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Erroneous Coding of Developmental Disabilities as Underlying Cause of Death

将发育障碍错误编码为潜在死因

基本信息

批准号：
10078585
负责人：
Scott D Landes
金额：
$ 7.5万
依托单位：
SYRACUSE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-01 至 2021-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10078585
关键词：
Address Adult Age Alzheimer&apos s disease related dementia Awareness Cause of Death Centers for Disease Control and Prevention (U.S.)Cerebral Palsy Cessation of life Characteristics Choking Code Data Death Certificates Death Rate Development Developmental Disabilities Disadvantaged Disease Down Syndrome Education Elderly Emergent care Female Food Funding General Population Goals Guidelines Healthcare Systems Heterogeneity Income Individual Injury Intellectual functioning disability Investigation Laws Lead Legal Life Morbidity - disease rate Outcome Persons Policies Population Population trends Premature Mortality Research Research Personnel Risk Services Subgroup System Time Variant Vital Statistics Vulnerable Populations Woman autism spectrum disorder base comorbidity disability disadvantaged population experience health care service men mortality mortality disparity peer prevent racial minority social social exclusion social group sociodemographics young adult

项目摘要

PROJECT SUMMARY Adults with developmental disabilities die at ages approximately 20 years younger than peers in the general U.S. population. This striking mortality disadvantage is larger than the mortality gap between men and women, Whites and Blacks, and adults in the top and bottom income quartiles. The reasons for the disparity are poorly understood despite decades of research on the topic. However, new research shows that a rampant practice of erroneously coding death certificates for adults with developmental disability results in widespread misclassification of their underlying causes of death. Furthermore, these erroneous codes obscure alarmingly high rates of death due to choking and Alzheimer’s disease and related dementias. While uncovering the obscuring effect of erroneous coding was a crucial advance in research, ongoing efforts to eliminate this misguided practice require empirical evidence on the multilevel factors that determine erroneous coding. The proposed project will systematically assess whether erroneous coding disproportionately occurs (1) among certain sociodemographic subgroups of decedents, (2) when certain comorbid diseases or injuries are present at the time of death, and (3) across certain U.S. state contexts. By identifying which subgroups are at greatest risk of misclassification, results will inform strategies to prevent misclassification and, thereby, determine robust estimates of cause-specific mortality among these adults. The study’s central hypothesis is that erroneous codes are more commonly found among decedents from marginalized social groups, in situations when the true cause of death was highly preventable (e.g., choking), and within U.S. states where fiscal and legal policies are less amenable to the needs of individuals with developmental disability. Using data from the National Vital Statistics System 2012–2016 U.S. Multiple Cause-of-Death Mortality files merged with state-level information on financial commitments to developmental disability services and laws governing the certification of death certificates, this project will address three Specific Aims: (1) Examine the extent to which decedents’ sociodemographic characteristics predict the likelihood of having developmental disability erroneously coded as the underlying cause of death; (2) Assess whether the presence of comorbid diseases and injuries present at the time of death, with an emphasis on choking incidents, predicts the likelihood that a developmental disability is erroneously coded as underlying cause of death; and (3) Determine whether variation in funding for developmental disability services among states, and in state laws regarding who can certify a death certificate, predict whether developmental disability is erroneously coded as underlying cause of death. Results will provide a multilevel understanding of how individual-level sociodemographic characteristics, individual-level comorbid diseases and injuries, and state-level policies determine erroneous coding among adults with developmental disabilities. Based on these results, the project will present strategies for preventing misclassification. The long-term goal of this project is to better understand and reduce mortality among this historically disadvantaged population.

项目摘要在美国，患有发育障碍的成年人的死亡年龄比同龄人大约年轻20岁。人口这种明显的死亡率劣势比男性和女性之间的死亡率差距更大，黑人和收入最高和最低四分之一的成年人。造成这种差异的原因是很糟糕的尽管对这个问题进行了几十年的研究，但人们还是理解了这一点。然而，新的研究表明，对发育性残疾成年人的死亡证明进行错误编码，他们根本死因的错误分类。此外，这些错误的代码令人担忧地掩盖了因窒息和阿尔茨海默氏症及相关痴呆症而死亡的比率很高。在揭开模糊错误编码的影响是研究的一个关键进展，正在努力消除这一点，被误导的做法需要关于确定错误编码的多层次因素的经验证据。的拟议的项目将系统地评估错误编码是否不成比例地发生在（1）死者的某些社会人口学亚组，（2）当存在某些共病或损伤时在死亡的时候，（3）在某些美国州的背景下。通过确定哪些子组最大错误分类的风险，结果将为防止错误分类的策略提供信息，从而确定可靠的这些成年人的特定原因死亡率的估计。这项研究的中心假设是，在边缘化社会群体的死者中更常见，死亡是高度可预防的（例如，窒息），以及美国各州的财政和法律的政策较少适合有发育障碍的个人的需要。使用国家生命统计数据 2012-2016年美国多死因死亡率文件与州一级财务信息合并对发展性残疾服务的承诺和管理死亡证明认证的法律，该项目将解决三个具体目标：（1）检查死者的社会人口统计学这些特征预测了发育障碍被错误地编码为潜在障碍的可能性。（2）死亡原因;（2）评估死亡时是否存在合并症和损伤，以窒息事件为重点，预测发育障碍被错误地编码为潜在的死亡原因;（3）确定是否在发展残疾的资金变化各州之间的服务，以及关于谁可以证明死亡证明的州法律，预测是否发育残疾被错误地编码为潜在死因。结果将提供一个多层次了解个人水平的社会人口学特征、个人水平的共病疾病和伤害，和国家一级的政策确定错误的编码成人发育障碍。根据这些结果，该项目将提出防止错误分类的战略。的长期目标该项目旨在更好地了解和降低这一历来处于不利地位的人口的死亡率。