Unexplained differences between hospital and mortality data indicated mistakes in death certification: an investigation of 1,094 deaths in Sweden during 1995
Unexplained differences between hospital and mortality data indicated mistakes in death certification: an investigation of 1,094 deaths in Sweden during 1995
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DOI：
10.1016/j.jclinepi.2009.01.010
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发表时间：
2009-11-01
影响因子：
7.2
通讯作者：
Westerling, Ragnar
中科院分区：
文献类型：
--
作者：
Johansson, Lars Age;Bjorkenstam, Charlotte;Westerling, Ragnar
目的：死亡统计是流行病学研究的重要内容。我们检查死亡证明（DC）和出院条件（HDC）之间的差异是否表明certification errors.Study Design and Setting：从1995年瑞典39，872例医院死亡病例中，我们随机选择了600例DC和HDC不相容的“病例”和600例相容的“对照”，在性别、年龄和潜在死因上相匹配。我们获得了其中1，094例（91%）的病例摘要。使用结构化的协议，我们评估了DCs.Results的准确性：回归分析表明，诊断组和“病例”或“对照”的变量，最影响的准确性。恶性肿瘤“对照”的准确性最高（92%），良性和未指明的肿瘤“病例”的准确性最低（20%）。对于所有诊断组，除了一个，兼容的“控制”比不兼容的“情况”有更好的准确性。例外，慢性阻塞性肺疾病，有低准确性的“情况”（54%）和“控制”（52%）。结论：DC和HDC之间的不兼容性表明认证错误的风险更大。然而，对于某些诊断组，即使DC和HDC兼容，DC也经常不准确。通过要求提供关于不相容病例和高风险诊断组中所有死亡的补充资料，死亡率统计数据的编制者可以提高统计数据的准确性。(C)2009 Elsevier Inc. All rights reserved.
Objective: Mortality statistics are important for epidemiological research. We examine if discrepancies between death certificate (DC) and hospital discharge condition (HDC) indicate certification errors.Study Design and Setting: From 39,872 hospital deaths in Sweden in 1995, we randomly selected 600 "cases," where DC and HDC were incompatible, and 600 compatible "controls," matched on sex, age, and underlying cause of death. We obtained case summaries for 1,094 (91%) of these. Using a structured protocol, we assessed the accuracy of DCs.Results: Regression analysis indicated diagnostic group and "case" or "control" as the variables that most affected the accuracy. Malignant neoplasm "controls" had the highest accuracy (92%), and benign and unspecified tumor "cases," the lowest (20%). For all diagnostic groups except one, compatible "controls" had better accuracy than incompatible "cases." The exception, chronic obstructive lung disease, had low accuracy for both "cases" (54%) and "controls" (52%).Conclusion: Incompatibility between DC and HDC indicates a greater risk of certification errors. For some diagnostic groups, however, DCs are often inaccurate even when DC and HDC are compatible. By requesting additional information on incompatible cases and all deaths in high-risk diagnostic groups, producers of mortality statistics could improve the accuracy of the statistics. (C) 2009 Elsevier Inc. All rights reserved.