The medical records of New York City (NYC) residents who died in 1992 and who had a listing of tuberculosis (TB) on their death certificates were reviewed to determine the accuracy of death certificate TB listings. Notation was also made of all cases where TB was mentioned, but was not the cause of death. All cases of TB found on the death certificates were compared against NYC TB registry records, which list individuals from whom Mycobacterium- tuberculosis has been extracted. Of the death certificates examined, 635 listed TB as either a contributing or underlying cause of death. The NYC TB Registry had a record of 377 (59%) of these cases. Of the 258 cases not confirmed by the TB registry, medical records were available for 230. Of these, 114 had no evidence of current active TB while 85 had infections of other Mycobacterium species. This review showed that NYC's TB registry is more accurate and complete than are physician's diagnoses on death certificates in indicating the TB burden in NYC. The authors conclude that death certificate listing of TB is an inaccurate measure of TB burden in NYC.