Causes of death are often very obscure. IIRC a thorough forensic review of causes of death for a random sampling of major US cities found that a good 20-30% of listed causes of death on certificates were arguable wrong, or at best speculative. When very old people die, or people people who already have known health issues it’s VERY common that only a cursory check for ‘causes of death’ is performed. When child and infant mortality was common, cause of death often wasn’t even investigated and it was simply written ‘failure to thrive’ or left blank because kids died so often for unknown reasons.