systems Serving the Same Region and Social Security Administration Death Master File in the Southern United States
ABSTRACT
Background:
There are multiple sources that document the date of a person’s death in the United States. Unfortunately, this seemingly simple information is either incomplete or costly to obtain. On the other hand, the information of such events is critical for both health systems and clinical studies to assess the outcomes of operational and therapeutic interventions.
Objective:
As part of a larger assessment of the quality of multi-source death information, we compared the death data from two health systems serving the same region and the Social Security Administration Death Master File(SSADMF).
Methods:
This study linked death records for patients seen in either health system with the SSADMF from 2007 to 2020 to identify concordant and discordant death data among sources. Analyses included cross-system matching, classification of death records by overlap, and calculation of agreement using Fleiss’ kappa.
Results:
Among 904,581 matched patients, only 209 deaths were confirmed by all three sources. Large proportions of deaths were uniquely recorded by a single source: 10,697 by Health System A, 1,017 by Health System B, and 3,972 by SSADMF. The Fleiss’ kappa was negative (-0.312), reflecting less agreement than expected by chance.
Conclusions:
While not generalizable, it is likely that without processes in place to obtain external data regarding patient death, healthcare facility death information should not be relied upon as a complete list of those who have died. The discordances observed highlight the potential for significant gaps in death reporting within healthcare systems, which could impact the accuracy of mortality-based analyses and quality assessments.
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.