Death by mental retardation? The influence of ambiguity on death certificate coding error for adults with intellectual disability
Death by mental retardation? The influence of ambiguity on death certificate coding error for adults with intellectual disability
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DOI：
10.1111/j.1365-2788.2012.01614.x
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发表时间：
2013-12-01
影响因子：
3.6
通讯作者：
Peek, C. W.
中科院分区：
文献类型：
--
作者：
Landes, S. D.;Peek, C. W.
虽然先前的研究人员已经认识到将智力迟钝作为潜在死亡原因的编码是错误的，但影响这种不准确性的因素并没有得到充分的分析。本研究探讨了自2004年以来，美国死亡证明上精神发育迟滞被编码为潜在死亡原因的诊断模糊性对风险的影响。方法利用2004年以来美国所有包含智力障碍死亡原因编码的死亡证明，进行逻辑回归分析，估计将智力障碍错误编码为潜在死亡原因的可能性。用于测量模糊性的估计器包括多种死亡原因的数量、死亡地点和ICD-10诊断章节代码。结果自2004年以来，美国共有2278份死亡证明包含智力迟钝的死亡原因代码。在这些死亡证明中，有20%错误地将智力迟钝列为潜在的死亡原因。精神发育迟滞更有可能被编码为死亡证书编码准确性的潜在原因，这反映了诊断模糊性对死亡证书编码准确性的负面影响：(1)死亡证书提供的合并症疾病过程信息较少；(2)死于门诊或急诊室；或(3)有异常症状或因伤、意外或其他外因死亡的。本研究的发现以及之前的研究表明，试图了解这一人群的死亡率趋势必须注意到频繁的潜在死亡原因编码错误，这些错误会威胁到死亡原因数据的准确性。此外，有必要调查美国死亡证明编码政策背后的推动力，该政策继续允许错误地将死亡编码为智力迟钝。
BackgroundAlthough the coding of mental retardation as underlying cause of death has been recognised by previous researchers as erroneous, factors influencing this inaccuracy have not been sufficiently analysed. This study explores the effects of diagnostic ambiguity on risk of mental retardation being coded as underlying cause of death on US death certificates from 2004.MethodsUtilising all US death certificates from 2004 that included a cause of death code for mental retardation, logistic regression analysis provided estimates of the likelihood of having mental retardation erroneously coded as the underlying cause of death. Estimators used to measure ambiguity included the number of multiple causes of death, the place of death, and ICD-10 diagnostic Chapter codes.ResultsA total of 2278 US death certificates from 2004 included a cause of death code for mental retardation. Of these death certificates, 20% erroneously coded mental retardation as the underlying cause of death. Reflecting the negative impact of diagnostic ambiguity on death certificate coding accuracy, mental retardation was more likely to be coded as underlying cause of death for decedents who: (1) had a death certificate that provided less information on co-morbid disease processes; (2) died in an outpatient or emergency room setting; or (3) had either abnormal symptomatology or death by injury, accident or other external cause.ConclusionsFindings from this study, as well as prior research, demonstrate that attempts to understand mortality trends for this population must attend to frequent underlying cause of death coding errors which threaten accuracy of cause of death data. Furthermore, inquiry is warranted into the impetus behind US death certificate coding policy that continues to allow the erroneous coding of death by mental retardation'.