Abstract
BackgroundCause 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.MethodsA 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.ResultsThe 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%.ConclusionsResearchers should be aware of the accuracy of COD data from death certificates used as research resources, especially for cases of elderly patients with pneumonia.
Highlights
Cause of death (COD) data from death certificates are often used in epidemiological studies to estimate mortality rates or risk of death from certain diseases
All subjects were registered in the geriatric autopsy database (GEAD) at the Tokyo Metropolitan Geriatric Hospital, which contains clinical information and pathological findings (720 items frequently encountered in autopsy examinations of elderly subjects)
The overall agreement between Underlying CODs (UCODs) identified on death certificates and the reference standard was classified into the following categories: 1. Perfect ICD-10 code agreement; 2
Summary
Cause of death (COD) data from death certificates are often used in epidemiological studies to estimate mortality rates or risk of death from certain diseases. The accuracy and utility of COD data from death certificates are uncertain and often questionable.[1,2,3,4,5] For cancer mortality statistics in particular, uncertainty regarding the information on death certificates has been discussed for more than 100 years. 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. Conclusions: 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
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