Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1528 1536 Marija Anđelković Apostolović Department of Medical Statistics and Informatics, Medical Faculty University of Niš, Niš, Serbia Miodrag Stojanović Center for Informatics and Biostatistics in Health Care, Institute of Public Health Niš, Niš, Serbia Dragan Bogdanović 1. Center for Informatics and Biostatistics in Health Care, Institute of Public Health Niš, Niš, Serbia 2. State University of Novi Pazar, Novi Pazar, Serbia Branislav Apostolović Department of Nephrology, University Clinical Center Niš, Niš, Serbia Marija Topalović Department of Pulmonology, University Clinical Center Niš, Niš, Serbia Zoran Milošević 1. Department of Medical Statistics and Informatics, Medical Faculty University of Niš, Niš, Serbia 2. Center for Informatics and Biostatistics in Health Care, Institute of Public Health Niš, Niš, Serbia Roberta Marković 1. Department of Medical Statistics and Informatics, Medical Faculty University of Niš, Niš, Serbia 2. Center for Health Promotion, Institute of Public Health Niš, Niš, Serbia Aleksandra Ignjatović 1. Department of Medical Statistics and Informatics, Medical Faculty University of Niš, Niš, Serbia 2. Center for Informatics and Biostatistics in Health Care, Institute of Public Health Niš, Niš, Serbia 2023 03 07 2023 09 18 Background: We aimed to evaluate the quality of the cause of death (COD) concerning mortality patterns and completeness of death registration to identify areas for improvement in Serbia. Methods: COD data collected from the mortality register in Serbia from 2005 to 2019 (1540615 deaths) were analyzed with the software Analysis of National Causes of Death for Action. The Vital Statistics Performance Index for Quality (VSPI(Q)) is estimated for the overall COD data quality. Results: The completeness of death certification was higher than 98%. Usable underlying COD was registered in 57%, 24.1% with an unusable and 18.6% with insufficiently specified COD. The VSPI(Q) was 67.2%, denoting medium quality. The typical error was using intermediate COD (24.7% of all deaths), while 13.2% and 8.5% of all garbage codes (GC) belonged to the Very High and High Severity classes. The leading underlying COD is unspecified cardiomyopathy. The analysis revealed that 39.1% of GC has been redistributed to non-communicable diseases, 2.5% to external causes and 1.1% to communicable diseases. Conclusion: In the 15 years' worth of data analyzed, the true underlying COD, in many cases, was ill-defined, indicating that COD data at the national level could be distorted. The additional and continuous professional education of medical students as well as physicians is needed. It should focus on the most common GC among the leading COD and acquiring skills in certifying external causes of death. https://ijph.tums.ac.ir/index.php/ijph/article/view/31410 https://ijph.tums.ac.ir/index.php/ijph/article/download/31410/8285