Accuracy of death certificates for coding coronary heart disease as the cause of death
Accuracy of death certificates for coding coronary heart disease as the cause of death
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DOI：
10.7326/0003-4819-129-12-199812150-00005
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发表时间：
1998-12-15
影响因子：
39.2
通讯作者：
Levy, D
中科院分区：
文献类型：
--
作者：
Lloyd-Jones, DM;Martin, DO;Levy, D
背景：死亡证明广泛应用于流行病学、临床调查和国家统计。目的：检验死亡证明将冠心病编码为潜在死因的准确性。设计：自1948年以来以社区为基础的初始队列研究。地点：马萨诸塞州弗雷明翰。患者：2683名已故弗雷明翰心脏研究参与者。测量：死亡证明的敏感度、特异度和预测值。结果：在2683名死者中，死亡证明中942人死于冠心病，758人死于冠心病。死亡证明对冠心病的敏感性为83.8%(95%CI，81.1%~86.4%)，阳性预测值为67.4%(CI为64.4%~70.4%)，特异性为84.1%(CI为82.4%~85.7%1)，阴性预测值为92.9%(CI为91.7%~94.1%)。死亡证明将242例死亡病例(占总死亡人数的9.0%)中的51.2%归因于冠心病，而医生小组无法确定死亡原因。与医生小组相比，死亡证明将死于冠心病的总人数增加了24.3%，超过85岁的死者死于冠心病的人数增加了一倍多。当排除了医生小组指定的不明原因的死亡后，死亡证明仍然将更多的死亡归因于冠心病(7.9%，在年龄最大的年龄组中为43.1%)。结论：死亡证明上冠心病可能被过度描述为死因。以死亡证明数据为基础的国家死亡率统计数据可能高估了冠心病的总发病率7.9%至24.3%，老年人的高估幅度高达两倍。
Background: Death certificates are widely used in epidemiologic and clinical investigations and for national statistics.Objective: To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death.Design: Community-based inception cohort followed since 1948.Setting: Framingham, Massachusetts.Patients: 2683 deceased Framingham Heart Study participants.Measurements: Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians.Results: Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1% to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%1), and negative predictive value of 92.9% (CI, 91.7% to 94.1 %) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a ca use. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group).Conclusions: Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as twofold in older persons.