Accuracy of Death Certificates and Assessment of Factors for Misclassification of Underlying Cause of Death.
Accuracy of Death Certificates and Assessment of Factors for Misclassification of Underlying Cause of Death.
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DOI：
10.2188/jea.je20150010
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发表时间：
2016
影响因子：
4.7
通讯作者：
Sawabe M
中科院分区：
文献类型：
--
作者：
Mieno MN;Tanaka N;Arai T;Kawahara T;Kuchiba A;Ishikawa S;Sawabe M
从死亡证明中获取的死因信息往往不准确和不完整。然而，当存在多种疾病时，死亡证明书上记录的基础COD（UCOD）的准确性尚未得到全面描述。2000年2月至2002年8月，在日本的一家老年病医院进行了450例连续尸检。我们评估了死亡证明上报告的主要UCOD（癌症、心脏病和肺炎）与基于尸检数据和临床记录的病理学家评估参考标准的一致率、敏感性和特异性。进行Logistic回归分析，以评估性别，年龄，合并症，和UCOD对错误分类的影响。癌症的一致率相对较高（81%），但心脏病（55%）和肺炎（9%）的一致率较低。总体一致率为48%。性别和合并症并不影响UCOD的错误分类率，这往往随着患者的年龄增加，虽然与年龄的关联也不显着。UCODs是导致错误分类的最强因素（P < 0.0001）。癌症的敏感性和特异性非常高（分别为80%和96%），但心脏病和肺炎的敏感性分别为60%和46%。各UCOD的特异性均大于85%。研究人员应该意识到死亡证明作为研究资源的COD数据的准确性，特别是对于老年肺炎患者的情况。
Cause of death (COD) information taken from death certificates is often inaccurate and incomplete. However, the accuracy of Underlying CODs (UCODs) recorded on death certificates has not been comprehensively described when multiple diseases are present. A total of 450 consecutive autopsies performed at a geriatric hospital in Japan between February 2000 and August 2002 were studied. We evaluated the concordance rate, sensitivity, and specificity of major UCODs (cancer, heart disease, and pneumonia) reported on death certificates compared with a reference standard of pathologist assessment based on autopsy data and clinical records. Logistic regression analysis was performed to assess the effect of sex, age, comorbidity, and UCODs on misclassification. The concordance rate was relatively high for cancer (81%) but low for heart disease (55%) and pneumonia (9%). The overall concordance rate was 48%. Sex and comorbidity did not affect UCOD misclassification rates, which tended to increase with patient age, although the association with age was also not significant. The strongest factor for misclassification was UCODs (P < 0.0001). Sensitivity and specificity for cancer were very high (80% and 96%, respectively), but sensitivity for heart disease and pneumonia was 60% and 46%, respectively. Specificity for each UCOD was more than 85%. Researchers should be aware of the accuracy of COD data from death certificates used as research resources, especially for cases of elderly patients with pneumonia.