Practice of Epidemiology Agreement on Cause of Death Between Proxies, Death Certificates, and Clinician Adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Practice of Epidemiology Agreement on Cause of Death Between Proxies, Death Certificates, and Clinician Adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
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中风地理和种族差异原因（REGARDS）研究中代理人、死亡证明和临床医生裁决者之间关于死亡原因的流行病学协议的实践
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发表时间：
2011
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通讯作者：
M. Safford
中科院分区：
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作者：
J. Halanych;F. Shuaib;Gaurav M Parmar;R. Tanikella;V. Howard;D. Roth;R. Prineas;M. Safford
死亡证明可能缺乏准确性，并错误地分类死亡原因。代理人报告的死亡原因的有效性尚未得到很好的确定。作者检查了卒中地理和种族差异原因（REGARDS）研究中336名参与者的死亡记录，该研究是一项对30，239名社区居住的美国成年人（2003-2010年）进行的国家队列研究。经过培训的专家使用研究数据、医疗记录、死亡证明和代理报告来裁定死亡原因。作者根据死亡证明、代理人和裁定计算了死亡原因的一致性，以及对某些疾病的敏感性和特异性。判定的死亡原因与代理报告的一致率（73%; Cohen's kappa（j）统计量1/4 0.69）高于与死亡证明的一致率（61%; j1/4 0.54）。对于所有疾病特异性死亡原因，代理报告与裁定者之间的一致性优于与死亡证明的一致性。使用裁定者评估作为疾病特异性死亡原因的“金标准”，代理报告具有相似或更高的特异性和更高的灵敏度（灵敏度1/4 50%- 89%）比死亡证明（灵敏度1/4 31%-81%）。代理报告可能与裁定的死亡原因比死亡证明上列出的死亡原因更一致。在许多情况下，代理报告可能是确定死亡原因的更好策略，而不是依赖死亡证明。
Death certificates may lack accuracy and misclassify the cause of death. The validity of proxy-reported cause of death is not well established. The authors examined death records on 336 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a national cohort study of 30,239 community-dwelling US adults (2003–2010). Trained experts used study data, medical records, death certificates, and proxy reports to adjudicate causes of death. The authors computed agreement on cause of death from the death certificate, proxy, and adjudication, as well as sensitivity and specificity for certain diseases. Adjudicated cause of death had a higher rate of agreement with proxy reports (73%; Cohen’s kappa (j) statistic 1⁄4 0.69) than with death certificates (61%; j1⁄4 0.54). The agreement between proxy reports and adjudicators was better than agreement with death certificates for all disease-specific causes of death. Using the adjudicator assessments as the ‘‘gold standard,’’ for diseasespecific causes of death, proxy reports had similar or higher specificity and higher sensitivity (sensitivity 1⁄4 50%– 89%) than death certificates (sensitivity 1⁄4 31%–81%). Proxy reports may be more concordant with adjudicated causes of death than with the causes of death listed on death certificates. In many settings, proxy reports may represent a better strategy for determining cause of death than reliance on death certificates.