Postmortem diagnostic overshadowing—defined as inaccurately reporting a disability as the underlying cause of death—occurs for over half of adults with cerebral palsy. This practice obscures cause of death trends, reducing the effectiveness of efforts to reduce premature mortality among this marginalized health population. Using data from the National Vital Statistics System 2005 to 2017 U.S. Multiple Cause of Death files (N = 29,996), we identify factors (sociodemographic characteristics, aspects of the context and processing of death, and comorbidities) associated with the inaccurate reporting of cerebral palsy as the underlying cause of death. Results suggest that inaccurate reporting is associated with heightened contexts of clinical uncertainty, the false equivalence of disability and health, and potential racial-ethnic bias. Ending postmortem diagnostic overshadowing will require training on disability and health for those certifying death certificates and efforts to redress ableist death certification policies.

超过一半的脑瘫成年人会出现死后诊断掩盖的情况（定义为不准确地将残疾报告为根本死因）。这种做法掩盖了死因趋势，降低了减少边缘化健康人群过早死亡率的努力的有效性。利用国家生命统计系统 2005 年至 2017 年美国多因死亡档案 (N = 29,996) 的数据，我们确定了与脑瘫报告不准确相关的因素（社会人口学特征、死亡背景和处理以及合并症）作为根本死因。结果表明，不准确的报告与临床不确定性的加剧、残疾和健康的错误等同以及潜在的种族偏见有关。结束尸检诊断的阴影需要对那些证明死亡证明的人员进行残疾和健康方面的培训，并努力纠正残疾死亡证明政策。