What do people die from? The challenges of measuring disease burden posed by multi-morbidity

Determining the precise cause of death of an individual has become increasingly difficult as life prolonging treatments mean that many people may die with multiple disorders, any of which, individually or in concert, might have killed them. Yet this problem has been recognised from the very earliest attempts to develop classifications of diseases. This paper traces the evolution of thinking on death certification and disease classification, describing what has been achieved but also identifying what more needs to be done to advance research and inform policy.